Podcast
Questions and Answers
A horse presents with subtle, intermittent lameness that worsens after exercise and improves with rest. Which aspect of the lameness definition best encapsulates this clinical presentation?
A horse presents with subtle, intermittent lameness that worsens after exercise and improves with rest. Which aspect of the lameness definition best encapsulates this clinical presentation?
- Functional disorder evident while standing.
- Disorder affecting multiple limbs simultaneously.
- Structural disorder evident only at movement.
- Severity varies by timing and exercise. (correct)
While performing a lameness exam, you observe a horse exhibiting a 'head nod.' This clinical sign is MOST indicative of pain originating from which anatomical location?
While performing a lameness exam, you observe a horse exhibiting a 'head nod.' This clinical sign is MOST indicative of pain originating from which anatomical location?
- The back or pelvis.
- Bilateral hind limbs.
- A single forelimb. (correct)
- Bilateral forelimbs.
During the palpation component of a lameness exam, which finding would be MOST suggestive of acute inflammation within a musculoskeletal structure?
During the palpation component of a lameness exam, which finding would be MOST suggestive of acute inflammation within a musculoskeletal structure?
- Localized increased heat. (correct)
- Symmetrical joint contours.
- Chronic muscle atrophy.
- Reduced range of motion without pain.
You are evaluating a horse for lameness and observe a 'boxy' conformation in its forelimb. Which statement BEST describes the diagnostic significance of this finding?
You are evaluating a horse for lameness and observe a 'boxy' conformation in its forelimb. Which statement BEST describes the diagnostic significance of this finding?
When using hoof testers during a lameness exam, a systematic approach is crucial. Which sequence represents the MOST comprehensive and recommended application of hoof testers?
When using hoof testers during a lameness exam, a systematic approach is crucial. Which sequence represents the MOST comprehensive and recommended application of hoof testers?
In equine lameness diagnosis, digital pulses are palpated over the sesamoid bones. An increased digital pulse is MOST indicative of:
In equine lameness diagnosis, digital pulses are palpated over the sesamoid bones. An increased digital pulse is MOST indicative of:
You observe a horse exhibiting lameness characterized by a shortened cranial phase of stride and reduced foot flight height in the forelimb. This gait abnormality is MOST consistent with pain located in:
You observe a horse exhibiting lameness characterized by a shortened cranial phase of stride and reduced foot flight height in the forelimb. This gait abnormality is MOST consistent with pain located in:
A horse is diagnosed with ipsilateral multiple limb lameness. Based on the principles of compensatory lameness, where is the MOST probable location of the primary lameness?
A horse is diagnosed with ipsilateral multiple limb lameness. Based on the principles of compensatory lameness, where is the MOST probable location of the primary lameness?
Flexion tests are a component of the lameness exam used for broad localization. Which statement BEST characterizes the sensitivity and specificity of flexion tests?
Flexion tests are a component of the lameness exam used for broad localization. Which statement BEST characterizes the sensitivity and specificity of flexion tests?
Following a distal forelimb flexion test, a horse exhibits a marked increase in lameness that persists for multiple strides. This response is BEST interpreted as:
Following a distal forelimb flexion test, a horse exhibits a marked increase in lameness that persists for multiple strides. This response is BEST interpreted as:
When performing a distal forelimb flexion test, which anatomical structures are primarily stressed?
When performing a distal forelimb flexion test, which anatomical structures are primarily stressed?
In contrast to pain-related lameness, mechanical lameness is characterized by which of the following gait patterns?
In contrast to pain-related lameness, mechanical lameness is characterized by which of the following gait patterns?
Stringhalt, a type of mechanical lameness, is characterized by:
Stringhalt, a type of mechanical lameness, is characterized by:
Diagnostic regional anesthesia, specifically perineural anesthesia, is indicated in a lameness exam to:
Diagnostic regional anesthesia, specifically perineural anesthesia, is indicated in a lameness exam to:
When considering perineural anesthesia, which of the following scenarios is a CONTRAINDICATION for performing nerve blocks?
When considering perineural anesthesia, which of the following scenarios is a CONTRAINDICATION for performing nerve blocks?
2% Lidocaine and 2% Carbocaine are commonly used local anesthetics in equine lameness diagnostics. Which statement accurately compares their onset and duration of action?
2% Lidocaine and 2% Carbocaine are commonly used local anesthetics in equine lameness diagnostics. Which statement accurately compares their onset and duration of action?
The palmar digital nerve block is designed to desensitize which primary anatomical region of the equine foot?
The palmar digital nerve block is designed to desensitize which primary anatomical region of the equine foot?
An abaxial sesamoid nerve block desensitizes a broader region than the palmar digital block. Which additional anatomical area is primarily desensitized by the abaxial sesamoid block?
