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Whether you have an expensive show horse that lives in an exclusive stable attached to an indoor arena with cushiony footing, or a backyard buddy that has the run of an old barn, sooner or later you’ll have a lameness problem. Anything that makes your horse uncomfortable and produces a change in gait qualifies. If he’s “just a tick off”, has “a hitch in his git-a-long”, or is “three legged lame”, it’s a concern for equine, owner and veterinarian.
At Buckeye Veterinary Service, we know lameness issues cause pain, worry, and lost time. Our goal is to find the cause of the problem, recommend appropriate treatment, and if possible, get your athlete back to competition.
The lameness exam typically starts with an evaluation of movement, stride, and limb placement. This can be done in hand, on a longe line, or for more subtle lamenesses, with a rider and tack. Many times, extra weight on the horse’s back will accentuate the discomfort and make it more obvious. We first look for dramatic abnormalities like a head nod, or a “hip hike”. Remember that, in normal horses, the head will drop down onto the “sound” leg if the lameness is in a front limb. A hip hike is simply the appearance of the rump elevating as the horse “short steps” off of a painful hind leg.
Hind limb soreness can also cause a head nod, which can complicate diagnosis. Depending on the area of pain, it may be easier to observe going the same way (ie. left front worse in circles to the left), or the opposite way (left front, worse to the right). Many times, that will give us a clue to the origin of the discomfort.
A thorough examination of the limbs, looking for heat, swelling, elevated pulse, thickened structures, and distended joint or tendon sheath capsules, is required. Pain on palpation (feeling the limb) or when the leg is flexed is noted. Usually you are provided with a “normal” leg to compare to the lame one: subtle differences are easier to determine if you know what “normal” feels and reacts like. So, when we start palpating the “wrong” leg, we’re trying to see what it SHOULD feel like.
Flexion tests are a subjective, but important method used to localize pain. The patient is observed jogging in hand, and then systematically the leg is “flexed” and the subject is jogged away again. If the lameness worsens after a specific flexion, it suggests that the pain is coming from that area. Typically we start with the lower limb, and work upward (proximally, in vet speak), holding the joint in flexion (or extension in some cases) for a short period, and trotting them away. Imagine fully bending your own arthritic joint, holding it there awhile, and then trying to move it. Or sitting cross-legged longer than you should, and trying to get up. You can envision the exaggerated discomfort: anything that hurt a little before, now barks at you.
The limitations of flexion tests are built into the horse itself: you cannot individually flex the joints in the lower limbs (coffin, pastern, and fetlock joints all are involved), and when the hind legs are flexed at the hock, every joint MUST flex (due to the “reciprocal apparatus” which allows the horse to sleep standing up). Nevertheless, many times these “flexions” will help us focus in, or eliminate, areas of interest.
Diagnostic Blocks are the next step, if a specific cause has not been suggested by observation, examination, and flexion tests. Using lidocaine or carbocaine (injectable numbing or “blocking” medications), we methodically numb the lame leg. Starting “at the ground”, the leg is blocked in segments, working up the limb until the lameness improves dramatically. When that happens, the source of pain must be between the last areas blocked, and we can move on to diagnostic imaging. These blocks can be over nerves or into specific joints, depending on the case. For example, if the entire foot was blocked and the lameness remained, but the horse improved after he was blocked above the fetlock, then the lameness has been isolated to the pastern/fetlock region, between the blocks.
Diagnostic Imaging, hopefully, will show the cause of the pain. Radiographs (x-rays) are frequently the first step, showing bone abnormalities like fractures, spurs, cystic or developmental lesions, increased or decreased bone density, or calcification and boney proliferation. At Buckeye Veterinary Service, we have portable digital x-ray technology that allows us to see and evaluate radiographs immediately at your farm.
Soft tissues (tendons, ligaments, and sometimes muscle) are evaluated by ultrasound imaging. Common injuries include superficial and deep flexor tendons, tendon sheaths, suspensory ligaments, and sesamoidean ligaments. Stifle joints can also be evaluated to some extent, visualizing the patellar and collateral ligaments and meniscal pads. Shoulders, hocks, and other regions may also have soft tissue lesions that can be seen with the ultrasound.
Computed Tomography (CT), Magnetic Resonance (MRI), and Nuclear Scintigraphy (bone scan) are available locally by referral for difficult cases needing more or different information.
Treatment depends on the specific cause of the lameness. From conservative methods (time off and anti-inflammatories) to more aggressive approaches ( intra-articular injections, IRAP, PRP, and Extracorporeal Shockwave therapy), we at Buckeye Veterinary Service are prepared to give you the best options for your horse. With our extensive racetrack and sport horse experience, you can be sure your horse will get excellent care.