3. Orthopaedic examination of the lame horse, clinical examination, provocation tests, diagnostic anaesthesia, supplementary diagnostic aids

Question 1

What is lameness?

Answer 1

Gait abnormalitiy

Characterized by:
- Limping
- Affected limb has a smaller forward movement
- Head nod: horse arises the head when the painful limb hits the ground
- Facial expression and muscoskeletal pain

Question 2

Name the different steps of lameness envestigation:

Answer 2

1. History
2. Physical examination in standing horse
3. Gait evaluation
4. Provocation test
5. Once the limb is identified
   - Diagnostic anaesthesia
   - Diagnostic imaging

Question 3

Why do we do diagnostic anaesthesia?

Answer 3

To localize the area/origin of pain

Question 4

Which information would you gather in the history?

Answer 4

1. Age, breed, discipline, purpose
2. When did the lameness start?
3. Is it sudden/gradual onset
4. severity and consistency
5. change in severity during excersise?

Question 5

Which information would you gather in the history?

Answer 5

1. Age, breed, discipline, purpose
2. When did the lameness start?
3. Is it sudden/gradual onset
4. severity and consistency
5. change in severity during exercise?
6. Any kind of trauma?
7. Previous lameness?
8. If treatment before: medication + response
9. When was the horse last shod/trimmed?
10. Change in feeding?

Question 6

How do perform physical examination in a standing horse?

Answer 6

• Observation
• Palpation
• Hoof testers

Question 7

What do we look for during “observation”?

Answer 7

1. Posture, balance, symmetry
2. Any kind of wounds, scars
3. Conformation
4. Hoof
5. Tail position (mostly kept away from the painful lelg)

Question 8

Which specifics do we look for in conformation during observation?

Answer 8

1. Muscle development
2. Position of the leg
3. Dropped elbow?
4. Fetlock drop, hyperextension?
5. Loading more on the medial aspect of the hood?
6. Angle of the joints

Question 9

When checking the hoof, what do we look at?

Answer 9

Shape, size, posture

Question 10

Where do we palpate and what can we detect?

Answer 10

All four limbs, head and neck

We can detect: Heat, swelling, tension, discomfort

Question 11

When do we use hoof testers?

Answer 11

To do a detailed examination of the hoof, by either a focal pressure or percussion with a hammer

Question 12

What is done in the picture?

Answer 12

Focal pressure of the hoof

Question 13

How do we perform the gait evaluation?

Answer 13

1. In hand
2. On the lunge
3. Ridden

Question 14

How to perform the “in hand” in gait evaluation?

Answer 14

We have to see the horse from the side and behind/in front

1. On even surface
2. On hard and on soft surface
3. walk and trot
4. Including small circles

Question 15

How to perform the “on the lounge” in gait evaluation?

Answer 15

On available surfaces - hard or soft
Both from the horses right and left side

Question 16

How to perform the “Ridden” in gait evaluation?

Answer 16

Only done if safe for the rider, and if its possible

Question 17

Where and how can we perform provocation tests?

Answer 17

We hold the limb for 1 minute and trot IMMEDIATELY after

Question 18

What type of provocation tests do we have on the forelimb?

Answer 18

1. Distal flexion test
2. Carpal flexion test

Question 19

Which provocation test is done in the picture?

Answer 19

Carpal flexion test

Avoid putting too much pressure on other structures other places, not pressing on the fetlock

Question 20

Which provocation test is done in the picture?

Answer 20

Distal flexion test

Flexes the fetlock, pastern and interphalangeal joint (coffin). Carpus is as relaxed as possible!

Question 21

What type of provocation tests do we have on the hindlimb?

Answer 21

1. Distal flexion test
2. Tarsal flexion test

Question 22

Which provocation test is done in the picture?

Answer 22

Tarsal/distal flexion test

Flexing the pastern, coffin and fetlock joint.
The stifle and hock is relaxed

Question 23

Which provocation test is done in the picture?

Answer 23

Proximal flexion test.

Flexing the stifle and hock

Question 24

In stead of letting a person hold the limb, which test can be performed as a provocation test?

Answer 24

The wedge test (keiltest).
Use a wooden block, where the dorsal side is elevated

Question 25

What is important in diagnostic anaesthesia?

Answer 25

Proper preparation and adequate restraint

Question 26

There are two types of diagnostic anaesthesia, name them and if they are clean or aseptic:

Answer 26

1. Perineural analgesia - Clean procedure
2. Intrasynovial analgesia - Aseptic procedure

Question 27

How to prepare for a perineural analgesia?

Answer 27

1. Hair clipping if necessary (in case of heavy hair)
2. Antiseptic scrub until clean. Povidone iodine, chlorhexidine
3. Alcohol with swab, then spray

Question 28

How to prepare for a intrasynovial analgesia?

Answer 28

1. Hair clipping
2. 5 min antiseptic scrub: Povidone iodine, chlorhexidine
3. Alcohol wash
4. Wear sterile gloves
   (use a fresh bottle of anaesthetic)

Question 29

Which anaesthetic would you use?

Answer 29

Mepivacaine - Less irritant, 2h duration

Bupivacaine - Less irritant, 4h duration: Slower onset (used of we want to check the lameness at a later time)

Lidocaine - Similar to mepivacaine, but more irritant in synovial environment

Question 30

What is the procedure when doing a block?

Answer 30

1. Block from distal to proximal, use regional blocks
2. After blocking: Sterile wrap for 5-10 minutes
3. Evaluation in general after 5-10 minutes