The Equine Lameness Examination (What the vet will do and why)

Wow - what a busy week I've had and it's not even over yet!

Besides being in the office 8-5pm, I spent Monday and Tuesday evening studying cell biology, last night I attended a lameness workshop at Nantwich Equine Vets and this evening I have ridden my friends pony Toby who has a bit of a separation issue when split up from his field mate Tigger. So to say this evenings ride was eventful would be an understatement!

This week's post is going to be based around the workshop I attended last night:

Can't beat an information pack! 

 The Equine Lameness Examination (What the vet will do and why) 

"A lameness examination is a forensic investigation of the horse." 

- Alasdair Topp BVM&S Cert AVP (EOS) MRCVS

History

First of all the vet will want to know about the horses history. Key things your vet will ask are:

• Age
• Sex
• Breed
• Use/Performance level
• Management - Surfaces worked on/stabled or at grass etc. 
• Previous problems?
• Duration of lameness
• What does the owner think is wrong

Observation

Next your vet will want to spend a few minutes just observing your horse all over. Things a vet will look at include:

1.Confirmation

• How are his forelimbs? Are they in proportion to the rest of his body? Are his feet turned out or pigeon toed? His knees - are they over at the knee/Back of the knee? - Horses that are back at the knee can have excessive amounts of strain placed on the tendons
• How are his hind limbs? Are they well put together? Is he base narrow or base wide? His hocks? Are they sickle/over straight/up in the air?
• His back - is he roach backed or have a dipped back?
• His body - the shoulder and rump angle should be 90° anything over this and the horses strides will tend to be shorter and anything under will result in a weaker structure. 

2. Foot balance
3. Symmetry of the horse
4. Swelling - bony/soft tissue
5. Posture - e.g. laminitic ponies will tend to rest on the heels of all four feet

6. Distribution of weight placed over limbs

Image - A Photographic Guide to Confirmation - Such a good read!

Palpation

This is where your vet will examine the horse for heat, swelling and pain. 

Usually starting at the foot using hoof testers and working the way up the limb using his hand, your vet will feel for any heat/swelling and locate areas of causing pain. He may do this by applying a slight pressure in certain areas to see the reaction of the horse. 

After viewing the limbs your vet may want to view the range of movement in the spine. 

• Ventroflexion is the arching of the spine, to do this the vet will either use his hand or run a pen ventrally along the abdomen so the horse arches his spine. 
• Dorsiflexion is the hollowing away from pressure applied either side of the withers.
• Lateral flexion is a sideways flexion. By running a hand down the spine applying pressure to either side of the spine should cause the horse to curve away in lateral flexion. 

The overall body will also be looked at to see if there is any muscle wastage/atrophy or unusual sweat marks. 

Movement

Your vet will use a baseline for each lameness examination. This is basically a starting point and when viewing the movement of the horse, each issue will have its own baseline. 

Your vet will want to:

• View the horse walking and trotting in a straight line. Things your vet will look for when doing this are head nods and hip action. 
• Flexion tests - using reasonable force for about 40 seconds the joint in question is flexed to full capacity to accentuate any problems.
• Extension tests - joints may be extended as opposed to flexed, this is rarely used. 
• Lunge on a hard surface - this can highlight bone related issues and typically shows inside limb lameness.
• Lunge on a soft surface - this can highlight soft tissue issues and typically shows outside limb lamness.
• Ridden - some horses may only show lameness when ridden so your vet will want to see this.

Lunging Crunchie

Things your vet may notice (and you too!):

• Forelimb lameness - a head nod on the sound leg
• Hind limb lameness - a hip hike on the lame limb and a possible head nod on the contralateral forelimb (opposite forelimb) when this occurs it's easy to mistake hind limb lameness for forelimb lameness
• Hoof pattern sound - unusual pattern caused by a toe drag?
• Change in limb flight during cranial and caudal phases - as the limb moves forward (cranial phase) it may have a shorter stride due to lameness
• Foot landings
• Mechanical lameness - physically abnormality preventing the a normal motion

Your vet will then grade the lameness on a scale of 0-5. 

