Neck Arthritis in Horses: Diagnosis, Imaging and Treatment
Neck arthritis is relatively common in horses, particularly as they age, but determining whether changes identified in the cervical spine are clinically significant can be challenging.
The cervical spine contains seven vertebrae, with paired articular process joints, commonly referred to as cervical facet joints, allowing movement while providing stability through the neck. Like other synovial joints, these joints can develop osteoarthritis and associated inflammation.
Importantly, finding arthritic change on an X-ray does not necessarily mean that it is causing pain or affecting performance.
Diagnosis requires the imaging findings to be considered alongside the horse's history, clinical examination and functional assessment.
To learn more about anatomy of the neck, check out our blog here.
What are the signs of neck arthritis in horses?
Clinical signs can vary considerably between horses and may be subtle.
Some horses demonstrate obvious neck stiffness or reduced range of motion, while others present primarily with changes under saddle. Signs that may warrant further investigation include:
Reduced or asymmetric cervical range of motion
Difficulty bending or maintaining flexion in one direction
Resistance to contact or changes in head and neck position
Difficulty with lateral work
Reduced willingness to work through the neck and back
Changes in performance or behaviour under saddle
Localised sensitivity or muscle tension through the cervical region
These signs are not specific to neck joint disease. Similar changes can occur with other musculoskeletal problems, which is why assessment of the whole horse remains important.
Neurological abnormalities can also occur with some diseases affecting the cervical spine. Horses demonstrating ataxia, weakness or other neurological signs require a neurological assessment and potentially further diagnostic investigation.
How is neck arthritis diagnosed?
Assessment begins with the horse's history and a thorough physical examination. This may include evaluation of cervical range of motion, muscle development and symmetry, localised sensitivity, spinal mobility and the horse's ability to perform controlled movements or baited stretches. Gait assessment is also important, including a ridden assessment, as neck related conditions can cause forelimb lameness or neurological related gait abnormalities. Diagnostic imaging is then used when indicated to assess the cervical spine and surrounding structures.
X-rays
Cervical radiographs allow us to evaluate vertebral alignment, the articular process joints and changes to the surrounding bone.
Osteoarthritis may be associated with enlargement or remodelling of the articular processes, changes in joint margins or narrowing and irregularity of the joint space.
However, radiographic changes must be interpreted cautiously. Research has demonstrated cervical articular process joint changes in horses without obvious clinical signs, meaning that an abnormal radiograph alone does not prove that a particular joint is responsible for the horse's presenting problem.
Ultrasound
Ultrasound provides different and complementary information about the soft tissues of the neck. It allows assessment of the articular process joints, including the joint margins and surrounding joint tissues, and may identify features such as joint inflammation and remodelling of the joint margins.
Ultrasound is also particularly important when treatment is indicated because it allows the joints to be visualised during injection and the needle to be accurately guided towards the intended location.
This is another example of why X-rays and ultrasound are often used together rather than considering one modality inherently better than the other.
Ultrasound image of a normal C6-C7 joint Ultrasound-guided cervical facet joint assessment and treatment in a horse
When is cervical facet treatment considered?
Treatment is considered when the clinical examination and diagnostic findings support cervical facet pain or inflammation as being relevant to the horse's presentation.
Management is individualised and may include modification of training, rehabilitation, treatment of concurrent lameness or other musculoskeletal problems, and targeted treatment of affected neck joints.
Cervical facet joints are synovial joints, and intra-articular medication can be used to reduce inflammation and improve comfort when clinically indicated.
Corticosteroids have traditionally been used for this purpose however, in our practice we have found regenerative therapies are providing equal results with added benefit of being protective for the cartilage of the joints. These treatments, in particular Pro-Stride has been a valuable tool in our kit for managing neck related discomfort.
Using Pro-Stride in cervical facet joints
Pro-Stride APS is an autologous treatment, meaning it is prepared from the horse's own blood. Processing concentrates platelets and anti-inflammatory proteins, including increased concentrations of interleukin-1 receptor antagonist protein, which are then administered into the affected joint.
