Coffin joint injection (left front) & adjustment

Duke stayed ever so slightly off after John took out the nail, so I took him down to see Dr. Revenaugh and was able to combine it with a visit from Dr. Salewski while we were in Oregon.
Dr. Revenaugh said his flexion was fine, and that he was off in the left front but it was "subtle" (making me feel less like a nut because I could hardly see it or feel it but it was there).  He stayed the same on the lunge line, but lunging on a small circle on the hard ground it was very obvious.
We did x-rays, and had his old (May) x-rays to compare (although it wasn't necessary).  His x-rays were very clean, great looking bones, nothing obvious going on.  Dr. R had a very awesome tool where he could zoom in on any part of the X-ray and make sure there was nothing there.
Dr R said that sometimes, particularly after a shoeing, the foot just gets "p-o'ed" but if you don't get it settled down and keep them working, it starts being a chronic problem, and six months from now, when competition season starts, we'll still be messing around with it.  He doesn't know what part of the soft tissue is irritated, and because it's so subtle, he thought that a nerve block or MRI wouldn't be helpful.  Nerve block because you won't be able to tell if it really blocked a sore spot or if it's just a moment when the subtleness isn't showing up.  MRI because there might not be enough damage to show up (yet).
He said what he tends to see is if I keep going and start doing my gallop sets, Duke is likely to bow a tendon in the other front leg.
So we did an injection in his coffin joint, to try to calm down the "p-o'ed" part of his hoof.  He has three days of stall rest with bute, then two weeks of very light work.  If he is still lame at the end of that two weeks, he'll go back down for an MRI to see if we can find any soft tissue damage.
Dr R also said that Duke's feet look good and balanced, he wouldn't recommend any changes to his shoeing.  While every thoroughbred would like to have feet a size or two bigger, there wasn't anything off in the shape of his feet or the type of shoes we're using.
Next up was Dr. Salewski, who said that Duke was locked up in his right sacroiliac joint, which would make him heavy on his front left and bulge out on his left shoulder, also making him stiff in his poll.  All of those are the things that John has noticed under saddle!  He gave Duke a very vigorous adjustment (Duke can lift his back in a "sit up" very, very high!) and said while he isn't a train wreck, he needed several pretty big adjustments.  He was able to do it, but he said that in ex-racehorses, it's common for them to get that right side locked up (presumably because they race on the left lead), and so this has probably been going on for several years.  He said Duke will probably forget how to canter when he goes back to work, because he's been compensating for years about not using that right hind, and he'll be all discombobulated at first.
So the hopeful part of all of this is that Duke is so young he hasn't done permanent damage to that left front, he'll be even and balanced now and the injection will let the irritation clear up, and this will have been an early warning that let us solve the problem before it was permanent.
Dr S said he comes up to Legacy Hunter Jumpers pretty regularly (next up is February), so I emailed them to try to get on his list.
The not hopeful part is that this will be a chronic problem he'll deal with his whole life, and he won't be a reliable competition horse and won't be able to compete at upper levels because I won't be able to keep him sound long enough to get fit, or getting him fit will make him not sound.  This last bit is my thoughts, not anything Dr R or Dr S said.  But there are those fancy stem cell/regenerative therapies and stuff, and we'll see if those are an option.
Both Dr R and Dr S said Duke had a great personality.  He was so sweet and quiet through all the treatments and loved Dr S's adjustment.  He yawned several times, looked at what Dr S was doing, then ate some hay.