An abaxial sesamoid nerve block desensitizes a broader region than the palmar digital block. Which additional anatomical area is primarily desensitized by the abaxial sesamoid block?
The 'Low 4 point' nerve block, also known as the 'Low 6 point' block, targets which nerve branches in addition to the medial and lateral palmar nerves?
The 'Low 4 point' nerve block, also known as the 'Low 6 point' block, targets which nerve branches in addition to the medial and lateral palmar nerves?
Intrasynovial anesthesia involves injecting local anesthetic directly into a joint or synovial structure. What is the typical needle gauge and length recommended for a navicular bursa block?
Intrasynovial anesthesia involves injecting local anesthetic directly into a joint or synovial structure. What is the typical needle gauge and length recommended for a navicular bursa block?
When performing a DIP joint block, various approaches can be used. Which approach is described as inserting the needle perpendicular to the dorsal surface of the pastern?
When performing a DIP joint block, various approaches can be used. Which approach is described as inserting the needle perpendicular to the dorsal surface of the pastern?
For a PIP joint block, a 1.5-inch, 20-gauge needle is recommended. What is the typical volume of local anesthetic to be injected into the PIP joint?
For a PIP joint block, a 1.5-inch, 20-gauge needle is recommended. What is the typical volume of local anesthetic to be injected into the PIP joint?
Which of the following joints of the equine carpus is/are targeted in the RC/IC/CMC joint block?
Which of the following joints of the equine carpus is/are targeted in the RC/IC/CMC joint block?
In equine lameness diagnostics, what BEST defines 'gait symmetry'?
In equine lameness diagnostics, what BEST defines 'gait symmetry'?
According to the AAEP lameness grading scale, a horse exhibiting lameness that is consistently observable at a trot in both straight lines and circles would be classified as grade:
According to the AAEP lameness grading scale, a horse exhibiting lameness that is consistently observable at a trot in both straight lines and circles would be classified as grade:
Which of the following gait deviations is MOST indicative of hindlimb lameness rather than forelimb lameness?
Which of the following gait deviations is MOST indicative of hindlimb lameness rather than forelimb lameness?
In subjective lameness assessment, 'audio clues' can be valuable. Which of the following auditory observations would be MOST suggestive of lameness?
In subjective lameness assessment, 'audio clues' can be valuable. Which of the following auditory observations would be MOST suggestive of lameness?
When evaluating lameness, it's important to differentiate between neurologic and pain-associated lameness. Neurologic lameness is MOST typically characterized by:
When evaluating lameness, it's important to differentiate between neurologic and pain-associated lameness. Neurologic lameness is MOST typically characterized by:
Fibrotic myopathy, causing mechanical lameness, primarily affects which muscle group in horses?
Fibrotic myopathy, causing mechanical lameness, primarily affects which muscle group in horses?
In equine lameness examination, which component is considered part of the 'passive exam'?
In equine lameness examination, which component is considered part of the 'passive exam'?
Which of the following questions is MOST relevant to include in the 'history' component of a lameness evaluation?
Which of the following questions is MOST relevant to include in the 'history' component of a lameness evaluation?
When performing palpation of the equine digit, which of the following is MOST crucial to differentiate?
When performing palpation of the equine digit, which of the following is MOST crucial to differentiate?
Which of the following is a primary goal of a lameness exam?
Which of the following is a primary goal of a lameness exam?
During active movement evaluation for lameness, it is recommended to observe the horse under which of the following conditions?
During active movement evaluation for lameness, it is recommended to observe the horse under which of the following conditions?
In lameness assessment, 'Lameness Locator' technology primarily provides which type of objective data?
In lameness assessment, 'Lameness Locator' technology primarily provides which type of objective data?
For weight-bearing palpation of the fetlock, the primary focus is to assess:
For weight-bearing palpation of the fetlock, the primary focus is to assess:
When palpating flexor tendons in the non-weight bearing limb, the examiner should focus on:
When palpating flexor tendons in the non-weight bearing limb, the examiner should focus on:
Palpation of the back in a lameness exam should include assessment for:
Palpation of the back in a lameness exam should include assessment for:
What is the PRIMARY reason for evaluating ALL limbs during a lameness exam, even if the client is only concerned about one?
What is the PRIMARY reason for evaluating ALL limbs during a lameness exam, even if the client is only concerned about one?
A horse exhibits a subtle, chronic hindlimb lameness. Upon initial visual assessment, no overt gait deviations are noted at a walk. However, when trotted in tight circles, the lameness becomes consistently apparent. Which aspect of the lameness definition is BEST highlighted by this clinical scenario?
