Lameness Evaluations
Lameness Evaluations
Doing these types of evaluations are the mainstay of the practice and evaluating overall soundness plus determining what factors are affecting a horse's movement have and will always be the primary focus. There may be conditions that have minimal implications which may require periodic management and others that are more involved and may require treatment to return the horse to work. Fortunately with the diagnostics and treatment options currently available a positive resolution is more likely to take place.
Each lameness case is different and how it is managed is determined by a number of factors. Spending the time diagnostically to pursue an answer is integral to determining the best course of treatment. At Burlington Equine, because this is our primary goal, there will always be adequate time to pursue a diagnosis, consult with experts in referral centers when necessary, perform treatments and offer follow-up.
Diagnostic steps to evaluate a lameness:
Observe horse under saddle, on the lunge and/or in hand
Palpate, manipulate various body parts and regions and evaluate range of motion
Perform flexion tests
Use local anesthetics to localize the lameness
Digital x-rays
Digital ultrasound
Thermography
Performing an upper limb - hock flexion test
Flexion tests are done on the upper and lower portions of a limb in an effort to identify regions that may be involved in causing soundness issues. For instance, after flexing a hock region if a horse trots away more lame that may support problems in that are and/or the area proximal to this. From there more diagnostic steps will be taken to narrow down the potential causes.
An Ultrasound exam being done on a Proximal Suspensory Ligament.
An ultrasound exam may be done to screen or rule out an area or to make an actual diagnosis once its been determined what region and structures are likely involved in the unsoundness.
Digital ultrasound images
In the above image an ultrasound exam was done on a tendon where a diagnosis of a “bowed tendon” was made. In this situation the image on the right shows the area encircled by the green line and that’;s the Superficial Digital Flexor Tendon at a site just below the knee and the area encircled with the red shows a central core lesion where the fibers are disrupted and the black area indicates the fibers are missing and a tear has occurred.
Potential Therapeutic Procedures:
Injecting medication into a stifle joint.
Systemic and/or intra-joint medications
Regenerative Therapies - PRP, IRAP, Pro-Stride and Stem Cell treatments
Chiropractic adjustments
Acupuncture
Mesotherapy
Shockwave Therapy
Laser Treatments
Functional Electrical Stimulation (FES)
Selected Examples of Digital xrays:
These 2 digital images below were taken of a horse's spine in the withers and saddle area. The left image is of the withers and just anterior to where the saddle would be contacting a horse's back. The right x-ray demonstrates how the spacing between the vertebrae is markedly decreased in the area where the saddle and weight of the rider contact the horse's back. Because there is minimal spacing and the dorsal vertebral processes are touching which is commonly known as "kissing spine disease", an explanation can be given for why the horse has recurrent back pain. Fortunately treatments are available and they were pursued with this horse.
Back Radiographs:
Hock Radiographs:
The below 2 radiographs demonstrate a normal hock joint on the left and a very abnormal hock joint with a significant degenerative process where the arrow is pointing that was causing this horse to be lame. Intra-joint medications plus systemic therapies were used to manage the joint pain and allow him to be ridden.
Carpal or Knee Radiographs:
The below 2 radiographs contrast the differences between the normal knee on the left and the one causing the lameness with this horse on the right.
Normal x-ray of the carpus (knee). There are smooth edges and the black lines indicating joint spaces are all open and not compressed.
X-ray of a carpus (knee) demonstrating significant degenerative changes and the presence of bone fragments. The double arrows indicate a site where there has been a reaction on the bone surface that appears as an irregular sharp edge. The single arrow indicates a bone fragment in the joint space. The normal spacing between the bones as seen on the left x-ray is decreased and the bones appear less regular in terms of the appearance of the grey and white areas. This horse was very lame at a walk, had a markedly swollen knee and would only allow about 30% of normal joint flexion. Fortunately after a relatively short period of treatment with topical, systemic and intra-joint treatments he was significantly improved.
There are more cases and examples throughout this website that delve into similar cases along with regional exams using most of the modalities described in this article.
