Whether you have a highly competitive show horse that lives in an exclusive stable, or a backyard buddy that has a run in shed, sooner or later you’ll have a lameness problem. Anything that makes your horse uncomfortable and produces a change in gait qualifies. If he’s “just a bit off”, has “a hitch in his gitty-up”, or is “three legged lame”, it’s a concern for horse, owner, and veterinarian. At McGee Equine Clinic, we know lameness issues cause pain, worry, decreased performance, and lost time. Our goal is to find the cause of the problem, recommend appropriate treatment, help get your horse moving better, and extend his performance career. Our veterinarians work with horses of many disciplines including pleasure, trail, lesson programs, gaited horses, hunters, jumpers, eventers, dressage, driving, barrel racing, team penning, calf roping, mounted shooting, reigning, cutting, jousting, therapeutic programs, heavy pulling horses, retirees, mounted police horses, and pasture pets.
Our lameness exams start with a thorough physical examination including palpations of all limbs, back and neck, and application of hoof testers if indicated. We are feeling for heat, swelling, elevated pulse, thickened structures, and distended joint or tendon sheath capsules. Pain on palpation (feeling the limb) or when the leg is flexed is noted. Usually you are provided with a “normal” leg to compare to the lame one: subtle differences are easier to determine if you know what “normal” feels and reacts like. So, when we start palpating the “wrong” leg, we’re trying to see what it SHOULD feel like.
Next, we move on to movement exams, where we evaluate the gait, stride, and limb placement in hand and/or on a longe line, or for more subtle lamenesses, with a rider and tack. We may also ask to watch the horse move on different surfaces. We first look for dramatic abnormalities like a head nod, or a “hip hike”. Remember that, in normal horses, the head will drop down onto the “sound” leg if the lameness is in a front limb. A hip hike is simply the appearance of the rump elevating as the horse “short steps” off of a painful hind leg. Hind limb soreness can also cause a head nod, which can complicate diagnosis. Depending on the area of pain, it may be easier to observe going the same way (ie. left front worse in circles to the left), or the opposite way (left front, worse to the right). Many times, that will give us a clue to the origin of the discomfort.
Once a limb or area of pain is identified, we will then perform flexion tests, an important method used to localize pain. Systematically the different joints are flexed and the horse is observed jogging away. If the lameness worsens after a specific flexion, it suggests that the pain is coming from that area. Typically we start with the lower limb, and work upward (proximally, in vet speak), holding the joint in flexion (or extension in some cases) for a short period, and trotting them away. Imagine fully bending your own arthritic joint, holding it there awhile, and then trying to move it. Or sitting cross-legged longer than you should, and trying to get up. You can envision the exaggerated discomfort: anything that hurt a little before, now barks at you. The limitations of flexion tests are built into the horse itself: you cannot individually flex the joints in the lower limbs (coffin, pastern, and fetlock joints all are involved), and when the hind legs are flexed at the hock, every joint MUST flex (due to the “reciprocal apparatus” which allows the horse to sleep standing up). Nevertheless, many times these “flexions” will help us focus in, or eliminate, areas of interest.
Diagnostic Analgesia (Nerve Blocks):
Nerve or Joint Blocks are often the next step, if a specific cause has not been suggested by observation, examination, and flexion tests. Using lidocaine or carbocaine (injectable numbing or “blocking” medications), we methodically numb the lame leg in order to narrow down the specific source/location of the pain/lameness. Starting “at the ground”, the leg is blocked in segments, working up the limb until the lameness improves dramatically. When that happens, the source of pain must be between the last areas blocked, and we can move on to diagnostic imaging. These blocks can be over nerves or into specific joints, depending on the case. For example, if the entire foot was blocked and the lameness remained, but the horse improved after he was blocked above the fetlock, then the lameness has been isolated to the pastern/ fetlock region, between the blocks.
Diagnostic Imaging, is typically the next step to further define the cause of the pain. Radiographs use x-rays to show abnormalities of bone like fractures, spurs, osteoarthritis, cysts or developmental lesions. At McGee Equine Clinic, we have cutting edge portable digital x-ray technology that allows us to see and evaluate radiographs immediately at your farm. The images can be brightened or darkened, and specific areas of interest or concern can be magnified. We can also email the radiographs to you and/or your farrier if needed. The Doctors at McGee Equine also consult with several renowned equine surgery specialists on complex cases and referral situations.
Soft tissues (tendons, ligaments, internal organs, and sometimes muscle) are evaluated by ultrasound imaging, which uses sound waves. Common injuries include superficial and deep flexor tendons, tendon sheaths, suspensory ligaments, and sesamoidean ligaments. Stifle joints can also be evaluated to some extent, visualizing the patellar and collateral ligaments and meniscal pads. Shoulders, hocks, and other regions may also have soft tissue lesions that can be seen with the ultrasound.
Once the underlying cause of the lameness has been identified, the veterinarians at McGee Equine will work together with you to create an individualized treatment plan for your horse. We offer a wide range of both traditional and advanced treatments, from conservative methods such as time off and anti-inflammatories, to more aggressive approaches such as joint injections, IRAP, PRP, and Extracorporeal Shockwave therapy. In addition to the services that we provide, our veterinarians have great relationships with many other professionals including surgeons and farriers, and encourage a team approach to management.