A horse exhibits a subtle, chronic hindlimb lameness. Upon initial visual assessment, no overt gait deviations are noted at a walk. However, when trotted in tight circles, the lameness becomes consistently apparent. Which aspect of the lameness definition is BEST highlighted by this clinical scenario?
During a lameness exam, you observe a horse consistently landing heavier on the right forelimb compared to the left. While this asymmetry is noted, no distinct 'head nod' or 'hip hike' is readily apparent. Which of the following BEST explains this observation in the context of compensatory mechanisms in equine lameness?
During a lameness exam, you observe a horse consistently landing heavier on the right forelimb compared to the left. While this asymmetry is noted, no distinct 'head nod' or 'hip hike' is readily apparent. Which of the following BEST explains this observation in the context of compensatory mechanisms in equine lameness?
You are presented with a horse exhibiting acute onset, severe, non-weight bearing lameness (AAEP grade 5/5) in the right hindlimb. Which of the following goals of the lameness exam is LEAST relevant at this initial presentation, compared to a horse with chronic, subtle lameness?
You are presented with a horse exhibiting acute onset, severe, non-weight bearing lameness (AAEP grade 5/5) in the right hindlimb. Which of the following goals of the lameness exam is LEAST relevant at this initial presentation, compared to a horse with chronic, subtle lameness?
In which scenario would performing perineural anesthesia as part of a lameness exam be MOST judiciously deferred or contraindicated based on the goals of the lameness examination?
In which scenario would performing perineural anesthesia as part of a lameness exam be MOST judiciously deferred or contraindicated based on the goals of the lameness examination?
During the 'passive' component of a lameness examination, which of the following findings would be considered the MOST subjective and reliant on the examiner's clinical experience?
During the 'passive' component of a lameness examination, which of the following findings would be considered the MOST subjective and reliant on the examiner's clinical experience?
A horse presents with bilateral forelimb lameness, graded 2/5 on the AAEP scale in both limbs. To accurately assess the primary source of lameness, what is the MOST critical modification to the standard lameness examination protocol?
A horse presents with bilateral forelimb lameness, graded 2/5 on the AAEP scale in both limbs. To accurately assess the primary source of lameness, what is the MOST critical modification to the standard lameness examination protocol?
When evaluating hoof conformation as part of the visual exam, which statement BEST reflects the diagnostic relevance of 'boxy' feet in a horse?
When evaluating hoof conformation as part of the visual exam, which statement BEST reflects the diagnostic relevance of 'boxy' feet in a horse?
During palpation of the distal limb, differentiating between effusion and tissue thickening is crucial. Which of the following palpation characteristics would be MOST suggestive of effusion within a synovial structure?
During palpation of the distal limb, differentiating between effusion and tissue thickening is crucial. Which of the following palpation characteristics would be MOST suggestive of effusion within a synovial structure?
When applying hoof testers during a lameness exam, why is it recommended to start with circumferential testing of the toe before moving to the frog and heels?
When applying hoof testers during a lameness exam, why is it recommended to start with circumferential testing of the toe before moving to the frog and heels?
Increased digital pulses are a significant finding during palpation of the digits. However, in which clinical scenario might an increased digital pulse be a less specific indicator of localized digital lameness?
Increased digital pulses are a significant finding during palpation of the digits. However, in which clinical scenario might an increased digital pulse be a less specific indicator of localized digital lameness?
A horse exhibits lameness characterized by a shortened cranial phase of stride and decreased foot flight height in the right forelimb. Based on gait biomechanics, where is the MOST likely primary location of pain?
A horse exhibits lameness characterized by a shortened cranial phase of stride and decreased foot flight height in the right forelimb. Based on gait biomechanics, where is the MOST likely primary location of pain?
In a case of ipsilateral multiple limb lameness (both limbs on the same side affected), where is the primary lameness MOST likely located, considering principles of compensatory lameness?
In a case of ipsilateral multiple limb lameness (both limbs on the same side affected), where is the primary lameness MOST likely located, considering principles of compensatory lameness?
Flexion tests are used for broad localization in lameness exams. Which statement BEST describes the inherent limitations of flexion tests in equine lameness diagnosis?
Flexion tests are used for broad localization in lameness exams. Which statement BEST describes the inherent limitations of flexion tests in equine lameness diagnosis?
Following a distal forelimb flexion test, a horse exhibits a transient, mild increase in lameness that resolves within the first few strides. How should this response be BEST interpreted?
Following a distal forelimb flexion test, a horse exhibits a transient, mild increase in lameness that resolves within the first few strides. How should this response be BEST interpreted?
When performing a distal forelimb flexion test, which anatomical structures are primarily subjected to compressive and tensile forces?
