Tonight's session is hind limb lameness. Aiming to cover lameness assessment, nerve blocks, radiography and day one skills.
How do you recognise hind limb lameness when trotting a horse up?
Listening to sound can also be really helpful to enable you to spot the lame limb.
So, will the lame leg drop more or less?
Where should we start with the nerve blocking in the hind limb?
Yes well done Tash – Palmar digital, abaxial sesamoid, low 6 point and high 6 point blocks are the correct sequence of blocks. Only problem with this route is that it will take 10 injections to get above the fetlock.
Also important to remember the contra-indications for blocking: Severe lameness, Hx of trauma, acute onset or infection
Remember you can try to localise the region of interest using: Positive flexion tests, joint effusions, painful regions, swollen/inflamed area.
Sadly, there was nothing to help localise in this case – welcome to real life!
What drug, needle and volume will you use to perform a nerve block? #Day1Skills
Some people have been mentioning sedating the horse, whats everyone's thoughts?
N.b. it won't affect kick reaction but ACP does calm them down without ataxia or analgesia. May well be what you need if they are bucking and cantering on the spot. If you need to use alpha-2 and opiod to remain safe then do so.
Lots of comments as well about clipping and surgical scrubbing… which blocks do we actually need to do this for?
If we now go back to restraint and technique, starting with a 6 point block, how are you going to do this as safely as possible?
Yes, good physical restraint (handler, twitch), lifting leg if needed, communicating with you team about when you are injecting. Insert needle with confidence and speed to avoid being kicked! Stocks are also very helpful.
How would you go about doing the medial side?
Anatomy revision time now – what are the landmarks for low 6 points (remember 6 in hind limb)?
Yes, so what area does this anaesthetise – assuming your block worked?
What would you do if the block hasn't worked and you still have sensation?
Don't forget you may have to re-block multiple times… It happens to everyone!
So high plantar or lateral plantar was mentioned earlier – where do you do these?
Everyone seems to be a lot happier with nerve blocks now. No don't forget you can always refer…
Going on to a spot of radiography now:
Going back to the previous session on equine lameness. There where lots of questions about small tarsal joint changes. What would this block too?
Yes, Tarsometatarsal joint block would be a good start. 1 block in total versus 16 if you did palmar digital block all the way up to high 6 point.
So going back to the radiograph the following changes can be seen:
Well that is all for tonight folks! Thank you to Sarah Freeman for running a fantastic session on equine hind limb lameness. If you have any queries you are welcome to email her.
If your knowledge on colic workups is a little rusty, check out react.vet which is a new website aimed to help new grads with cases.