The last part of our series, following on from Part III.
Because the causes of the lameness may be difficult to diagnose, a systematic diagnostic exam can be performed by the veterinarian to pinpoint to problem.
Most experienced veterinarians have developed systems for examining horses for lameness based on the reasons for the evaluation. Your veterinarian’s procedures may vary depending on the past history of the horse (and how familiar the vet is with them), but essentially these are the steps of diagnosis leading to treatment:
1. Taking a comprehensive medical history – including previous levels of work, current regime, treatments, access to previous diagnostics, etc.
2. Doing an evaluation of the horse in motion with particular attention paid to any deviations in gait, failure to use all four feet in sync, unnatural shifting of weight from one limb to another, head bobbing, stiffness, shortening of stride, and irregular hoof placement.
Part of the evaluation includes the vet flexing the joints and then releasing the leg to exaggerate symptoms – as the horse trots away, the veterinarian watches for signs of pain, weight shifting, or irregular movement. Flexion tests are not always helpful, especially in older horses.
3. Completing a physical examination of the horse using palpation and manipulation of muscles, joints, bones, and tendons, joint flexion tests, and application of hoof testers to reveal evidence of injury or stress. The physical examination will also appraise conformation, weight-bearing, and balance.
4. Radiographs / X-rays to identify damage or changes in bony structures.
5. Analgesic diagnostic techniques, such as nerve and joint blocks, to identify the location of the injury or stress that is causing the lameness. Working from the foot up, the veterinarian temporarily deadens sensation in specific parts of the limb, one joint at a time, until the lameness disappears. This procedure isolates the area of pain causing the lameness and also helps determine whether the condition is treatable.
6. Machines! UTC scanning is invaluable in soft tissue diagnostics, the next most common problem in lamenesses after hooves. Read more here about this mobile affordable technology.
Ultrasonography, nuclear scintigraphy (bone scan), or magnetic resonance imaging (MRI) to look for soft-tissue problems involving tendons, ligaments, joint surfaces, and muscle tissue.
Computer tomography / CT scanning may be used for both tissue and bone problems but is not mobile and is prohibitively expensive.
7. Arthroscopy to allow for an optical examination of internal joint tissues or tendon sheaths. Arthroscopy requires general anesthesia, but is sometimes only way to fully determine the damage, e.g. from a puncture wound and infection.
8. Samples of blood, synovial (joint) fluid, and tissue samples taken for examination to determine if infection or inflammation are present. These tests require lab evaluation before results are available.
It sounds obvious, but LOOKING and PALPATING are often the most valuable, as they can save unnecessary and costly interventions by highlighting the problem area.
Watching a horse move for half an hour, on a variety of surfaces and patterns, in all paces, ridden and unridden, is invaluable insight that an experienced vet can use to correlate biomechanics to the source of pain.
This should never be forgotten, and can often save you the above!
In many cases, the vet will not need to complete an examination this extensive, and in other cases, different procedures may be followed. Your vet’s prime purpose is to diagnose your horse’s problem and prescribe the treatment and rehabilitation that will bring your horse back to the full potential of its athletic and work abilities.
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