EQUINE: CLINICAL MEDICINE, SURGERY AND REPRODUCTION

MUSCULOSKELETAL SYSTEM
APPROACH TO THE LAME HORSE
- Lameness: alteration in the animal’s normal stance and/or mode of progression caused
by pain, neural or mechanical dysfunction.
- It has to be carried out in a logical sequence in order to:
1) Define which limb or limbs are involved.
2) Find the exact site of pain.
HISTORY
- Careful questioning: signalment of the case, age, sex, breed, use of the horse, length of
ownership or training, type and amount of work, previous lameness problems, previous
arthroscopic surgery.
- When (duration of lameness), where lameness was first noted (at pasture or in
competition), has the lameness improved or worsened with rest, were any traumatic
episodes associated, does the lameness improves or deteriorates with exercise.
CLINICAL EXAMINATION
AT REST
- Visually inspected, both sides, front and behind.
- Evaluation of pastern (cuartilla, 1ra falange) and foot angle.
- Foot symmetry/shape, compare sizes of opposite feet.
- Posture and stance (it may indicate the horse’s response to pain in one or more limbs).
- Palpation: it is common in Thoroughbreds for there to be excessive reaction to palpation
of the distal suspensory ligaments without evidence of any pathology
- Inspect the ground bearing surface of the foot.
AT EXERCISE
- At the walk and trot, on a level, hard even surface.
- Move in a straight line and in circles.

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 - Forelimb lameness: a head nod is appreciated with the head being raised when the
lame limb strikes the ground.
- Hindlimb lameness: a hip hike (or pelvic hike) is present in the lame hindlimb. The pelvis
hikes upward when the lame hindlimb hits the ground.

- Lameness is graded to indicate severity, commonly on a scale of 0–5 or 0-10, where 0 is

sound and 5 out of 5 or 10 out of 10 is non-weight-bearing.

MANIPULATIVE TESTS
- Once the lame limb and degree of lameness have been ascertained, identification of the
site(s) of the lameness is carried out.
- These tests exacerbate temporarily the degree of lameness. Flexion tests should be
performed on all pairs of limbs for comparison, and lastly on the lame limb.
- 45-60 seconds with mild force is used. Afterwards, the horse is trotted away from, and
back to the examiner. An increase in lameness is positive.

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 - Due to the reciprocal apparatus or stay apparatus of the hindlimb, flexion tests may not
be as specific as the forelimb.

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DIAGNOSIS
DIAGNOSTIC ANALGESIA
- Perineural nerve blocks, local infiltration and intrasynovial joint/bursa blocks; to abolish
lameness temporarily and thereby further isolate a site of pain.
- Local anesthetics: mepivacaine and prilocaine.
- Only lameness due to pain (i.e. not mechanical or neurologic types of lameness) are
suitable for this approach to lameness diagnosis.
- The blocks should start distally and progressing proximally.
- A partial or complete response to diagnostic analgesia warrants further investigation of
that region  radiography or echography.

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SYNOVIAL FLUID COLLECTION AND ANALYSIS

RADIOGRAPHY
- The most common diagnostic imaging modality used for the musculoskeletal system.
- Total number of X-rays produced  mAs; ability of the X-ray to penetrate tissue  kV.
- Mineralized structures are radiodense and absorb many of the X-rays of the primary
beam, whereas soft tissues are more radiolucent.
ULTRASONOGRAPHY
- High frequency sound waves to produce a real time image.
- The higher the frequency, the better the resolution but the less the penetration.
- To image soft tissue structures, such as tendons, ligaments, joint capsules, muscles and
nerves.
NUCLEAR IMAGING
- “bone scanning”.
- Intravenous injection of radioactive substance that is then distributed throughout the
horse. A gamma camera is then placed alongside the horse and an image pattern is
produced for interpretation.
THERMOGRAPHY
- Use of a thermographic camera in the early diagnosis of certain types of lameness.
- Can detect superficial inflammation.

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MAGNETIC RESONANCE IMAGING (MRI)
- Water and fat contain the most hydrogen nuclei and the MRI signal created is built up
from these.
- 2-D or 3-D images can be achieved depending on the machine used.
- High-signal areas are depicted as white and low-signal areas as black.
- It can only be performed under general anesthesia.
COMPUTED TOMOGRAPHY
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