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Equine Health Resource

Lameness Exam

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Horses with a history of lameness, poor performance, or an apparent problem with a limb should have a lameness exam.

The lameness exam is a multi-step methodical veterinary exam wherein a veterinarian tries to determine which limb (or limbs) is lame and where specifically the pain in the limb originates. Only by finding the pain site and anatomy involved, and somehow alleviating the pain, can lameness be properly and directly treated. This is also the only way that a prognosis and management plan can be provided.

Generally, lameness exams consist of (1) a careful history, (2) a standing exam, (3) an exam in movement (mostly at the trot if possible) (4) flexion and hoof tester exams, (5) diagnostic anesthesia – nerve blocks, and (6) imaging the site of injury – radiographs, ultrasound, MRI and others. The diagnosis treatment plan and prognosis are derived from a synthesis of findings from all of the above parts of the lameness exam.

HISTORY: The first step in a lameness evaluation is a thorough history of both the horse and the owner/ traimer’s account of the problem. Information gathered about the horse includes breed, age, and prior use all of which provide clues to the problem. The history of the lameness includes the date that lameness was first noticed, how severe the lameness has been, and how it occurred, if known. All of these are important questions that we ask and you should try to be as complete as possible in your responses.

STANDING EXAM: A standing examination is done at a distance to evaluate the horse’s conformation and general appearance. This is followed by more careful examination and palpation of specific anatomic structures for swelling, heat, and pain. It also includes an assessment of body condition, posture, scars, and static flexion (manipulation of various structures in the standing horse for range of motion and pain response).

EXAM IN MOVEMENT: The next part of the exam involves watching the horse in movement. Lameness is mostly evaluated at the trot. Most thorough lameness exams are performed on firm to hard, consistent footing Examination often includes circles to both directions and may include inclines or specific patterns. For the diagnosis of some types of lameness problems, having a rider up can be advantageous.

FLEXION EXAMS AND OTHER MANIPULATIVE TESTING: Flexion exams involve putting specific joints or regions of the limb under stress for a specified and consistent period of time. The horse’s degree of lameness is assessed before and after flexion. The result, which is the change in severity of lameness following flexion, provides additional information regarding the origin of the pain. As with many parts of the exam, flexion tests must be interpreted in light of what is normal for that specific horse. Wedge tests, extension tests are similar in principle. The specific ones used depend greatly on the practitioner’s preference and experience.

HOOF TESTERS: Hoof testing involves the use of a pincer-like tool to put pressure on specific regions of the foot in search of a pain response. As with flexion exams, the key to accurate interpretation of hoof tester examination is knowledge of what constitutes a normal response. This can only be gained through a methodical approach, and lots of experience with different types of horses and hooves.

At this point in the exam, the veterinarian usually has determined which limb is lame, and may have an idea where the pain is located within that limb. Often, nerve blocks may then be necessary to determine precisely where the pain is located.

NERVE & JOINT BLOCKS: Nerve blocks are used to methodically numb portions of the limb as a means of finding the site of pain, using the process of elimination. Also known as diagnostic anesthesia, “blocking” is the injection of a local anesthetic agent around specific nerves or into specific joints or other structures. The horse is examined at the trot before the block, and the degree of lameness determined. Then the area in question is numbed, and the horse is asked again to trot off. Either there is improvement in the lameness or not.

If there is not, the process is continued on specific nerves progressing up the limb until the lameness is visibly lessened. Specific joints and tendon sheaths can also be blocked for a more specific localization of lameness. Blocks into a joint or tendon sheath require surgical cleanliness to prevent infection of these structures. Limitations include spread of local anesthetics to adjacent regions, clouding the interpretation of the result.

IMAGING THE SITE OF PAIN: Once the site of pain is located, diagnostic imaging is used to view the structures in the area and provides additional information about the nature of the injury. This most commonly includes radiographs (x-rays) to image bone, followed by ultrasound to image soft tissues. Cases not fully understood using these diagnostics may require the use of MRI, CT Scan or Nuclear Scintigraphy (bone scan), among others to provide more detailed information.

The lameness exam is the cornerstone of the equine practitioner’s art. Many of us have developed and perfected this exam through our veterinary careers. It is as much an art as science. It relies to a great extent on our knowledge of anatomy, pattern recognition, meticulous technique, horsemanship, knowledge of the horse type and discipline, and the ability to tie all aspects of clinical assessment together with other diagnostics and imaging.

See the related Topic: “Subtle or Hard to Diagnose Lameness: What Horse Owner’s Should Know” for a more detailed discussion of these advanced diagnostics.

