Equine Lameness Flashcards
What background history should we initially collect for a potentially lame patient?
Signalment Use Duration of ownership Recent management - work/exercise, feeding, shoeing, housing Previous medical problems
What specific history should we collect about a potentially lame horse?
Limb(s) affected Timing and nature of onset of signs Associated events or incidents Details of any areas of swelling/heat/pain Progression of signs since onset Treatments/management employed to date Current state of problem
What are the aims of the initial lameness workup?
Is horse actually lame? If so: Identify the limb(s) affected Score the severity of lameness Try to identify source/cause Implement treatment plan
What does the initial lameness workup generally include?
Physical examination Focused exam of MSK system Gait evaluation - walk/trot/lunge Flexion tests Further exam of affected limb Further workup - nerve/joint blocks, diagnostic imaging
How do we carry out a lameness physical examination?
General clinical exam General body condition Conformation of body, limbs and feet Posture and weightbearing on limbs Skeletal and soft tissue symmetry Localised swellings/thickenings Detailed evaluation - inspection/palpation/manipulation
What do we want to establish when evaluating gait?
Is there a gait abnormality? Is this due to lameness or something else (e.g. neurological)? What degree of lameness? Which limbs are affected? What exacerbates the lameness?
How do we carry out a gait evaluation?
Different surfaces - soft or hard
Start with walk - if obviously lame at walk then will not trot
Trot up in a straight line
Move on to lunging (soft and hard surface)
What considerations should we have when trotting up a horse?
PPE - hard hat, steel toe-capped boots, overalls, gloves Location - safe, flat surface, weather Contained? How lame? Temperament of horse Restraint - headcollar +/- bridle
How do we recognise forelimb lameness?
Assess as the horse is walking/trotting towards you
Head nod
Head lifts UP as the LAME leg hits the ground or vice versa
How do we recognise hindlimb lameness?
Assess as horse is walking/trotting away from you
Harder to recognise and identify than forelimb
Hindquarters as a whole pushed up by sound limb and sink during stance phase of lame limb
‘Hip’ of the lame limb will rise and fall through a greater range of motion than the sound side
What other aspects are we assessing in gait evaluation?
Relative lengths of phases of stride
Arc of foot flight
Path of foot flight (medial/lateral)
Foot placement
How do we grade lameness?
Two different grading systems used commonly - out of 10 or out of 5
Most useful for individual clinician to assess improvement
Why do we use provocative (flexion) tests?
To demonstrate occult lameness in ‘sound’ horse
To exacerbate a mild lameness
To aid localisation of source of lameness
How do we carry out a flexion test?
Limb held in flexion for about 1 minute
Horse trotted away as soon as limb released
Allowed a few lame strides
Horse should be standing ready to trot away
Attempt to flex only the joints you are testing
What are the limitations of the flexion test?
Lack of specificity to site
Inconsistency
Lack of hard criteria for ‘positive’
False positives and negatives
How do we lunge a horse?
Lameness often exacerbated on a circle
Usually exacerbates lameness with lame leg on the inside
Can be performed on hard or soft ground - hard usually exacerbates more
What considerations should we have for lunging a horse?
PPE - hard hat, steel toe-capped boots, gloves, overalls
Correct equipment - lunge line, lunge whip, bridle/lunging cavesoon, boots for horse
Does the horse lunge well?
Location - soft e.g. school, arena, lunging pen / hard e.g. hospital area
Is location flat, large, secure, safe, appropriate surface?
How do we carry out nerve blocks?
Start distally and work up
Clean area with chlorhex and spirit +/- clipping
Usually unsedated - consider safety
Left 10 mins then trot up to check for improvement
What are common sites and equipment for nerve blocks?
Palmar/plantar digital, abaxial sesamoid, low 4 point
23-25G, 5-8” needles, 2ml syringes
Other nerve blocks if need to go higher up limb
How do we carry out joint blocks?
Intrasynovial admin - sterility is key!
Sterile skin prep - chlorhexidine and spirit
Evaluated at 10 mins and then later
