Investigating Lameness

Question 1

what are the most common patterns of lameness

Answer 1

forelimb > hindlimb

distal > proximal

foot pain most common cause of lameness

Question 2

what are the steps in information gathering and analysis

Answer 2

patient data, focused medical history

focused physical examination

gait evaluation

use info to inform further (diagnostic local anaesthesia, diagnostic imaging)

diagnosis –> develop list of differential diagnoses at early stage, re-visit to refine as more info becomes available

Question 3

what is the patient data used to gather info about lameness

Answer 3

1. breed, age, sex
2. use
3. duration of ownership: implications regarding medical history
4. management: exercise, shoeing, feeding

Question 4

what is the medical history focused on lameness

Answer 4

1. owner’s description: severity, nature of onset and progression, duration
2. external trauma (kicked)
3. localizing signs (swelling)
4. response to therapy: any treatments, meds
5. previous lameness (re-occurance)
6. exercise
7. when last shod

Question 5

what is the general inspection of physical exam entail (hands off)

Answer 5

1. posture: is horse weight bearing normally at rest
2. body condition
3. asymmetry: swellings, mustlce atrophy, bony landmarks
4. conformation: foot and limb

Question 6

what is the hands on exam entail

Answer 6

1. close inspection
2. palpation: heat, pain, swelling, digital pulse strength
3. manipulation: reduced range of joint movement, pain
4. compare left with right

Question 7

what does the hands on foot exam entail

Answer 7

hoof testers and percussion –> pain?

use hoof knife to remove superficial solar horn in painful areas for better inspection

surface temp, digital pulse

Question 8

how is the gait evaluated

Answer 8

not if fracture

straight line (in hand)

lunge (circle)

• effect of direction on lameness: loading –> inside limb > outside limb (inside limb: lateral > medial, outside limb: medial > lateral)
• effect of surface on lameness: hard –> impact pain, ex. laminitis, bruised sole. soft: max weight bearing pain, ex. suspensory ligament injury

Question 9

what is the effect of lunge on pelvic movement on hard surface

Answer 9

inside limb: increased minimum pelvic height during stance phase and decreased maximum pelvic height at push off (compared to outside)

Question 10

what is the effect of soft surface on lunge and pelvic movement

Answer 10

inside limb: increased minimum pelvic height during stance phase and increased maximum pelvic height at push off (compared to outside)

Question 11

what are the aims of flexion tests

Answer 11

to exacerbate mild lameness/provoke lameness to localize the lesion causing the lameness

less lame limb first

Question 12

what are the techniques of diagnostic local anaesthesia

Answer 12

perineural: nerve blocks
intrasynovial: joint/tendon sheath/bursa block

and then assessment following –> when, how, what is significant imrpovement?

Question 13

what are the diagnostic imaging options

Answer 13

radiography

ultrasonography

bone scan

CT, MRI

arthroscopy, tenoscopy, bursoscopy - endoscopy

synovial fluid analysis - infection