Changes

Lameness can be caused by '''trauma, congenital or acquired abnormalities, infection, metabolic disturbances, circulatory and nervous disorders''', or a combination of these.

Lameness can be caused by '''trauma, congenital or acquired abnormalities, infection, metabolic disturbances, circulatory and nervous disorders''', or a combination of these.

Lameness results from '''painful''' and non-painful alterations in gait, called '''mechanical lameness''' or lameness resulting from neurologic dysfunction.

Lameness results from '''painful''' and '''non-painful''' alterations in gait, called '''mechanical lameness''' or it may result from neurological dysfunction.

The diagnosis of lameness requires a detailed knowledge of anatomy, a thorough history and clinical examination and the use of further diagnostic tests.

The diagnosis of lameness requires a detailed knowledge of anatomy, a thorough history and clinical examination and the use of further diagnostic tests.

==The lameness examination==

==The Lameness Examination==

===History===

===History===

A comprehensive history including age, type and training regimen may give important clues as well as the time of onset of the lameness and the management up to now. Any '''farrier work''' should be noted and any periods when the lameness seems to worsen or improve.

A comprehensive history including age, type and training regimen may give important clues as well as the time of onset of the lameness and the management up to now. Any '''farrier work''' should be noted and any periods when the lameness seems to worsen or improve.

Response to anti-inflammatory medication might also be useful information.

Response to anti-inflammatory medication might also be useful information.

'''Haematology and biochemistry''' analyses might indicate problems that influence overall performance such as anaemia or raised AST and CK indicating rhabdomyolysis.

'''Haematology and biochemistry''' analyses might indicate problems that influence overall performance such as [[:Category:Anaemia|anaemia]] or raised AST and CK indicating [[Equine Rhabdomyolysis|rhabdomyolysis]].

===Clinical examination and palpation===

===Clinical Examination and Palpation===

Thorough '''palpation and manipulation''' of limbs in weightbearing and non-weightbearing positions should be undertaken. The contralateral limbs probides a useful comparison in most cases.

Thorough '''palpation and manipulation''' of limbs in weightbearing and non-weightbearing positions should be undertaken. The contralateral limbs provides a useful comparison in most cases.

Any '''heat, joint distension, abnormal tissue tension''' and the reaction of the horse to '''joint flexion and extension''' should be noted.

Any '''heat, joint distension, abnormal tissue tension''' and the reaction of the horse to '''joint flexion and extension''' should be noted.

The '''back and neck''' should be examined with the horse standing square. The neck should be assessed for range of movement and the musculature of the neck and back should be equal on either side.

The '''back and neck''' should be examined with the horse standing square. The neck should be assessed for range of movement and the musculature of the neck and back should be equal on either side.

===Gait evaluation===

===Gait Evaluation===

This is only an option if the lameness is '''minor and chronic'''. Horses with an acute and major lameness should undergo radiographs or ultrasonography as soon as possible.

This is only an option if the lameness is '''minor and chronic'''. Horses with an acute and major lameness should undergo radiographs or ultrasonography as soon as possible.

The horse is trotted back and forth in a straight line and lunged on hard and soft surfaces. Visual appraisal of the lameness should be possible, and impact sounds and footfall should be listened for.

The horse is trotted back and forth in a straight line and lunged on hard and soft surfaces. Visual appraisal of the lameness should be possible, and impact sounds and footfall should be listened for.

===Flexion tests===

===Flexion Tests===

These are useful to assess the '''range of movement and response to passive flexion''', along with any increase in lameness or onset of lameness following flexion. The distal leg should be flexed independently of the carpus and hock in the first instance, then a more proximal flexion test can be performed.

These are useful to assess the '''range of movement and response to passive flexion''', along with any increase in lameness or onset of lameness following flexion. The distal leg should be flexed independently of the carpus and hock in the first instance, then a more proximal flexion test can be performed.

The test should be consistently applied using the same handler and surface.

The test should be consistently applied using the same handler and surface.

===Ridden examination===

===Ridden Examination===

This is often necessary in '''subtle lameness cases or multi-limb lamenesses'''. Minor signs might include aversion to certain movements, a slight head tilt, tail swishing. Different riders might have to be used due to different riding styles which might mask or accentuate a lameness.

This is often necessary in '''subtle lameness cases or multi-limb lamenesses'''. Minor signs might include aversion to certain movements, a slight head tilt, tail swishing. Different riders might have to be used due to different riding styles which might mask or accentuate a lameness.

===Neurological examination===

===Neurological Examination===

Some lameness might be due to peripheral nerve dysfunction and a neurological examination should be performed during a lameness evaluation.

Some lameness might be due to peripheral nerve dysfunction and a neurological examination should be performed during a lameness evaluation.

The horse can be asked to execute complicated movements such as turning in small circles, backing and hopping on one forelimb. This helps evaluate for '''reduced proprioception, weakness and spasticity'''.

The horse can be asked to execute complicated movements such as turning in small circles, backing and hopping on one forelimb. This helps evaluate for '''reduced proprioception, weakness and spasticity'''.

==Diagnostic analgesia==

==Diagnostic Analgesia==

This is an important component of the lameness examination if the site of pain is uncertain. It involves infiltration of an area with '''local anaesthetic''' and further evaluation of gait to see if an improvement in the lameness has occurred. It should not be used in cases of suspected fracture as the horse might bear more weight on the limb and exacerbate the condition.

This is an important component of the lameness examination if the site of pain is uncertain. It involves infiltration of an area with '''local anaesthetic''' and further evaluation of gait to see if an improvement in the lameness has occurred. It should not be used in cases of suspected fracture as the horse might bear more weight on the limb and exacerbate the condition.

Cases in which diagnostic analgesia is useful include: foot pain, navicular disease, joint disease and proximal suspensory desmitis.

Cases in which diagnostic analgesia is useful include: foot pain, [[Navicular Disease|navicular disease]], joint disease and proximal suspensory desmitis.

===Perineural analgesia===

===Perineural Analgesia===

This should '''start distally and work proximally''' until a response is seen.

This should '''start distally and work proximally''' until a response is seen.

Commonly performed blocks include: palmar/plantar digital nerve block, abaxial sesamoid nerve block, low 4-point/6-point nerve block, subcarpal/subtarsal nerve block and more proximal blocks.

Commonly performed blocks include: palmar/plantar digital [[Specific Nerve Blocks|nerve block]], abaxial sesamoid nerve block, low 4-point/6-point nerve block, subcarpal/subtarsal nerve block and more proximal blocks.

===Intrasynovial analgesia===

===Intrasynovial Analgesia===

This may start proximally if indicated, as distal analgesia can still be performed if necessary.

This may start proximally if indicated, as distal analgesia can still be performed if necessary.

Joints blocked most commonly include: coffin, fetlock, carpal, tarsal and stifle joints.

Joints blocked most commonly include: coffin, fetlock, carpal, tarsal and stifle joints.

==Imaging techniques==

==Imaging Techniques==

Many different techniques can be used to evaluate areas of interest.

Many different techniques can be used to evaluate areas of interest.

[[Category:To Do - Helen]]

[[Category:To Do - Helen]]