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Musculoskeletal examination, often referred to as a lameness exam, is conducted by a thorough evaluation of the horse’s clinical history, conformation, physical examination and gait. The history is reviewed with the rider and we check the horse for obvious problems with conformation. We like to evaluate the horses gait at hand and while the horse is lunged or worked under saddle. Palpation of the limbs, joints, back and neck are important as they allow us to look for pain, inflammation, and range of motion. Hoof testing is performed to test for pain or inflammation in the hoof. Flexion tests are an important part of the musculoskeletal exam as they stress various joints of the body and often help identify subtle lameness. On horses that are significantly lame, we often choose not to exercise the horse until we have examined the horse at rest so that we don’t exacerbate a serious injury.
Frequently with lameness associated problems, we will further localize a problem by using diagnostic nerve or joint blocks to de-sensitize a painful area. This allows us to confirm the location of the problem. Once we have an area localized, we often used radiology or ultrasound to better define the problem and help formulate a therapy that is right for the patient. In some cases, horses may be referred for nuclear scintigraphy or MRI imaging to assist with the diagnosis.