We discussed the mechanism and potential applications of this treatment in more detail in our previous blog, Is Pro-Stride Right For Your Horse?
Most published equine research investigating Pro-Stride and similar autologous protein solutions has focused on naturally occurring or experimentally induced osteoarthritis in appendicular joints rather than cervical facet osteoarthritis specifically. Therefore, its use in cervical facet joints should not be presented as having the same evidence base as its use in other joints.
Rather, it represents a treatment option that may be considered based on the individual horse, the clinical findings and the veterinarian's treatment objectives.
A recent cervical facet case
One recent case provides a useful example of how this can be applied clinically. The horse presented with cervical stiffness and restriction, with reduced range of motion particularly evident during assessment of the neck as well as a forelimb lameness during ridden work.
Diagnostic imaging identified enlargement of cervical facet joints on radiographs, while ultrasonography identified associated synovial inflammation. The findings were considered alongside the horse's clinical presentation rather than relying on the imaging abnormalities alone. Following assessment, selected cervical facet joints were treated with Pro-Stride under ultrasound guidance.
Following treatment, the owners reported a significant improvement in the horse, and on reassessment there was a subjective improvement in cervical range of motion and an improvement in the lameness under saddle. The horse also improved contact during ridden work and was less heavy on the hands.
Objectively the horse also showed a significant improvement in the RF lameness in hand on the left rein.
This is an individual clinical response and should not be interpreted as evidence that every horse with cervical facet osteoarthritis will respond similarly. It does, however, demonstrate how clinical examination, complementary imaging and targeted treatment can be brought together when managing cervical facet disease.
Treatment is only part of the picture
Improving inflammation within a painful joint does not automatically restore normal movement.
A horse that has been protecting its neck may have developed altered movement patterns, reduced muscle function or compensatory restrictions elsewhere in the body. Appropriate rehabilitation following treatment is therefore important to progressively restore cervical mobility, strength and normal function.
Concurrent sources of pain also need to be considered. In some horses, cervical pain exists alongside limb lameness, thoracolumbar or pelvic dysfunction, saddle-related factors or other musculoskeletal problems.
The objective is therefore not simply to treat an abnormal joint, rather manage the horse holistically. Quite often management requires a multimodal approach not only in medical management but on going rehab, physio and diffenet joint therapies.
Frequently Asked Questions
What are the symptoms of neck arthritis in horses?
Signs can include cervical stiffness, reduced or asymmetric range of motion, difficulty bending, resistance to changes in head and neck position and altered performance under saddle. These signs are not specific to neck arthritis, so veterinary assessment is important.
Can neck arthritis affect a horse's performance?
Yes, clinically significant cervical pain may affect movement, willingness to bend, contact and overall performance. However, cervical imaging abnormalities can also occur without obvious clinical signs, so imaging findings need to be interpreted in context.
How is neck arthritis diagnosed in horses?
Diagnosis may involve physical and functional assessment, gait examination, radiography and ultrasonography. Advanced imaging such as CT may be recommended in selected cases where further information about the cervical spine is required.
Can cervical facet joints be injected?
Yes. When clinically indicated, cervical articular process joints can be treated using image-guided injection. Ultrasound guidance allows the veterinarian to visualise the relevant anatomy and guide needle placement.
Can Pro-Stride be used in a horse's neck?
Pro-Stride may be considered for cervical facet joints in selected horses. However, the published evidence for Pro-Stride specifically in equine cervical facet osteoarthritis is currently limited, and treatment decisions should be based on the individual horse and clinical findings.
Concerned about your horse's neck or performance?
Changes in cervical mobility, comfort or performance can have multiple causes. A thorough musculoskeletal assessment can help determine whether the neck is clinically relevant and whether further diagnostic imaging or treatment is indicated.
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