Approach to the lame Horse

The reason this is the chosen topic this evening…

Lets start

http://twitter.com/Seh_Fid/status/446738573401018368

We were pretty unanimous here…history is really important.

Getting a more detailed history, important things being:
age of the horse, current work load, management (t/o or stabled), how long in owners possession, any previous lameness & what tx has the owner given- important to know if they’ve bute’d it themselves!

so we’ve got a history on the horse, we need to work out what our plan is next…

http://twitter.com/Seh_Fid/status/446741864839139328

Lots of great answers here, its important to observe the horse from a distance for its posture, foot balance & weight bearing.

A very useful hint here…never forget the foot & use the hoof testers!

An interesting point was bought up next, when should we palpate the leg, before/after trotting up?

It was decided that we can get mis-led by findings on palpation, unless we have a severe lameness (10/10) gait analysis before you go for the palpation…so it doesn’t skew your findings!

Now we can look at the horse trotting up, but firstly what are the contraindications of trotting up?!

We were all pretty confident on this one!

Always beware of trotting up a 10/10 lame, making a fracture worse or severe tendon injury!

The video got a bit lost in things here, but overall the consensus was it wasn’t obviously lame…and no leg was identified at this time.

So we wanted to think about the top differentials in this case…

So what are the main things we want to look at when walking the horse?

http://twitter.com/Seh_Fid/status/446746299761954817

http://twitter.com/CharlotteBanks0/status/446746363993546752

All good answers, but the best things to identify at walk are…

Fetlock dropping can be an indication of tendon disease

But also remember fetlock drop is to do with loading

After discussing what we’d look for at walk we needed to decide what to do next

So why do we trot?

Some good thoughts on the trotting, but what if its bilateral?

So what do we plan to do next

http://twitter.com/Seh_Fid/status/446751376354598913

So here is our horse, and what we can see

Good point, just because it is lame on one-side, doesn’t mean we have ruled out a bilateral lameness.

So as we can see, lunging is a good plan!

So we’ve finally decided on a leg, what is our next step?

http://twitter.com/Seh_Fid/status/446752744356200449

We got a bit carried away , but not forgetting those hoof testers…get them out at this point if you haven’t already. Remember common things are common & foot lameness is common!

And what we found on the nerve blocks

What this shows

So we’ve diagnosed a bilateral forelimb lameness in our horse, top ddx for this being navicular & laminitis

And that’s exactly what we did…

Sadly we were running out of time by this point, so couldn’t fully discuss the x-ray, but this is what we thought we could see.

http://twitter.com/Seh_Fid/status/446754816120061952

So some of these are findings consistent with Navicular, but we would need some more views to be taken to properly image the navicular bone- the important views for imaging for navicular are

U pright Navicular (D60Pr-PaDi
oblique) &
Flexor Navicular (Pa45Pr-PaDi
oblique)

Here is a nice in-practice article on navicular disease in horses
 http://inpractice.bmj.com/content/35/6/325.full.pdf+html 

The radiograph also shows poor dorso-palmar foot balance. However to investigate further blocks needed & possibly MRI to pin down exact dx in palmar heel pain.
Remember to always assess x-rays for HPA, think about biomechanics & foot balance.

Here is a nice review of equine conformation, useful to look at the importance of broken forward/back, and use this to help you look at the radiograph above.

And an important extra point!

Thanks to everyone that joined us this evening for #vetfinals. I think us running out of time, and not getting chance to cover everything proves how big the topic of lameness in horses is.
I’ve also attached a nice article that Tom sent for gait analysis.
A bit of extra reading for you all.

Thanks very much for joining in, look forward to seeing you all next week for some anaesthesia!