Reasons to UseRelated Observations

Bobbing Head when Trotting or at Gait
Lameness, Generally
Stumbling, Seems Uncoordinated Under Saddle
Lameness, Chronic Hind Limb
Lameness, Recent Front Limb
Lameness, Chronic Front Limb
Lameness, Recent Hind Limb
Reduced Racing Performance
Pointing, Placing One Limb Forward when Standing
Not Engaging or Collecting, Lacks Impulsion
Swelling of Joint or Tendon Sheath in Lower Leg
Hindquarters Seem to Fall Away or Collapse while Ridden
Swelling on Back of Lower Limb, Flexor Tendon Area
Swelling of Multiple Joints
Swollen Hock, Generally
Carpus (Knee) Swollen
Lameness, Severe, Cannot Support Weight on Limb
Digital Pulse Can Be Felt in Foot
Heat in Hoof Walls, Foot or Feet
Lameness, Immediately Following Trauma or Accident
Seems Sore in Feet, Especially on Hard Ground or Gravel
Hard Bump on Inside of Lower Hock
Lameness, Sudden Onset Under Saddle
Hesitant to Walk on Hard Surfaces
Worsening Attitude or Performance Under Saddle
Rushes through Maneuvers or around Obstacles
Disjointed Feeling Under Saddle
Saddle Slips during Work
Scar on Coronet, Hairline of Hoof
Swelling on Outside of Carpus (Knee)
Dished Front of Hoof Wall
Hoof too Upright, Club Foot
Sheared Heels, Coronet Not Same Height at Heels or Quarters of Hoof
Choppy or Short Gait, Short-Strided
Stifle Area Seems Swollen
Hoof-Limb Contact, Foot Interfering or Overreaching
Swollen Fetlock (Ankle)
Loss of Muscle Mass, Generalized, on Top-line or Back
Single Lump or Swelling on Lower Limb or Leg
Bump or Swelling around Coronet or Pastern
Hoof Wall Crack, Parallel to Ground, Horizontal, with Lameness
Swelling of Multiple Lower Limbs or Legs
Splints or Braces Against Pressure from Hands
Conformation Problems, Generally
Fetlock Sagging Low, Hyper-Extending (in Adult)
Crooked Leg, Poor Limb Conformation (in Adult)
Sole of Hoof, Red Discoloration Visible
Will Not Stand for Farrier, Will Not Hold Leg Up for Long
Frog Falling or Peeling Off
Back Sore, Dips Away from Pressure with Hands
High-Stepping Gait of One or Both Hind Limbs
Bucking
Bubble of Soft Swelling on Outside &/or Front of Hock
Bench Knee, Offset Cannon Bone
Rearing while Under Saddle
Hind Limb, Short-Strided on One or Both Limbs
Sprung, Twisted or Bent Shoe
Bucked Shins, Pain Response to Pressure over Front of Cannon Bones in Race Horse
Swelling on Top of Hip, One Side or Both
Dent in Rear End
Hip (Pelvis) Shape or Height Asymmetry Viewed from Behind
Loss of Shoulder Muscle on Right or Left
Resists Raising, Lifting, or Bending a Limb
Widened White Line of the Hoof
Hind Limb Swings Inward, Viewed from Behind
Abrasion or Scrape on Lower Limb or Leg
Abrasion or Scrape on Upper Limb or Leg
Toe of Hoof Raises Off Ground when Weight Bearing
Sores, Crusts, Growths or Scabs on Lower Limb(s)
Shoe Lost While Riding