When performing a distal forelimb flexion test, which anatomical structures are primarily subjected to compressive and tensile forces?
Mechanical lameness differs fundamentally from pain-related lameness. Which gait characteristic is MOST indicative of mechanical lameness rather than pain-associated lameness?
Mechanical lameness differs fundamentally from pain-related lameness. Which gait characteristic is MOST indicative of mechanical lameness rather than pain-associated lameness?
Stringhalt, a form of mechanical lameness, is characterized by involuntary hyperflexion of the hindlimb. Which aspect of the gait cycle is MOST dramatically affected in horses with classic stringhalt?
Stringhalt, a form of mechanical lameness, is characterized by involuntary hyperflexion of the hindlimb. Which aspect of the gait cycle is MOST dramatically affected in horses with classic stringhalt?
Diagnostic regional anesthesia using perineural nerve blocks is a crucial step in lameness localization. What is the PRIMARY purpose of perineural anesthesia in the equine lameness exam?
Diagnostic regional anesthesia using perineural nerve blocks is a crucial step in lameness localization. What is the PRIMARY purpose of perineural anesthesia in the equine lameness exam?
Which of the following scenarios presents the GREATEST risk of misinterpreting the results of perineural anesthesia and potentially leading to an inaccurate lameness diagnosis?
Which of the following scenarios presents the GREATEST risk of misinterpreting the results of perineural anesthesia and potentially leading to an inaccurate lameness diagnosis?
2% Lidocaine and 2% Carbocaine are common local anesthetics used in equine lameness diagnostics. Which statement accurately contrasts their pharmacokinetic properties relevant to nerve blocks?
2% Lidocaine and 2% Carbocaine are common local anesthetics used in equine lameness diagnostics. Which statement accurately contrasts their pharmacokinetic properties relevant to nerve blocks?
The palmar digital nerve block is strategically placed to desensitize which specific anatomical region of the equine digit, commonly implicated in distal limb lameness?
The palmar digital nerve block is strategically placed to desensitize which specific anatomical region of the equine digit, commonly implicated in distal limb lameness?
An abaxial sesamoid nerve block desensitizes a more proximal and extensive region compared to the palmar digital block. Which additional anatomical area is MOST significantly desensitized by the abaxial sesamoid block?
An abaxial sesamoid nerve block desensitizes a more proximal and extensive region compared to the palmar digital block. Which additional anatomical area is MOST significantly desensitized by the abaxial sesamoid block?
The 'Low 4 point' nerve block, also known as the 'Low 6 point' block, targets additional nerve branches beyond the medial and lateral palmar nerves. Which nerves are specifically targeted to expand the desensitized region in this block?
The 'Low 4 point' nerve block, also known as the 'Low 6 point' block, targets additional nerve branches beyond the medial and lateral palmar nerves. Which nerves are specifically targeted to expand the desensitized region in this block?
When performing intrasynovial anesthesia, specifically a navicular bursa block, which needle gauge and length are typically recommended to balance effective injection with minimizing iatrogenic trauma?
When performing intrasynovial anesthesia, specifically a navicular bursa block, which needle gauge and length are typically recommended to balance effective injection with minimizing iatrogenic trauma?
For a DIP joint block, various approaches exist. The 'dorsal perpendicular' approach is described as inserting the needle:
For a DIP joint block, various approaches exist. The 'dorsal perpendicular' approach is described as inserting the needle:
When performing a PIP joint block, a 1.5-inch, 20-gauge needle is commonly used. What is the typical volume of local anesthetic recommended for injection into the PIP joint to achieve effective analgesia?
When performing a PIP joint block, a 1.5-inch, 20-gauge needle is commonly used. What is the typical volume of local anesthetic recommended for injection into the PIP joint to achieve effective analgesia?
When performing an RC/IC/CMC joint block to target the equine carpus, which specific joint(s) is/are the intended target for intrasynovial anesthesia?
When performing an RC/IC/CMC joint block to target the equine carpus, which specific joint(s) is/are the intended target for intrasynovial anesthesia?
In the context of equine lameness diagnostics, gait symmetry is a critical concept. Which of the following BEST defines 'gait symmetry' in a sound horse?
In the context of equine lameness diagnostics, gait symmetry is a critical concept. Which of the following BEST defines 'gait symmetry' in a sound horse?
According to the AAEP lameness grading scale, a horse exhibiting lameness that is consistently observable at a trot in both straight lines AND circles, but not readily apparent at a walk, would be classified as grade:
According to the AAEP lameness grading scale, a horse exhibiting lameness that is consistently observable at a trot in both straight lines AND circles, but not readily apparent at a walk, would be classified as grade:
Which gait deviation is MOST reliably indicative of hindlimb lameness rather than forelimb lameness, when subjectively assessing a horse trotting in a straight line?
