Lameness Exam

Lecture 2

List important things to ask about when taking a history for a lameness exam.

signalment

use of horse

duration of lameness

worse or better at certain times or circumstances

gradual vs acute onset

history of trauma

management changes

medications administered

past lameness history

which leg the owner thinks is affected

when last trimmed or shod by farrier

List the steps, in order, for a lameness evaluation.

history

physical evaluation (can use hoof testers here if you wish)

motion exam

flexion tests

hoof testers (if not already done)

localize lameness

diagnostic imaging

What are the steps to a lameness exam?

quick TPR

observation from a distance

limb palpation

back palpation

hoof testers

gait evaluation

flexion tests

lameness localization

What are you evaluating during your initial distance evaluation?

conformation

swellings

how horse is standing

hoof care

muscle symmetry

What are you evaluating during limb palpation?

effusion, edema, boney proliferation

joints —> effusion, ROM

tendons/ligaments —> enlargement, thickening, pain

digital pulses

What is the most appropriate conclusion to make from palpating increased digital pulses?

the horse has inflammation in the foot

While back pain can be a primary source of pain, it is often secondary to what?

hock pain/hind limb lameness

Should hoof testers be used before or after blocking the horse?

Before

What directions do you want to see the horse move?

walk in straight line

trot in straight line

trot in circle, both directions, on hard and soft surface

can evaluate at canter and under saddle if needed

What gait is used to evaluate stride length?

walk

What gait is best for evaluating lameness?

trot

Lameness Grading Scale:

• lameness not perceptible under any circumstance

0

Lameness Grading Scale:

• lameness difficult to observe

• not consistently apparent

1

Lameness Grading Scale:

• lameness difficult to observe at a walk or trot in straight line

• consistently apparent under certain circumstances

2

Lameness Grading Scale:

• lameness consistently observable at a trot under all circumstances

3

Lameness Grading Scale:

• lameness is obvious at a walk

4

Lameness Grading Scale:

• lameness produces minimal weight bearing in motion and/or at rest

• complete inability to move

5

The “not” lame leg or legs.

sound

Refers to the movement of the horse’s head and neck when lame in the front limb.

head bob

Lame limb has increased motion in pelvus as the horse tries to bear less weight on the lame hind limb.

hip hike

Sound limb fetlock drops further with increased weight bearing to compensate for lame limb.

fetlock drop

Hind limb lands in or beyond front limb hoof print.

tracking up

Comparable between sound and lame limbs.

stride length

What is the prupose of flexion tests?

put stress on a joint to see if it changes the horse’s lameness

Flexion tests in the hindlimb challenge what apparatus?

reciprocal apparatus

How long should you hold the joint flexed for distal limb?

30 seconds

How long should you hold the joint flexed for carpus/tarsus?

45 seconds

What can be used to localize lameness as a last step?

nerve blocks —> SQ over nerves

joint blocks —> into joint

Which nerve block is typically skipped in the hind limb?

PD

What local anesthetics can be used for nerve/joint blocks?

mepivicaine (most common, less tissue irritation)

lidocaine

bupivicaine

What structures are blocked by palmar digital nerve block?

caudal 1/3 of the foot

sole

navicular apparatus

What structures are blocked by abaxial sesamoid nerve block?

all structures below fetlock ± fetlock itself

What structures are blocked by low 4 point nerve block?

fetlock joint and distal

inconsistent loss of skin sensation dorsally on hind limb