4. Examination of the limbs, the neck and the back region Flashcards
Common clinical signs indicating a problem of limbs, neck or back region:
- lameness
- Ataxia
- Painful back
- Abnormal/dangerous behaviour saddling + riding
- Poor performance
Steps of examination of the limb, neck and back:
- History
- Specific examination of the limbs, neck and back
- Physical examination in standing horse
- Gait evaluation
- Provocation tests - Diagnostic imaging: X-ray, ultrasound, CT, MRI, scintigraphy
If we suspect a disorder of the spinal column, which additional examination is important?
Complete general physical examination and neurological examination
Which information would you gather in the “history”?
- Age, breed, discipline, purpose
- When did the problem start?
- Is it sudden/gradual onset
- severity and consistency
- change in severity during exercise?
- Any kind of trauma?
- Previous lameness/pain?
- If treatment before: medication + response
- When was the horse last shod/trimmed?
- Change in feeding?
During physical examination in a standing horse, which are the 3 main examination steps?
- Observation
- Palpation
- Observe movements
What to observe on the limbs?
- Any kind of wounds, scars
- Posture, balance, symmetry
- Position of the legs
- Drops elbow?
- Fetlock drop - hyperextension?
- Loading more on the medial aspect of the hoof?
- Angle of the joints
- Tail position: mostly kept away from the painful leg
What to observe on the neck + limbs?
- Any kind of wounds, scars
- Position, posture, symmetry
- Torticollis? (= abnormal, asymmetrical head or neck position=
- Scoliosis? (=abnormal lateral curvature of the spine)
- Muscle development
- Voluntary movement
Where do we palpate, and what can we check for?
Palpate all four limbs, neck and back
We can detect: heat, swelling, tension, discomfort
Deep palpation for detection of muscle pain in the back region
How to check movements of the head?
Check volountary movements via offering feed to the sides, up and down
Gently bend the neck to both sides, up and down
How to perform the gait evaluation?
- By walking, trot and if possible: riding
- On a straight line and on curved circle, on both hands (longing)
- On both soft and hard ground
-> Check for lameness, any signs of pain or incoordination
Which possible tools do we have for diagnostic imaging?
- X-rays
- Myelography
- Ultrasound
- MRI
- CT
- Scintigraphy
How to perform X-ray on the neck?
Cervical column.
Standing horse and sedated.
LL view
Oblique view: Lateroventral-Laterodorsal for articular processes
How to perform X-ray on the back?
Thoracic/Lumbar/Sacral vertebrae.
Challenging due to thickness and high exposure is therefore required
LL view: Visualisation of dorsal spinal processes, vertebral bodies
Ventral to dorsal oblique view: Visualisation of articular processes/facet joints
What is myelography?
an imaging test that checks for problems in your spinal canal. Visualisation of subarachnoid space - liquor space
We check for spinal cord compression
How to perform myelography?
- Required GA
- Aseptic preparation
- Withdrawal of 50 ml CFS (slowly!!)
- Elevation of the head - Prevent cranial passage of the contrast
- Application of contrast medium into vertebral canal at atlanto-occipital joint -> water-soluble iopamidol: ca 50ml
- After 5 min X-rays should be taken: LL in normal, flexed and extended position