Which gait deviation is MOST reliably indicative of hindlimb lameness rather than forelimb lameness, when subjectively assessing a horse trotting in a straight line?
In subjective lameness assessment, 'audio clues' can provide valuable supplementary information. Which auditory observation would be MOST suggestive of hindlimb lameness?
In subjective lameness assessment, 'audio clues' can provide valuable supplementary information. Which auditory observation would be MOST suggestive of hindlimb lameness?
Differentiating neurologic lameness from pain-associated lameness is critical. Which gait characteristic is MOST typically associated with neurologic lameness?
Differentiating neurologic lameness from pain-associated lameness is critical. Which gait characteristic is MOST typically associated with neurologic lameness?
Fibrotic myopathy, a cause of mechanical lameness, primarily affects which muscle group in the equine hindlimb, leading to a characteristic gait abnormality?
Fibrotic myopathy, a cause of mechanical lameness, primarily affects which muscle group in the equine hindlimb, leading to a characteristic gait abnormality?
In equine lameness examination, which component is considered part of the 'passive exam', focusing on static observation and palpation without induced movement?
In equine lameness examination, which component is considered part of the 'passive exam', focusing on static observation and palpation without induced movement?
Which question is MOST critical to include in the 'history' component of a lameness evaluation to differentiate between acute and chronic lameness and guide diagnostic priorities?
Which question is MOST critical to include in the 'history' component of a lameness evaluation to differentiate between acute and chronic lameness and guide diagnostic priorities?
When performing palpation of the equine digit, differentiating between the superficial digital flexor tendon (SDFT) and deep digital flexor tendon (DDFT) is essential. Which of the following techniques BEST facilitates individual palpation of the DDFT?
When performing palpation of the equine digit, differentiating between the superficial digital flexor tendon (SDFT) and deep digital flexor tendon (DDFT) is essential. Which of the following techniques BEST facilitates individual palpation of the DDFT?
What is the overarching, PRIMARY goal of conducting a thorough lameness exam in a horse, beyond simply identifying the presence of lameness?
What is the overarching, PRIMARY goal of conducting a thorough lameness exam in a horse, beyond simply identifying the presence of lameness?
During the 'active movement evaluation' component of a lameness exam, observing the horse under which condition provides the MOST diagnostically valuable information for subtle lameness detection?
During the 'active movement evaluation' component of a lameness exam, observing the horse under which condition provides the MOST diagnostically valuable information for subtle lameness detection?
In lameness assessment, 'Lameness Locator' technology utilizes inertial sensors to provide which type of objective data to supplement subjective clinical findings?
In lameness assessment, 'Lameness Locator' technology utilizes inertial sensors to provide which type of objective data to supplement subjective clinical findings?
For weight-bearing palpation of the fetlock, which anatomical region and tissue type are the PRIMARY focus of the examiner's assessment to identify common sources of fetlock lameness?
For weight-bearing palpation of the fetlock, which anatomical region and tissue type are the PRIMARY focus of the examiner's assessment to identify common sources of fetlock lameness?
When palpating flexor tendons in the non-weight bearing limb, the examiner should focus on which specific characteristics to differentiate tendinitis from desmitis of the suspensory ligament branches?
When palpating flexor tendons in the non-weight bearing limb, the examiner should focus on which specific characteristics to differentiate tendinitis from desmitis of the suspensory ligament branches?
Palpation of the back in a lameness exam should encompass assessment for hyper-reactivity and hypo-reactivity. What clinical significance does hypo-reactivity to back palpation MOST likely indicate in a horse?
Palpation of the back in a lameness exam should encompass assessment for hyper-reactivity and hypo-reactivity. What clinical significance does hypo-reactivity to back palpation MOST likely indicate in a horse?
What is the PRIMARY rationale for systematically evaluating ALL limbs during a lameness exam, even when the client is only concerned about a single limb?
What is the PRIMARY rationale for systematically evaluating ALL limbs during a lameness exam, even when the client is only concerned about a single limb?
Flashcards
Lameness Definition
Lameness Definition
Structural or functional disorder in one or more limbs or the back that is evident while the horse is standing or at movement.
Common causes of lameness
Common causes of lameness
Trauma, Congenital/acquired anomalies, developmental defects and infection.
Goals of Lameness Exam
Goals of Lameness Exam
Goals include confirming lameness, identifying affected limb(s), guiding detailed investigation, and assessing appropriateness of perineural anesthesia.
