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Diagnosis and Management of Lameness in the Horse


By Dr. Kevin Keane, DVM
Dr. Kevin Keane
Dr. Kevin Keane has a special interest in equine sports medicine.

Diagnosing lameness in horses can be a complicated science but it's also part "feel" like an art. It's impossible to cover everything, so I'm going to concentrate on the basics and on the latest technologies that are improving diagnostic capabilities.

Defining Lameness

Basically, lameness is any musculoskeletal deficit that interferes with the horse's health or performance. Lameness emanates from two tissues in the limb or body: either bony tissue or soft tissue such as muscle, tendons and ligaments. Examples of bony lesions would be fractures, splints and most commonly, arthritis; anything which can affect any joint of the limb or skeleton. Soft tissue lesions are muscle inflammation, bowed tendons, and strained or torn ligaments. Problems can be found in both forelimbs and hind limbs with the incidence of each of these depending on the discipline the horse is involved in. There are obvious causes of lameness such as infection from a wound or abscess in the foot; and subtle lameness stemming from mild foot imbalance and cartilage changes that are not even evident on radiographs. Although lameness can be found anywhere in the limb, the highest percentage is found in the foot, especially the forefoot.

Detecting Lameness

Our goal in detecting lameness is to be as precise as we possibly can in localizing the site and exact cause of the pain. Usually experienced horse people have a very good idea about what's wrong before the vet arrives. Observe your horse, and keep a history, whatever information the horse owner gathers can be very helpful in making a diagnosis. Early detection helps avoid further issues, especially with soft tissue components. It's one of the reasons you should call in a vet as soon as possible with lameness issues. A specific diagnosis most often is not possible without veterinary examination and diagnostic imaging. It starts with a physical examination. Once an area has been detected, we may, and often do, administer a regional nerve block, somewhat like when your dentist uses Novocaine. If the problem is eliminated by the nerve blocking procedure that gives us definitive evidence where the problem lies. The response to treatment is predicated on the diagnosis. When you are able to tell what's wrong with the horse you can aim a specific treatment for the cause of that horse's lameness.

Technological Advances

Newer, more sophisticated technology allows vets to see more discreet changes in tissues and gives a clearer image that often allows for a quicker and more precise final diagnosis. Four of these new technological tools that are frequently employed are: Digital Ultrasound, Digital Radiography, Nuclear Scintigraphy, and MRIs.

Digital radiography allows for x-ray evaluation of specific trouble areas such as joints of the limb or neck. The higher quality images provided by digitization give immediate gratification as the images are produced through sensors in the plate in conjunction with a computer screen. Higher quality images appear on the screen than with the older method of plain film radiography and allow us more confidence in finding smaller, subtle lesions that cause discomfort to the animal.

Digital ultrasound uses ultra-sound waves to view soft tissues such as muscle, tendons and ligaments; all of which can contribute to a problem for a horse when these tissues are inflamed or torn.

With Nuclear Scintigraphy, a radiopharmaceutical is injected into the horse's vein and after a period of time some photos are taken which detect uptake within the tissue of the pharmaceutical. Because inflamed tissue has an affinity for the injected compound, scintigraphy or "bone scan" can detect problems not yet visible on radiographs. The procedure can often find inflammation on the cellular level not yet "large" enough to be seen with an x-ray. This procedure is extremely helpful in finding stress fractures and small bone bruises. Nuclear Scintigraphy has some cost associated with it, and it is not needed in every case so we tend to use it in the more difficult to diagnose cases.

MRIs use strong magnets and with the aid of computers, allow us to divide the horse's body into very thin slices or planes to see lesions that you cannot see any other way. MRIs are especially helpful in examining the horse's feet, as motion needs to be eliminated. To MRI above the feet, we may lie the horse down under anesthesia to reduce motion.

Every veterinarian's goal is to help you with the health and soundness of your horse. Once a diagnosis is made, treatment can be aimed at correcting the problem, so the horse can get back to the ring, back to the track and back to doing his or her job.

Dr. Kevin Keane spent his youth on a farm outside of Chicago, earned his doctorate from the University of Illinois and has special interest in Sports Medicine and musculo-skeletal disease in horses. He traveled extensively as a Veterinarian for the US and Australian Equestrian Teams, and contributed to the textbook by Ross and Dyson, Diagnosis and Management of Lameness in the Horse.


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