An 8-year-old Holstein cow presented to Cornell Equine and Food Animal Hospital for evaluation of chronic, worsening lameness with onset of clinical signs approximately 3 months prior to presentation. The owner reported the patient was due to calve within 10 days. On presentation, the patient was tachycardic, tachypneic and in moderate to severe musculoskeletal discomfort demonstrated as frequent weight shifting in the front limbs and reluctance to bear weight on forelimb medial claws; on orthopedic exam she presented moderate bilateral swelling of the carpi and periarticular left hock swelling. Lameness evaluation revealed asymmetrical hindlimb gait with counter-clockwise rotation of the sacrum and short-strided stiffness of the left hindlimb. Hind limb radiographs revealed osteoarthritis of the left tarsus. Evaluation of front feet revealed bilateral sole ulcers, managed with hoof trimming and lateral hoof blocks. Several methods of analgesia were pursued, including meloxicam 1mg/kg PO q24hrs, morphine 0.1mg/kg IM q4-6hrs, gabapentin 10mg/kg PO q8hrs, Adequan 500mg IM, a spinal epidural with preservative-free morphine and ultrasound-guided sacro-iliac intra-articular injections with triamcinolone and methylprednisolone. The patient’s comfort improved and she was discharged to the owner after recovery. The owner agreed that the patient would only be used for superovulation and would never be used for consumption as milk or meat.