Components of Lameness Exam
Components of Lameness Exam
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History In Lameness Evaluation
History In Lameness Evaluation
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Physical Exam Focus
Physical Exam Focus
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Visual Exam: Conformation
Visual Exam: Conformation
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Palpation Purpose
Palpation Purpose
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Hoof/Foot Exam Factors
Hoof/Foot Exam Factors
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Using Hoof Testers
Using Hoof Testers
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Lameness Location
Lameness Location
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Active Movement Exam
Active Movement Exam
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Movement Principles
Movement Principles
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Visual Signs of Lameness
Visual Signs of Lameness
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Forelimb Lameness
Forelimb Lameness
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Hindlimb Lameness
Hindlimb Lameness
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Compensatory Lameness
Compensatory Lameness
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Flexion Tests Purpose
Flexion Tests Purpose
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Flexion Tests: Response
Flexion Tests: Response
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Upper Forelimb Test
Upper Forelimb Test
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Mechanical Lameness Examples
Mechanical Lameness Examples
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Further Localization
Further Localization
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Diagnostic Anesthesia Types
Diagnostic Anesthesia Types
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Forelimb Nerve Blocks
Forelimb Nerve Blocks
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Palmar Digital Block Desensitizes
Palmar Digital Block Desensitizes
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2% Lidocaine
2% Lidocaine
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High 4 Point block includes:
High 4 Point block includes:
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Forelimb Joints Anesthesia
Forelimb Joints Anesthesia
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Treatment options
Treatment options
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Study Notes
- Lameness diagnosis can be challenging
- Incorrect diagnoses, resulting in unsuccessful treatments, are frustrating to veterinarians and owners
Definition of Lameness
- Lameness is a functional or structural disorder in one or more limbs or the back
- It becomes evident when the horse is standing or in motion
- The definition is simple, but recognition, localization, characterization, and management are complex
- Severity varies with timing and exercise
- Can affect multiple limbs
Common causes of lameness
- Trauma, either monotonic or repetitive
- Congenital or acquired anomalies
- Developmental defects
- Infection
- Combinations of the above
- Other causes include mechanical or neurologic issues
Goals of a Lameness Exam
- To determine if lameness is present
- To identify which limb or limbs are affected
- To identify areas needing further investigation
- To determine if perineural anesthesia is indicated; not indicated if a fracture is suspected
Components of a Lameness Exam
- History, visual examination, palpation, movement, and manipulative (flexion) tests
- Diagnostic analgesia and imaging are components
- Ultimately leading to a diagnosis
- Visual and Palpation are considered Passive Exams
- Movement and Manipulative tests are considered Active Exams
History
- Information to ascertain includes what the horse does for a living
- How long the horse has been lame, and if there is a history of traumatic incidents
- Important to know if the issue worsens, improves, or stays consistent with exercise
- Important to know if the issue is intermittent or consistent
- Important to know if issue is better on soft ground vs. hard ground
- Important to know if the issue improves with NSAIDs
- Owners' expectations should be considered
Physical Examination for Lameness
- General physical musculoskeletal exam is important
- Check for abnormal conformation and soft tissue swelling or joint effusion
- Palpate flexor tendons
- Assess joint range of motion
- Check for increased heat or digital pulses
- Palpate for pain elicited on touch or manipulation
- Check for wounds/scars and draining tracts
Visual Examination: Conformation
- Horses do well even with less than ideal ("crooked") conformations
- Conformation suggests a location for lameness, but will not necessarily prove it
Visual Examination: Swelling, Atrophy, Asymmetry
- Observe "boxy" ankles/distal metacarpal physitis or fetlock effusion in the palmar pouch
