Approach to the Lame Horse Flashcards
What methods would you use to approach lameness in a horse?
History (Anamnesis - info from owners) - Breed, age, Sex, Use
Observation from distance - Symmetry, posture, conformation
Observation of gait/movement -baseline, additional tests)
Palpation (inclu hoof testers)
Selected examination (manipulation of joints (RoM), flexion tests)
Diagnostic analgesia
Diagnostic Imaging
Treatment
(Nerve and joint blocks)
What questions would you ask about the current episode of lameness?
History of trauma Duration Deterioration or improvement Effects of exercise Any management changes - shoeing, flooring, bedding, health/diet, training, medication (Past lameness issues?)
What is a common lameness condition in older horses?
Chronic progressive osteoarthritis seen in many places:
- proximal interphalangeal joint (pastern - between P1 and P2)
- distal interphalangeal joint (coffin - between P2 and P3)
- Metacarpophalangeal joint (Fetlock - between cannon and P1)
- Carpometacarpal joint (between distal carpal bones and the proximal metacarpals)
- Coxofemoral joint (hip joint)
- Femorotibial joint (stifle joint)
- Tarsus
- Previous injury (retired racehorses)
What factors do you look at when observing from a distance?
Symmetry - in muscle
Posture
Conformation
What can you palpate to help your diagnosis of lameness?
Hoof testers- abscesses
Insertions (SDFT) + origins (suspensory ligament)
Joints - distension, temp, pain, R of motion, swelling, heat
Distal sesamoidean ligments
Digital pulses
Tendons - loaded and unloaded
What can you palpate to test hindlimb lameness?
Back
Pelvis
-Tuber coxae (wings lateral side)
-Tuber ischii (caudal - just below tail base)
What is limb movement composed of?
Horse’s TRAVEL and ACTION
What is the definition of travel?
Flight of a single foot in comparison to the other limbs
- Arc of hoof flight
- view from the side/behind
What is the definition of action?
Overall description of gait characteristics
- joint flexion, stride length, suspension and others
- varies between breeds
What are the different phases of stride?
Landing
Stance - Loading phase
Breakover (Heel lift, toe pivot)
Swing
What are the 4 different gaits?
Walk
Trot
Pace
Gallop
What are the characteristics for ‘Walk’?
a) Suitable to see lameness?
Even rhythm - 4 beat gait
(each foot comes down by itself)
a) Not suitable to see subtle lameness
What are the characteristics for ‘Pace’?
a) Suitable to see lameness?
2 beat lateral gait
Ipsilateral fore- and hindlimbs elevate together + and then alternate to contralateral side
a) Impure gait in most breeds - seen mainly in STB racehorses
What are the characteristics for ‘Canter’?
a) Suitable to see lameness?
3 beat gait with lead preference
(Left leading - (RH—> then LH and RF —> LF ))
a) Difficult to see subtle lameness but useful to see back,rider, saddle associated problems
What are the characteristics for ‘Trot’?
a) Suitable to see lameness?
2 beat diagonal gait
(Opposite fore and hind limbs land together and swing
a)Steadiest + most rhythmic gait in most horses
PREFERRED FOR LAMENESS EXAMINATION
What questions would you ask to assess a case of lameness?
- Which leg is lame?
- How lame?
-appreciate difference with diagnostic imaging
Trot the horse
Goal: localise lesion for targeted diagnostic imaging/tx
What 2 things can you see when recognizing lameness?
-Fetlock drop
usually more on opposite (sound) fore- or hind-limb
EXCEPTION: Tendon or Suspensory Ligament damage
-Changes in Limb flight
cranial and caudal phase of stride
What is the subjective quantification of lameness?
Grade 0: Sound
Grade 2/10: Lameness hard to detect at walk or trot - not apparent
Grade 4/10: Lameness barely detectable at walk, easy to see at trot - consistently seen
Grade 6/10: Easily detectable lameness at walk
Grade 8/10: Hobbling at walk. Unable/unwilling to trot
Grade 10/10: Non weight-bearing
What do you recognise mostly in Forelimb lameness?
-Head nod/ Head elevation
When the lame forelimb hits ground - reduce load
(head down opposite forelimb)
-Asymmetrical contraction pectoral mm
-Sound/Concussion
Harder landing on sound limb (louder)
What do you recognise in Hindlimb lameness?
-Pelvic hike
Pelvis hiked up when lame limb on around
Pelvis hiked down when sound limb hits the ground
-Elevation tuber calcis
-Drifting
Horse move away from lame limb (hindlimb does not follow forelimb)
Lame limb goes under body, in between space of forelimbs
-Sound harsher when sound limb lands
What other methods can you use to access lameness?
- Acceleration sensors
- Different surfaces - soft/hard
- Circle
- Different gaits - severe lameness/suspected facture = WALK
- Under saddle - owner and separate rider
- High-speed Treadmill - STB pacers, trotters
