The 6 steps in your lameness exam:
1) History – A key component of any thorough exam starts with patient history. Often the rider or trainer will feel changes in a horse’s movements even before major visible signs of issues are clear. Understanding recent and past performance issues, changes, and patterns help the doctor get a picture of what may be contributing to current issues.
2) Physical Exam – In this part of the exam the doctor is looking at the animal’s conformation, balance, and how the patient is bearing weight on all four limbs. The goal here is to look for evidence of injury or stress. This includes meticulously checking muscles, joints, bones and tendons for evidence of pain, heat, swelling or other abnormalities. Sometimes hoof testers are used to apply pressure to the sole and frog of the foot in order to check for sensitivity or pain.
3) In Motion – A key art of the lameness exam is watching the horse in motion. Evaluating the patient walk, trot and move at both a walk and a trot allows the doctor to observe any deviations in gait such as winging, or padding, as well as any failure to land squarely on all four feet. Signs can be obvious, or subtle – hence the art of the exam. The doctor is watching for any clue, such as shortening of the stride, irregular foot placement, head bobbing, stiffness or weight shifting. Ideally, we want to watch the patient move on both hard and soft ground. And occasionally, the doctor may want to observe the patient with a rider on, performing its athletic event.
4) Joint Flexion - Joint flexion is a process of putting specific joints or regions of the limb under stress for a specific and consistent period of time. It looks like the doctor holding a limb up, much like a physical therapist or chiropractor holding your leg in a stretch. Your equine vet is watching the patient’s movement before and after flexion, and assessing any possible change. While there is art in the interpretation of motion and flexion, equine veterinarians do use a universal scale, as outlined by the American Association of Equine Practitioners (AAEP), from 0 to 5. A lameness of “0” indicates no lameness perceivable under any circumstance. A score of “3” indicates lameness is consistently observable at a trot, and a score of “5” indicates lameness produces minimal weight bearing in motion and/or rest, or a complete inability to move
5) Diagnostic Tests – At this point, the doctor usually has determined which limb is lame, and may have an idea where on the limb the pain is located. However, this is where diagnostic tests begin in order to confirm what we’ve observed and determine the specific cause of the pain. These tests may include:
- Nerve and/or Joint Blocks: In this procedure injection of a local anesthetic agent is used to “block” or numb specifics segments of the leg, or one region or joint at a time in order to find the site of pain.
- Radiographs: These “x-ray” images are used to identify damage or changes to boney tissues. At Oakridge Equine Hospital we use digital radiography giving us the ability to have real-time diagnostics. Depending on the area we are imaging, this may mean more than one picture must be taken. For example, standard AAEP recommendations for assessing a joint includes four images. Other regions may require more or less in order to fully see all angles of the boney structure. Our goal is to be thorough, yet sensitive to cost where we can.
- Ultrasound: While radiographs are extremely valuable, they do have their limits, particularly in dealing with damage to soft tissues such as tendons, ligaments or structures inside the joint. That’s where ultrasound imaging comes into play. This non-invasive technology uses ultrasonic saves to image these internal structures.
- MRI: An advanced procedure, MRI (or Magnetic Resonance Imaging) is sometimes used for difficult and advanced cases. When necessary, we partner with specialty surgical facilities and radiologists to perform the test, then continue treatment and follow-up here at our facility.
- Lab Tests: Blood, synovial (joint) fluid, and tissue samples can be used to test for markers of inflammation or infection.
6) Treatment – Last, but not least, comes a treatment plan. Each individual patient and incident requires a personalized treatment plan. There’s no “one-size-fits-all” approach that can adequately consider both the individual animals history, desired performance, and specific injury. Depending on the patient’s exam, treatment may include one or more of the following:
- Shoeing Changes: We work directly with a wide range of farriers to help make sure the patients natural anatomy is being used to gain the most athletic potential.
- Prescription Medications: This may include anti-inflammatory medications to help control pain and assist healing.
- Advanced Therapies: Equine research is leading the way in new therapies that use the body’s own system to help achieve healing. This includes biological treatments such as Interleukin Receptor Antagonist Protein (IRAP), Platelet Rich Plasma (PRP), Stem-Cell Therapy.