- Observe "clubby foot" or pedal flexural deformity; where the dorsal surface is too steep, and the heel is off the ground
- Observe digital tendon sheath effusion and carpal swelling such as hygroma
- Observe atrophy of gluteal muscles
Palpation
- An important part of the lameness exam
- The exam must be systematic
- Palpate for swelling, heat, symmetry, and range of motion
- Palpate for pain on direct pressure or flexion/extension
- Palpate limbs both weight-bearing and not
- Compare to the other limb, keeping in mind that both may be abnormal
Visual and Palpation: Hoof/Foot
- Palpate the heel bulbs, looking for contraction, symmetry, and height
- Palpate for flare, cracking, and pain
- Symmetrical
- Frog is dry and healthy
Palpation: Hoof Testers
- Hoof testers must be used on all horses presented for lameness
- Be systematic by checking the circumference of the toe; from frog to quarters; and across the heels
Palpation: Digits
- Palpate digital pulses over the sesamoids
- Differentiate effusion (fluid) vs. tissue thickening
- Palpate for sensitivity and withdrawal, as most lameness occurs in the digit (fetlock and distal)
- Forelimb is more commonly affected than the hindlimb
- Check for swelling, effusion, heat, and ROM
Palpation: Flexor Tendons
- Palpate the fetlock while the horse is weight-bearing
- When non-weight bearing, palpate flexor tendons for discrete structures such as SDFT, DDFT, and suspensory ligaments
- Palpate deeply to elicit pain
Palpation: Back
- Palpate for hyper-reactivity and hypo-reactivity
- Check flexion, extension, and lateral motion
Subjective vs. Objective Movement Assessment
- Subjective assessments relate to the opinion of the observer, such as using the AAEP scale
- Objective assessments use a force plate to assess kinetics, calculating the amount of force exerted to the ground by each limb
- Objective assessments use lameness locators to assess kinematics or the movement of the head and pelvis
- Determine if the horse is lame or has a neurological issue
Subjective Assessment: AAEP Scale
- 0/5: Sound; no visible lameness at a trot
- 1/5: No lameness observed at the trot in the straightaway; inconsistent lameness noted in the turn
- 2/5: Inconsistent lameness observed at the trot in the straightaway; consistent lameness observed in the turn
- 3/5: Consistent lameness observed at the trot in both the straightaway and turns
- 4/5: Grade 3+ and will not bear full weight on the limb; lameness observed at the walk
- 5/5: Non-weight-bearing lameness
Active Movement Examination
- Examine on a smooth, flat, hard and soft surface
- Observe the horse walking & trotting in a straight line at a consistent speed and circling both directions
- If possible, perform the exam under saddle
- Examine from front, back, and side
Subjective Assessment: Visual and Audio Cues
- Visual cues include head nod ("down on sound"), hip hike (or hip drop), or fetlock drop
- Also observe shortness in stride, shortened stance phase of stride, abnormal limb movement, and toe dragging
- Audio cues include intensity of sound as the limb strikes, loose shoe, or extra sounds
Normal Movement
- Sound horses move symmetrically
- Horses adapt to lameness with compensatory movements à asymmetry between paired front and back limbs
- Horses reduce the load and time spent on the lame limb during stance (weight-bearing) à more load for more time on non-lame leg
"Down on Sound"
- A body part, either the head (forelimb) or ilio-sacral area (hindlimb) as a greater excursion downward when the NOT lame leg (sound) is bearing weight
- For some lameness, the "up" phase of an asymmetry is more visually obvious
Forelimb Lameness
- Forelimb lameness is easier to see than hindlimb lameness
- It involves head/neck movement and a reduction in foot flight height and length
Hindlimb Lameness
- More difficult to recognize than forelimb lameness
- Presents as a shortened stride, where the hind leg should land where the front leg was
- See increased concussion/weight on the good leg, resulting in a louder sound when the good leg hits the ground
- Assess for hip/pelvic hike, where the hip will be at the highest when the lame leg is on the ground
- Look for down movement of the point of croup and more movement overall on the lame side
- Fetlock drop will be dropped more on sound
Lameness Assessment
- Assess all limbs, not just the one the client is concerned about
- Consider multiple limb lameness, including compensatory lameness, where it is not a true lameness
- Consider contra-lateral lameness where primary lameness is likely forelimb, or ipsi-lateral lameness where the primary lameness is likely hindlimb
- Also consider secondary lameness, where a true lameness will be caused by the primary lameness
Flexion Tests
- Flexion tests provide a broad localization of lameness, but are not overly sensitive or specific
- Regarding the lower limb, assess the podotrochlear apparatus, DIP, PIP, and MCP/MTP joints
- Regarding the upper limb, assess the carpus or hock/stifle
- Positive or negative responses grade mild, moderate, or severe responses
