Lameness case 3

Lameness Investigation - Case Study: Turnip

  • Patient Profile:

    • Name: Turnip

    • Age: 14 years

    • Breed: Thoroughbred

    • Use: General riding

1. Introduction

  • Owner's concerns: Turnip has become agitated during farriery (shoeing) of the right hind leg.

  • Additional symptoms: Resentment to saddle and potential lameness in the hind end.

  • Next steps:Begin lameness investigation.

2. History Taking

2.1 Questions for the Owner

  • What happens during farriery?

  • Has there been any change in saddle?

  • What activities is the horse used for?

  • Has the exercise level changed?

  • Duration of problem? Did symptoms follow specific activities?

  • Any recent trauma (falls)?

  • New swellings, heat, or painful areas noticed?

  • When was the horse last trimmed or shod?

  • Previous treatments attempted?

  • Lameness progression (better or worse)?

  • Past history of lameness?

3. Static Examination

3.1 Conformation Assessment

  • 🐴 Observation:

    • Turnip's hind feet aligned together on flat surface.

    • Right gluteal muscle atrophy observed (right side muscle smaller than the left).

  • Interpretation: Loss of muscle mass indicates disuse atrophy likely due to pain. Suggests chronic lameness condition.

3.2 Palpation Findings

  • Areas palpated: neck, back, pelvis, hind limbs.

  • Findings:

    • Muscle Discomfort: Longissimus dorsi muscles tender to pressure.

    • Swelling: Firm, non-painful swelling on dorso-medial tarsus (distal intertarsal joint).

  • Terminology: 'Seat of spavin' - indicates potential joint issues.

3.3 Limb Elevation & Hoof Exam

  • Findings during examination:

    • Left hind limb: Acceptable to lift.

    • Right hind limb: Agitated response.

  • Observations:

    • Right hind seems stiffer, harder to lift; hoof is squared at the toe, indicating limited hoof clearance and potential discomfort.

    • Conclusion: Reduced range of motion due to identified discomfort during elevation.

4. Dynamic Examination

4.1 Straight Line Observation

  • At walk: No obvious lameness.

  • At trot:

    • Moderate severity of right hind lameness (3/5).

    • Asymmetric movement noted in gluteal muscles and hoof dragging sound distinctly audible.

4.2 Lunge Examination

  • At right trot on lunge: Lameness mirrors previous observations with decreased stride length and hoof dragging.

4.3 Flexion Testing

  • Process: Conduct flexion tests beginning with non-lame leg.

  • Results:

    1. Left hind distal - negative

    2. Right hind distal - negative

    3. Left hind proximal - negative

    4. Right hind proximal - sustained positive response, indicating severe lameness worsening in subsequent trotting.

5. Baseline Lameness

  • Observations:

    • Right gluteal muscle atrophy, pelvic issues, reduced range of motion at right hind leg, and swelling in target regions.

    • Overall scoring: 3/5 right hind lame at trot.

6. Regional Anaesthesia

6.1 Indications

  • Required due to insufficient signs for precise lameness localization combined with back pain.

6.2 Choice of Block

  • Initial block recommended: Tarso-metatarsal and distal intertarsal joint blocks to identify pain sources effectively due to previous findings.

7. Diagnostic Imaging

7.1 Initial Imaging Choice

  • Radiography selected as the primary imaging modality to assess distal tarsal region.

7.2 Tarsal Joint Overview

  • There are five significant joints in the tarsal region, crucial for understanding potential lameness sources.

8. Radiological Findings

8.1 Joint Space Analysis

  • Radiographic evidence of joint space narrowing in the distal intertarsal joint linked to cartilage degeneration, contributing to osteoarthritis diagnosis.

8.2 Subchondral Bone Sclerosis & Bone Lysis

  • Identified in third metacarpal and tarsal regions, denoting osteoarthritic changes. Corresponding lesions noted in joint evaluations.

9. Diagnosis

  • Final Findings:

    • Diagnosis of osteoarthritis in right distal intertarsal and tarso-metatarsal joints

    • Secondary muscular back pain resulting from altered movement patterns due to hind leg pain.

10. Treatment Options

10.1 Management Strategies

  • Discuss treatment options:

    • NSAIDs, corticosteroids, bisphosphonates, joint supplements, rehabilitation techniques, corrective farriery.

  • Emphasize importance of regular monitoring and adjustment of treatment as needed.

10.2 Long-term Considerations

  • Regular follow-up required to evaluate treatment success with re-examination within 4-6 weeks, adjusting plan based on progress.