0 - No lameness found

1 - Mild

2 - Obvious

3 - Pronounced

4 - Severe

5 - Not weight baring/inability to move

Diagnostic Modalities

This is where the vet will now try to localise the lameness to a specific region of the body. This can be done by using one of the below modalities:

Nerve Blocks – The most common modality used in localising lameness. Post trot up/flexion test, a vet would have identified a limb in which he believes the lameness is occurring from and starting from the foot and working his way up the limb, he would inject local anaesthetic to block the nerves until the lameness was eliminated.

Magnetic Resonance Imaging (MRI) –  Using magnetic fields and radio waves, this technology can provide a clear image of what’s going on under the surface of the skin. It's good for areas like cartilage.

Nuclear Scintigraphy – This requires the horse to be kept in for a few nights at a veterinarian practice due to the use of radioactive chemicals which are injected into the body and are then detected from outside to see where the most chemical build up occurs. This would highlight any areas that may need investigation.

Arthroscopy – A diagnostic tool by where a surgical procedure is required in the form of keyhole surgery to look into the joints of a horse. This is done using a very thin telescope and a light source.

Radiography (x-ray) –  Provides images on the skeletal structure by using electromagnetic radiation. The horse may need an additional scan should the x-ray prove to be inconclusive in its findings.

Ultrasound scan – Produces images of  the fibre patterns in the tendons, ligaments, tissues, vessels, organs and fluid accumulation by using sound waves. Veterinarian practices also use ultrasound as a guidance tool when medicating certain areas of the body. 

Thermography - Using an infrared camera, the technician has the ability to capture real time heat maps in the form of a thermogram. Thermograms are pictorial representations of the surface temperature of the horse in question. Measuring the surface temperature of the horse gives us an indication of any changes in the vascular, muscular, skeletal and nervous systems as we are able to view any inflammation going on underneath the skin which is undetectable to the human hand or eye. 

Hopefully by using one of the above modalities you will have been able to locate the problem and the right course of treatment will be then arranged by your vet.

I will be attending another workshop next month on common forelimb lameness and so I will keep you posted on how that goes too! 


Jess x

Common Injuries Part 3 - Cross Country

To conclude my three part post I'm looking at common injuries which can occur when participating in cross country. 

Bradwall Horse Trials 2015

Cross country demonstrates the strength, endurance and jump ability of the horse as well as how well the rider can use allotted time efficiently to get around the course. 

Injuries can occur during XC training and competition. It is thought that heavy conditioning training for XC increases the risk of injury however, insufficiently trained horses are just as susceptible to injury. A horse which is not fit enough to complete the course may have a rapid onset of fatigue as they're galloping above their anaerobic threshold, which increases the risk of in-coordination and reduction in muscular support due to the more erratic pace in which they are travelling at.

The main types of injury include: 

• Interference from another limb 
• Hitting an obstacle with forelimbs/stifles
• Rotational fall 
• Stress on the forelimbs (mainly distal) especially after jumping a fence with a drop
• Lacerations/contusions/punctures

The structures which are vulnerable to this external trauma include:

• Digital Flexor Tendons
• Extensor Tendons
• Tendon Sheath
• Fetlock joint and soft tissues
• Suspensory ligament
• Distal Sesamoidean ligaments
• Palmar/Plantar annular ligament
• Collateral ligaments in the fetlock joint
• Cannon bone trauma
• Skin
• Neurovascular system

Bradwall Horse Trials 2015

As I've covered off in the last two posts - thermography remains to be an amazing modality for XC too! :D

Happy eventing all! All you riders and horses stay safe!

Jess x

Common Injuries Part 2 - Show Jumping

As I highlighted in my Common Injuries Part 1 post, different disciplines are predisposed to specific injuries. These can then vary depending on the different training sessions and level of performance. 

In this post I am going to put together a high level summary of common show jumping injuries. 

Ben Maher. Image - Independent

Take off - Landing. Image - Sillydragon

Just to point out the obvious - show jumping requires a horse and rider to jump a course of fences in a quick time with plenty of tight turns and the need to cover ground when required. 

With the repeated loading onto the anatomical structure, injuries can be sudden/servere and are usually caused by over stretching the ligaments/tendons as well as the compression and twisting of the skeletal structure. An awkward landing/twist or poor footing upon landing are all contributing factors to show jumping injuries.

