Lameness can range from a subtle, performance limiting problem or very obvious, severe lameness. Interestingly, 95% of forelimb lamenesses will be caused by a problem below the knee level; elbow and shoulder problems are rare.
The causes of hindlimb lameness are more varied and investigation of these cases can be more time-consuming.
Usually the first examination of lameness is at your yard. In cases of severe lameness, we will usually only need to see a few steps of movement from the horse; however, in subtle lamenesses, we will need to see the horse walked and trotted, perform flexion tests, lunge them and sometimes even see them ridden.
If you do not have suitable facilities at home, Ashbrook Equine Hospital has all the facilities required for full lameness investigation including ridden exercise on our purpose built menage. The benefit of clinic based lameness investigations is that all the equipment is to hand, rather than requiring repeated trips to your yard to investigate, nerve block, x-ray or ultrasound scan your horse. This should hopefully provide a quicker route to diagnosis and treatment.
Isolating the Problem
Once the lame leg is established and if there are no obvious symptoms, we will usually require nerve blocks to establish the area causing lameness. Nerve blocks are small injections of local anaesthetic round nerves in the leg. After the injections, the lameness examination is repeated and if the horse has improved sufficiently, we can be sure the lameness originates from the area that has been 'numbed out' by local anaesthetic. If further specificity is required, we can then return later that day, or the following day, once the nerve block has worn off and put local anaesthetic directly into any joints or synovial structures in the area previously isolated.
Once we have established the area causing lameness, we can then image the area to provide a diagnosis, a treatment plan and a prognosis. Usually radiographs (x-rays) are taken using our in-house digital radiography machine (pic of radiograph machine). This allows assessment of the bony structures in the area. Our x-ray machine is ceiling mounted and has enough power to provide great images of necks, spines and upper limb joints. We also have mobile x-ray machines that can be taken to yards for radiographic examinations, providing instant viewing of the image as soon as it is taken.
Often, ultrasound scanning will also be useful as it enables us to assess for tendon or ligament damage or even damage to the surface of bones. We have multiple ultrasound scanners – the machine in hospital provides superior quality images and we also have mobile ones which can be transported for yard-based investigations, and reproductive work.
At Ashbrook Equine Hospital we have a standing Magnetic Resonance Imaging (MRI) unit. This can be used to provide vital information about the small tendon and ligament structures of the lower limb. This is especially important in the foot, where ultrasound cannot visualise through the hard hoof capsule.
Nerve and joint blocks, together with imaging results allows us to formulate a treatment plan. This can be medical or surgical. Medical treatment of lameness involves many different treatments and often we use a combination of these to provide the best result for you and your horse. Lameness problems that require surgical intervention can be operated on in our surgical suite.
Lameness Treatment Options
Medical treatment of lameness includes many different options to choose from. Some of these treatments are only suitable for certain conditions and some of the more costly options will be reserved for cases that have not responded to conventional treatments. We will also consider the whole horse and as such, can recommend remedial farriery, manipulative therapy and joint supplements as required. We will always try to incorporate your wishes, your horses' requirements, competition rules and any financial constraints into the treatment plan.
Non Steroidal Anti Inflamatory Drugs
Although 'bute, danilon or any other oral anti-inflamatories seem very old fashioned treatments, they are immensely beneficial to reduce swelling and pain while a simple injury heals. They may be used as a stand-alone treatment or until other treatments have a chance to improve the lameness.
Conventional Joint Medications
If a lameness has been isolated to a specific joint, we will often inject medications directly into that joint. This form of treatment can be very effective within a short period of time.
We have 2 different types of corticosteroid medication that are commonly used in joint medication. In high-motion joints, like fetlocks and coffin joints, we use a short acting steroid which has less negative effects on the cartilage joint surfaces. In low-motion joints, such as small hock joint pain associated with bone spavin, we will often use a longer acting steroid. This will have some degenerative effects on the cartilage but i mayt be beneficial as, once the cartilage is destroyed, the lameness will resolve. We will usually see a dramatic improvement in lameness within 10-14 days, allowing the horse to quickly return to his normal job.
This is a component of normal joint fluid and by medicating joints with this, you can improve the quality of joint fluid and it also provides some anti-inflammatory action. This is often used in conjunction with corticosteroids to provide the maximum benefit to the affected joint.
Equidronate (formerly tildren)
This drug acts on the damaged bone at the surfaces of arthritic joints by reducing the bone resorption associated with arthritis. It is licensed for bone spavin (hock osteoarthritis) although has been used successfully in a multitude of other conditions. This drug is given as an intravenous infusion and usually takes about 6-7 weeks to show its maximum benefit. If the improvement has only been partial, then it can be repeated at this stage. After that, it should only require repetition at 6-18 monthly intervals.
Extracorporeal Shockwave Therapy
This treatment uses pulsed waves of energy focussed over the area of damaged tissue to stimulate healing and also provide some degree of pain relief. It is most commonly used for proximal suspensory desmitis of the hindlimbs. Most horses do require some sedation for the procedure and it is usually repeated 3 times over a 6 week period.
At Ashbrook Equine Hospital we are also able to offer all the latest biological therapeutics available for lameness treatment. The newest of these is a stem-cell based product which can be injected directly into a joint suffering from early osteo-arthritic changes. This should improve joint health such that the horse's athletic career can continue successfully for longer periods of time.
We also offer biological therapies for tendon and ligament injuries, whereby the agents are injected directly into the problem area to stimulate a better quality healing response.