DR ANDY KANEPS: I'm Dr. Andy Kaneps of Kaneps Equine.
Today we're going to discuss lameness examinations
of your horse.
What we look for in a lameness examination
is gait abnormalities.
Normally a horse's gait is symmetrical and smooth.
When something either doesn't feel right
when you're riding your horse, or doesn't look right to you
or your trainer when the horse is in hand,
may indicate a gait abnormality that needs examination.
These examinations may amount to very subtle lamenesses that
are very difficult for you to see,
all the way to full non-weight-bearing lamenessess.
And the degree and extent of the lameness examination
will vary based on the nature of that lameness,
either severe or very mild.
What you want to have available when your veterinarian arrives
for the exam is a good, detailed history of when
the lameness was first seen, what
was first seen regarding the gait abnormality,
and what, if any, treatments may have been
undertaken before the exam.
You'll want to have a good lead rope, a lunge line,
and potentially your riding tack, because a subtle lameness
may only be evident when you're in the saddle.
The goals of the lameness examination
are to make as detailed a diagnosis as possible.
We want to determine where the major site of discomfort
is, what part of the leg or back or neck or what have you.
And then, what is causing that discomfort.
So we can offer treatment options
and also provide you with a prognosis.
You know, what are our chances of using
treatment A, with having a full result of a sound horse.
We start the examination by looking at the horse
from a bit of a distance.
How does the horse stand?
Does the horse point with a foot?
Does he not bear weight on a particular leg?
Does he have recognizable swelling in any part of the leg
that wasn't present before the lameness started?
Those facts are really important to assess
while we're asking the history from the owner or trainer
to determine what events may have led up to the lameness.
We move up onto the horse and do a detailed palpation
of neck, back, and limbs, looking for sites of discomfort
on palpation, swellings, extra fluid in joints,
and areas that we may focus more detailed evaluations.
After that, I like to see the horse moved,
in hand, on a hard surface.
The ideal surface is a flat driveway, asphalt or concrete.
But a flat surface that's hard will give us more information
about subtle lamenesses.
We start by walking the horse in about
a 30-yard long straight line, turn,
and walk back to the examiner.
What we look for at the walk is how
the horse sets the feet down.
Do the feet land heel, toe, which is normal?
And land evenly from the inside to the outside hoof wall?
Normally, they would land all but simultaneously.
Also we see, at the walk, how the horse tracks.
Does the horse swing the legs in or stand very narrow
at the walk?
That's information that we can use further
down the examination line.
Following the walk, we'll see the horse in-hand at the trot.
The horse is trotted on that same straight line
of about 30 yards, with the lead rope held loosely,
so that the horse may use its head and neck if needed.
And we assess movement of the head and neck, and also
symmetry or lack of symmetry as the horse trots.
Following that straight line trot,
we'll do manipulations, which include flexion tests.
Flexion tests are used to help localize or narrow down
the anatomic side of the lameness.
For example, we flex the lower limb,
which includes the fetlock, pastern, and coffin joints,
to stress those areas of the body.
We hold flexion for a period of half a minute or so,
and then trot the horse off.
If the horse is showing lameness following that flexion,
that may indicate that some degree of soreness
is in that anatomic area.
We do these flexions of the lower limbs, all four.
We do the carpus, or knees.
We do the full hind limb flexion,
which stresses the hip, stifle, and hock.
And we can also stress just the stifle on a flexion test.
All that information is recorded,
as is our physical findings, and keep
track of any of the abnormalities that we find.
Following the flexions, we do hoof testers.
In horses without pads on their feet,
we like to determine whether or not there's
sensitivity in the feet.
The reason for that is that 90% of all front limb lamenesses
are found in the foot.
Further localization of the soreness in the horse,
if a lameness is evident, is based on nerve blocks.
Where we put local anesthetic in nerves
to desensitize a part of the leg.
If, for example, we do a nerve block
at the heel of the horse, which blocks out
a good portion of the foot, and the horse
goes from lame to sound, we know that the pain is happening down
in the foot.
In horses that have very subtle lameness,
we need to try to narrow down the site of lameness
in other ways.
One straightforward way is to saddle up the horse
and see how the horse moves in its normal tack.
The weight of the horse, going in circles or figure eights,
may show us lameness where working just in a straight line
will not.
Also, just taking the horse on a lunge line
and putting it in a circle will provide additional stresses
to the horse that aren't present in a straight line.
A high-tech means of determining sites of lameness--
that's a very objective measure of gait symmetry,
or lack of that--
is with a gate analysis system.
There are portable gait analysis systems
that have sensors that are attached to the horse.
And the horse can be worked under saddle, in hand,
or can be worked on the lunge line.
And the computer program makes an assessment,
based on data from those sensors,
and tells us whether or not a limb is lame, whether or not
it's an impact or push- off lameness,
and whether or not it's a severe lameness or a mild lameness.
We've recorded our lameness examination findings,
such as the degree of lameness, which
can be recorded as 0 being sound and five
being non-weight-bearing.
That's the AAEP lameness scale.
Or any other scale that your veterinarian
finds most helpful.
Then we record our abnormal physical findings,
such as thickenings or joint swellings,
reaction to hoof testers, and then
certainly the response to flexion tests and nerve blocks.
Once we have narrowed down the anatomic site of the lameness,
to make a specific diagnosis, we need to undertake imaging.
On-farm imaging may include digital x-rays
or digital ultrasound.
If those findings are negative, and we
have a significant lameness, your veterinarian
may recommend advanced imaging, such as a bone
scan, magnetic resonance imaging, or MRI,
or computed tomography, CT.
Again the whole goal is to make a specific diagnosis,
so we can provide a specific treatment
with a hoped-for positive outcome.
If you have any other questions regarding
lameness examinations, please check the SmartPak Horse Health
Library.