Lameness diagnosis and treatment

Foundation of diagnosis.1

The ultimate goal of diagnosis is to identify the site/sites that is/are painful and to best characterize the location and severity of injury. This helps veterinarians render an accurate prognosis to institute the best treatment for the horse and client.

These are the clinical lameness examination approaches and diagnostic imaging modalities of the limbs that are commonly performed in practice.



Diagnostic lameness evaluation will vary based on clinical presentations.1

Clinical examination
  • The cornerstone for appropriate diagnosis of equine musculoskeletal issues
  • Veterinarians need to be able to:
    1. Recognize abnormal findings on visual and physical examination
    2. Understand the influences of various conformational abnormalities on the horse's capacity to fulfill its function
    3. Recognize if a horse is lame and in which leg or legs the horse is lame
    4. Grade the degree of lameness consistently for comparison with examination findings after diagnostic analgesia is used, and for follow-up assessment exams
    5. Recognize pain in the upper body (neck, back, and pelvis), which may not lead to overt lameness but rather to poor performance
Lameness examination phase 1:
Conformation evaluation
  • Both experience and science play a role
  • The horse should be evaluated from all sides and characterized in light of the intended use
  • The degree of pain on palpation and with flexion of joints; subjectively graded as normal, mild, moderate, or severe
Lameness examination phase 2:
Static examination
  • Hoof testers should be applied to the feet, especially around the nail holes, sole, frog, and hoof wall
  • The hoof capsule should be statically examined for conformation and coronary band characteristics
  • Wear pattern of the shoe should be characterized
  • Digital pulse should be appreciated both before and after walking and trotting
  • Joints and tendon sheaths should be palpated
  • Synovial effusion should be differentiated from joint capsule or tendon sheath thickening
  • Muscle symmetry should be appreciated
  • Soft tissues and bones should be palpated to determine geometry and pain
Lameness examination phase 3:
Dynamic examination
  • The clinician should observe the horse from the front, back, and sides
  • The horse should be initially walked to evaluate hoof landing and limb movement
  • Stride length and the cranial and caudal phase of the stride should be characterized
  • A neurologic assessment should be made
  • Walk the horse on both hard and soft footing to see if any change in limb use can be appreciated
  • Limb movement and lameness in the horse are best characterized at the trot
Diagnostic analgesia
  • In most cases, it is best to use diagnostic analgesia to further characterize the site(s) of pain
  • After use, lameness is recharacterized at different time intervals
Imaging modalities
  • Radiography - for diagnosis of bone problems
  • Ultrasound - Used for the diagnosis and definition of tendon injury and ligamentous injury
  • Nuclear Scintigraphy - Indications for skeletal nuclear scintigraphy as a diagnostic aid are numerous; a sensitive diagnostic tool for athletic injury, used to confirm clinical suspicion of disease
  • Computer Tomography and MRI - allow the earlier diagnosis of injuries that may not be identified using standard imaging modalities; the strengths and weaknesses of each must be considered
    • CT has superior bone detail, but MRI is the only modality that can definitively identify fluid in bone, which is frequently present with certain types of joint injury

Treatment options

Once the trauma-related joint disease has been definitively diagnosed, a treatment regimen is established based upon the specific patient. Pharmaceutical treatment options may include nonsteroidal anti-inflammatory agents, corticosteroids such as BetaVet®, hyaluronic acid, and an FDA-approved polysulfated glycosaminoglycan (PSGAG), Adequan® i.m.

The only dual-action injectable corticosteroid approved by the FDA.

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ABOUT BETAVET®

The only FDA-approved equine PSGAG joint treatment.

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ABOUT ADEQUAN® i.m.

BetaVet® (betamethasone sodium phosphate and betamethasone acetate injectable suspension)
For Intra-articular (I.A.) use in Horses.
INDICATIONS: BetaVet® (betamethasone sodium phosphate and betamethasone acetate injectable suspension) is indicated for the control of pain and inflammation associated with osteoarthritis in horses.
IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS: BetaVet® is contraindicated in horses with hypersensitivity to betamethasone. Intra-articular injection of corticosteroids for local effect is contraindicated in the presence of septic arthritis. WARNINGS: Do not use in horses intended for human consumption. Clinical and experimental data have demonstrated that corticosteroids administered orally or parenterally to animals may induce the first stage of parturition when administered during the last trimester of pregnancy and may precipitate premature parturition followed by dystocia, fetal death, retained placenta, and metritis. Additionally, corticosteroids administered to dogs, rabbits and rodents during pregnancy have resulted congenital anomalies. Before use of corticosteroids in pregnant animals, the possible benefits should be weighed against potential hazards. Human Warnings: Not for use in humans. Keep this and all medications out of the reach of children. PRECAUTIONS: Corticosteroids, including BetaVet®, administered intra-articularly are systemically absorbed. Do not use in horses with acute infections. Acute moderate to severe exacerbation of pain, further loss of joint motion, fever, or malaise within several days following intra-articular injection may indicate a septic process. Because of the anti-inflammatory action of corticosteroids, signs of infection in the treated joint may be masked. Due to the potential for exacerbation of clinical signs of laminitis, glucocorticoids should be used with caution in horses with a history of laminitis, or horses otherwise at a higher risk for laminitis. Use with caution in horses with chronic nephritis, equine pituitary pars intermedia dysfunction (PPID), and congestive heart failure. Concurrent use of other anti-inflammatory drugs should be approached with caution. Consider appropriate wash out times prior to administering additional NSAIDs or corticosteroids. ADVERSE REACTIONS: Adverse reactions reported during a field study of 239 horses of various breeds which had been administered either BetaVet® (n=119) or a saline control (n=120) at five percent (5%) and above were: acute joint effusion and/or local injection site swelling (within 2 days of injection), 15% BetaVet® and 13% saline control; increased lameness (within the first 5 days), 6.7% BetaVet® and 8.3% saline control; loose stool, 5.9% BetaVet® and 8.3% saline control; increased heat in joint, 2.5% BetaVet® and 5% saline control; and depression, 5.9% BetaVet® and 1.6% saline control.
SHAKE WELL IMMEDIATELY BEFORE USE. For additional safety information, please see full prescribing information.
CAUTION: Federal law restricts this drug to use by or on the order of a licensed veterinarian.
1. McIlwraith CW, Frisbie DD, Kawcak CE, van Weeren PR. Joint Disease in the Horse. St. Louis, MO: Elsevier, 2016; 119-133.

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