Strain is mainly placed on the forelimbs when landing and the hind limbs when the horse is taking its first stride after landing as the limbs come right underneath them. The degree of injury may then depend on the level at which the horse is competing at. 

Common injuries/conditions include:

• Superficial Digital Flexor Tendonitis - strain which usually occurs when the coffin and fetlock joints are overextended
• Suspensory Ligament Desmitis - strain to the upper part of the ligament near to where it joins onto the cannon bone 
• Deep Digital Flexor Tendonitis - strain to the distal DDFT where it passes over the back of the navicular and inserts into the coffin/pedal bone
• Collateral Ligament damage to the coffin joints
• Joint inflammation due to compression/twisting
• Bruising to the foot
• Arthritis in the bottom two joints of the hock 
• Sacroiliac joint inflammation from sliding hind limbs
• Muscular soreness over the back and quarters 

For show jumping injuries, thermography has the ability to not only act as a prevention tool and assist in locating the issue in a non-invasive way, but it will also help in the rehabilitation of the injury. By having a series of thermography scans post injury you will be able to see how/if the treatment is working and it will give you that visual clarification to say you can return to work as the inflammation has resolved instead of hesitantly going off the vets word - I've been there before! Also whilst being back in work you will be able to see how the structure is holding up too! The infra-red camera cannot lie!

Jess x

Common Injuries Part 1 - Dressage

With the eventing season getting well under way I thought I would take a look at the three disciplines involved and the common injuries that can come with them. For me as a trainee thermographer this is something I need to be aware of. 

Each discipline puts different stresses on the anatomical structures and can vary depending on the level at which each disciple is being perfomed at.

First of all I'm going to take a high level look at dressage (or otherwise known as stressage). 

Zara Phillips & High Kingdom

Charlotte Dujardin & Valegro - of course!

Dressage is all about the riding and training of a horse in a manner which develops obedience, flexibility and balance. 

Unfortunately due the repetitive nature of dressage, injuries do occur. The degree of injury depends on the level of dressage the horse is competing at too. A horse competing at Preliminary is less likely to sustain the same kind of injury as a horse competing at Prix St Georges as the test requirements are different. 

Common injuries/conditions include:

• Hind Proximal Suspensory Desmitis (PSD) - inflammation of the upper part of the suspensory ligament due to increased weight put onto the hind limbs. PSD usually occurs bilaterally making diagnosis difficult. 
• Muscular soreness - shoulders, back, rump, neck, hamstrings.
• Degenerative joint disesase/arthritus - more susceptible in more advanced levels of dressage due to the extra pressures put on the joints such as the: pasterns, coffin joints, knees, fetlocks and hocks.
• Sacroiliac Pain

"Prevention is better than cure" - Desiderius Erasmus

With the demand of modern performances in dressage, injuries are always going to occur. However, with continuous monitoring of inflammation you will be able to view whether or not your schooling programme is working for both you and your horse. Regular thermography scans will allow you to view any structures - if any - which may be accumulating damage and pro-actively adjust your training program/seek veterinarian advice before a structure completely breaks down. 

Jess x

Suffolk in what...

Ahhh the first blog post... No pressure... 


So after months of studying the art of thermography and the Equine anatomy at home, I decided to take the plunge and made what turned out to be a 4 hour drive from Cheshire to Suffolk to train with my tutor - highly respected thermographer Sandie Chambers. 

Sandie's gorgeous place!

I stayed in the most adorable B&B - Church Farm B&B with Ruth and her husband Paul. Ruth was a wonderful host and the twin room which I had all to myself was perfect. If anyone is ever that way I would recommend you check out their farm!

Twin Room - all to myself!

I can honestly say it was so worth the 8 hours all in all of travelling, I managed to get my hands on an infra-red camera and take some scans of Sandie's prize possession and the ultimate horse model - Diablo. 

After a morning scanning it was straight on to analysing the images and producing a report. 

Distal forelimb shot

This shot shows a bilateral (when one side of the body is compared to the exact same region on the other side) temperature difference on the upper cannon region on Diablos offside distal limb. This inflammation can be attributed to the fact that Diablo has a splint there. 

Diablo suffers from mud fever and despite it appearing to have gone according to the human eye, the inflammation from the mud fever still remains in around the fetlock and pastern region - poor Diablo!

Jess x