Possible Diagnoses

Ligament & Tendon Injuries, Generally
Lameness, Conditions Causing, Generally
Bone Spavin, Distal Hock Arthrosis
Osteoarthritis, OA, Generally
Sole, Foot, Corn or Heel Bruise
Navicular Syndrome
Proximal Suspensory Ligament Injury, Hind Limb
Proximal Suspensory Ligament Injury, Front Limb
Joint Capsulitis, Synovitis, Tenosynovitis
Coffin Joint Arthritis, Low Ringbone
Flexor Tendon Injury, Tendinitis, Bowed Tendon
Pastern Arthritis, High Ringbone
Pedal Osteitis, Marginal Fractures Coffin Bone
Sheared Heels
Suspensory Ligament Body Injury
Splints, Splint Exostosis
Stocking Up, Stagnation Edema
Fracture of Splint Bone
Intermittent Upward Fixation of Patella
Sidebone, Ossified Collateral Cartilage
Suspensory Ligament Branch Injury
Fibrotic Myopathy
Fracture of Coffin Bone, Generally
Club Foot, Flexural Deformity (in Adult)
Laminitis, Chronic
Sacro-Iliac Strain & Pain
Annular Ligament Disease, Palmar or Plantar
Conformational Defects, Limbs, Generally
Deep Digital Flexor Tendinitis in Hoof
Idiopathic Bog, Joint Fluid Accumulation Top Joint of Hock
Lameness, Undiagnosed
Strain or Injury Distal Ligaments Proximal Sesamoid
Sole, Foot or Hoof Abscess
Back Pain, Generally
Interference, Limb to Limb Contact
Degenerative Suspensory Ligament Disease, DSLD
Cervical Vertebral Malformation, CVM
Coffin Joint Collateral Ligament Injury
Thoroughpin, Fluid Accumulation in Hock
Thrush
Contracted Heels
Peroneus Tertius Rupture
Hoof Wall Cracks, Generally
Collateral Ligament Injury or Rupture, Generally
Extensor Tenosynovitis, Non-Infectious
Stress or Hairline Fractures, Generally
Hoof Wall Crack, Heel & Quarter
Stifle Meniscal & Collateral Ligament Injury
Subchondral Bone Cyst, Stifle
Fracture of Accessory Carpal Bone
Subchondral Bone Cyst, Generally
Fracture of Sesamoid Bones
Poor Conditioning
Offset Carpus or Bench Knees
Fracture of Carpal Bone Chip & Slab
Flexural Deformity Fetlock Joint, SDFT
Older Horse Ataxia & Weakness
Carpal Arthritis, Carpitis
Foal, Contracted Tendon DDFT, Coffin Joint
Inferior Check Ligament Strains or Tears
Carpal Tunnel Syndrome, Carpal Canal Tenosynovitis
Capped Hock
Fracture of Navicular Bone
Laminitis, Acute
Biceps Brachii Tendinitis, Bicipital Bursitis
Fetlock Arthritis, Osselets
Hoof Imbalance
Hoof Pain After Trimming or Shoes Pulled
Overriding Dorsal Spinous Processes
Rein Lameness
Stringhalt
Keratoma, Hoof Wall
Pigeon Toe (in Growing Foal or Adult)
Behavioral Change Without an Obvious Cause
Windpuffs or Windgalls
Aorto-Iliac Thrombosis
Upward Fixation of Patella, Locking Stifle or Patella
Upward Curvature of Spine, Lumbar Kyphosis
Fracture of Olecranon of Elbow
Curb, Strain of Tarsal Plantar Ligament
Fracture of Pastern Bones
Trochanteric Bursitis, Whorlbone
Fracture of Hip, Pelvis
Fracture of Humerus
Carpal Hygroma, Synovial Hernia, Ganglion
Fracture of Cannon Bone, Condylar
Bucked Shins
Fracture of Scapula or Point of Shoulder
Fracture of Femur & 3rd Trochanter Fracture
Cruciate Ligament Injury
Fracture of Extensor Process P3
Infected Joint, Septic Arthritis (in Adult)
Wound or Laceration into Joint, Tendon Sheath or Bursa
Fracture or Broken Bone, Generally
Hoof Wall Avulsion
Fracture of Patella
Bone Bruise
Hoof Wall Crack, Blowout
Deep Digital Flexor Tendon Rupture
Nail or Other Foreign Body Punctures Foot, Sole or Frog
Foal or Newborn, Carpal Flexural Deformity
Wound or Laceration from Overreach Injury
Calcaneal Fracture
Radial Exostosis & Osteochondroma
Conformational Defects, Back, Generally
Navicular Bursa Penetrated by Foreign Body
Quittor, Infected Collateral Cartilage
Aging Changes, Generally
Carbohydrate or Grain Overload
Laminitis, Support-Limb

Benefits

The lameness exam is the hub of diagnostics for lameness and performance problems. The results of a lameness exam provides direction for further diagnostics and treatment.

Limitations

Even the most experienced and talented lameness clinicians run into problems that are very difficult to diagnose, especially in the hind limbs. The lameness exam may point to an anatomic location, but require other diagnostics (imaging) to determine the nature of the condition.

Helpful Terms & Topics in HSVGWritten, Reviewed or Shared by Experts in Equine Health

QUESTIONS TO ASK MY VET

  • What will we know after the clinical part of the lameness exam?
  • What can we expect to learn from imaging?
  • What do you think the different elements of the exam will cost?
  • Does the test have the potential to change our approach to managing or treating my horse?
  • Author: Doug Thal DVM Dipl. ABVP

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