- Assess for static flexion as withdrawal/resentment
- Assess motion following flexion for an increase in lameness over baseline persisting for several strides, where the first few strides can typically be ignored
- Assess compensatory issues when the non-flexed leg is lamer due to taking all the weight
Flexion Tests: Distal Forelimb
- Act on the coffin, pastern, and fetlock joints and associated soft tissues
- Fetlock ROM is about 90°
- Avoid carpal flexion and hold for 30-60 seconds
Flexion Test: Upper Forelimb
- Acts on the carpus including the radiocarpal, middle carpal, or carpo-metocarpal and less elbow and shoulder
- Carpus ROM > 90° and hold for 45-60 seconds
Flexion Test: Distal Hindlimb
- Similar to the forelimb
- HL Fetlock ROM is greater than FL Fetlock ROM with the hock and stifle in neutral position
- Hold the flexion for 30-60 seconds
Flexion Test: Proximal Hindlimb
- Use the “Spavin” Test, targeting the hock, stifle, and hip
- Hold at the distal MTIII or toe
- Protect your back by bending your knees during the 45-60 second hold
Mechanical vs Neurologic Lameness
- Neurologic lameness leads to inconsistent foot flight
- Neurologic lameness leads to alternating lame legs
- Neurologic lameness can be confused easily with pain associated lameness
- It is difficult when they are neurologic AND lame
- Mechanical lameness will be consistent and repeated the same way every stride
- Mechanical lameness is less natural and easier to observe than pain associated lameness
- Stringhalt and fibrotic myopathy
Diagnostic Regional Anesthesia
- Approaches include perineural anesthesia (nerve blocks) and intrasynovial anesthesia (joint blocks)
- Common medications are Carbocaine and Lidocaine, both of which are fast Na+ channel blockers
- Carbocaine
- Onset time is 10 minutes perineural lower limb and 20-30 minutes joints and upper limb - Duration of action for perineural is 90-180 min and intrasynovial is 55 min
- Lidocaine
- Onset time is 5 minutes perineural lower limb and 20-30 minutes joints and upper limb -Duration of action for perineural is 30-120 min and intrasynovial is 45 min
- Epinephrine which can increase intensity and duration of Carbocaine or Lidocaine, at 1:200,000 ratio
Locations for Perineural Anesthesia
- Forelimb - palmar digital (+/- dorsal branches), abaxial (basilar) sesamoid, low and high 4 point (volar), Suspensory (lateral palmar), and MUM (median, ulnar, & medial cutaneous)
- Hindlimb - Abaxial (basilar) sesamoid, low 6 point (low volar), suspensory (high plantar), tibial/peroneal
Nerve Blocks
- Palmar Digital Nerve Block: use 1.5-2 ml/nerve
- Desensitizes entire sole, navicular apparatus, soft tissues of the heel, DIP joint, and digital portion of the DDFT
- Abaxial Sesamoid Nerve Block: use 1.5-2 ml/nerve
- Desensitizes entire foot, PIP joint, middle phalanx and assoc soft tissue structures, and distal and palmar aspect of proximal phalanx
- Low 4 Point (6 Point) Nerve Block: use 2-3 ml/palmar nerve or 1.5 ml/palmar metacarpal nerve
- Desensitizes MCP/MTP joint and all structures distal and distal aspect of suspensory branches
Anatomical Locations for Intrasynovial Anesthesia
- Forelimb - Navicular bursa, DIP, PIP, MCP, Digital Sheath, CMC/ICJ, RCJ, Carpal sheath, Elbow, Shoulder
- Hindlimb - DIP, PIP, MTP, Digital Sheath, TMT, DIT, PIT/TC, Tarsal sheath, MFT/FP, LFT, Coxofemoral
Joint Blocks
- Navicular Bursa: use a 3.5 inch, 20 ga spinal needle with 2-4 ml volume
- Use a Verschooten et al. or Schramme et al. approach
- DIP Joint: use a 1-1.5 inch, 20-22 ga needle with 4-6 ml volume
- Use a Dorsal perpendicular, Dorsal parallel, Dorsal inclined, or Lateral appraoch
- PIP Joint: use a 1.5 inch, 20 ga needle with 8-10 ml volume
- Use Dorsal or Palmar/plantar
- MCP/MTP Joint: use a 1.5 inch, 20 ga needle with 8-12 ml volume
- Use Proximal plamar/plantar pouch, Collateral sesamoidean, or Dorsal
- RC/IC/CMC Joint: use a 1-1.5 in, 20-22 ga needle with 7-10 ml/joint volume
- Use Dorsal or Lateral approach
- TC/PIT Joints: use a 1.5 in, 20 ga needle volume with 10-20 ml volume
- Use Dorsal or Plantar pouches
- DIT/TMT Joints: use 5/8-1 in, 23-25 ga needle for DIT and 1.5 in, 20-21 ga needle for TMT
- DIT uses a dorsolateral, medial, and TMT uses a plantarolateral
- Stifle Joint: use a 1.5 in, 18-20 ga needle with 20-30 ml volume - Femoropatellar - cranial, lateral or Medial Femorotibial - medial, or Lateral Femorotibial - lateral
Western Performance Horses
- Often see 90% forelimb lameness in the foot and 90% hindlimb lameness in the hock
The Horse is“blocked out”, now what?
- Next step: Diagnostic imaging
- Radiography
- Ultrasonography
- CT
- MRI
- Nuclear Scintigraphy, though all to be covered in future lectures
Future Treatments
- Joint therapy, including arthroscopy and injections (HA, Steroids, IRAP)
- Additional injections with supplements such as Adequan, Legend, Pentosan or Myristol
- soft tissue therapy using stem Cells, PRP, shockwave therapy, etc.
- All to be covered in future lectures
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