FAQ – Lameness Exams

What does a comprehensive lameness exam entail? Why can’t HVC vets diagnose what is causing my horse to be lame from my post? How can I get the most information out of the HVC vets from my post? All these questions and more are answered in this file.

Version 1
Standardized Lameness Exam
Objective: a consistent way to evaluate and communicate regarding a lameness typically graded on
a scale of 0-5, 0-8, or 0-10
Procedure: Varies between practitioners, but may include:

1. Static Exam:
   a. evaluation of conformation and posture
   b. palpation: hands on evaluation of the entire horse
   • looking for heat, swelling, tenderness, range of motion (ROM)
   • hoof testers are used to “palpate” the hoof
   • practitioner dependent qualitative exam
   • may indicate inflammation or weakness in hoof capsule
   • Cervical, thoracic, and lumbar regions
   • careful, systematic palpation of muscles, ligaments, and bone
   • practitioner dependent exam – reactivity, flexibility, symmetry, tension, muscle mass
   • extremely variable responses and techniques
   b. ROM: range of motion: from poll to tail and every limb
   c. tack evaluation: saddle, bridle, collar/crupper etc.
2. Dynamic Exam:
   a. walk and trot – in hand – straight line on hard ground
   b. walk trot canter on longe line
   • both directions
   • hard and soft ground
   • large and small circles
   c. flexion tests – in hand –
   • specific joint/limb is flexed for set amount of time
   • horse is trotted off and gait evaluated
   • may involve wedges/boards/special boots for lower limb
   • typically graded 0-5 or 0-10
   d. ridden exam
   • dynamic saddle evaluation
   • evaluate horse movement under saddle
   • repeat 2A and 2B
   • observe special movements (jump, roll-back, pirouette etc)
   • evaluate rider balance, skill, influence
   • ideally observed with both owner/rider and a professional rider
3. Sequential Regional Nerve Blocks:
   a. local anesthetic used to “block” or numb a region
   • targets specific regions to localize pain
   • start low and move up limb (hoof to chestnuts)
   • may also be used to evaluate back pain cases
   • low risk/fairly non-invasive with high yield
   • allows targeted diagnostics
   • not all abnormalities on radiographs/ultrasound cause pain
   • allows diagnostic findings to be linked to pain/lameness
   b. area is prepped, blocked, and gait re-evaluated
   • gait does not improve → move up limb to next level nerve block
   • gait improves in 1st limb, appears in another → block 2nd limb
   • gait improves significantly → proceed to diagnostics
4. Joint Blocks:
   a. similar to nerve blocks
   • anesthetic is injected directly into a joint
   • higher risk, more prep due to possibility of joint infection
   b. used in conjunction with nerve blocks to further localize
   • e.g.: blocks to abaxial nerve block (below fetlock) → block coffin joint or pastern joint to differentiate
   • used to determine if intra-articular therapy will be effective – if anesthetic into the joint does not alleviate lameness → cortisone injected into same joint is unlikely to help
5. Diagnostics:
   a. localize lameness 1st
   b. radiographs evaluate bone, joint alignment, arthritic change
   c. ultrasound evaluates soft tissues: ligament, tendon, t-sheath, joint capsule, periosteum, muscle
   d. advanced options: MRI, CT, Scintigraphy, Pet Scan, Arthroscopy
   e. Lameness Localizer, blood/fluid tests
   
   Lameness Scales:
   
   AAEP: 0-5

• 0 – no perceptible lameness
• 1 – lameness inconsistent or difficult to observe in all circumstances
• 2 – lameness not observed at straight line W/T but consistently observed under special
  circumstances
• 3 – lameness is observable at a trot consistently
• 4 – lameness is observable at a walk consistently
• 5 – horse is reluctant/unable to bear weight on limb in motion or at rest
  UK/Dyson: 0-8
• 0 – not lame
• 2 – mild
• 4 – moderate
• 6 – severe
• 8 – non-weight bearing
  Variation of above: 0-10
  
  For us to best evaluate your horse:
  
• Conformation photos:
  ▪ whole horse:
  i. standing square on level flat ground
  ii. shot from left, right, front, and behind
  iii. hoof shots:
  ▪ standing square on level flat ground (not grass, deep sand etc)
  ▪ level camera to horizon, photo in good light
  ▪ 4 shots of each hoof from the side, front, back AND sole surface
  ▪ please provide shots of paired limb (e.g.: concern is left hind, 8 shots total → 4 from each foot so they may be compared to each other)
• Videos: try to have someone else video – have the whole horse in the video screen, but the
  horse should not be too far away
  ▪ in hand:
  i. straight walk towards & away from camera on flat hard ground
  ii. straight trot towards & away from camera on flat hard ground
  iii. optional:
  ▪ walk and trot up and down shallow slope/hill
  ▪ walk and trot in hand on soft, irregular, or rocky ground
  ▪ on longe line:
  i. walk, trot, canter in both directions, ideally repeated on both hard and soft ground
  ii. 2-3 circles at each speed
  iii. up/down transitions are very helpful
• PLEASE NOTE: if horse is 4/5 lame (visible under all circumstances), PLEASE:
  ▪ Do not proceed beyond in-hand work (walk/trot in a line)
  ▪ Call your DVM
  ▪ You are welcome to post as well but these horses need to be examined ASAP

Version 2

Standardized Lameness Exam
Information compiled by: Dr. Teresa Crocker
Objective: a consistent way to evaluate and communicate regarding a lameness typically graded on
a scale of 0-5, 0-8, or 0-10
Procedure: Varies between practitioners, but may include:

1. Static Exam:
   a. evaluation of conformation and posture
   b. palpation: hands on evaluation of the entire horse
   • looking for heat, swelling, tenderness, range of motion (ROM)
   • hoof testers are used to “palpate” the hoof
   • practitioner dependent qualitative exam
   • may indicate inflammation or weakness in hoof capsule
   • Cervical, thoracic, and lumbar regions
   • careful, systematic palpation of muscles, ligaments, and bone
   • practitioner dependent exam – reactivity, flexibility, symmetry, tension, muscle mass
   • extremely variable responses and techniques
   b. ROM: range of motion: from poll to tail and every limb
   c. tack evaluation: saddle, bridle, collar/crupper etc.
2. Dynamic Exam:
   a. walk and trot – in hand – straight line on hard ground
   b. walk trot canter on longe line
   • both directions
   • hard and soft ground
   • large and small circles
   c. flexion tests – in hand –
   • specific joint/limb is flexed for set amount of time
   • horse is trotted off and gait evaluated
   • may involve wedges/boards/special boots for lower limb
   • typically graded 0-5 or 0-10
   d. ridden exam
   • dynamic saddle evaluation
   • evaluate horse movement under saddle
   • repeat 2A and 2B
   • observe special movements (jump, roll-back, pirouette etc)
   • evaluate rider balance, skill, influence
   • ideally observed with both owner/rider and a professional rider
3. Sequential Regional Nerve Blocks:
   a. local anesthetic used to “block” or numb a region
   • targets specific regions to localize pain
   • start low and move up limb (hoof to chestnuts)
   • may also be used to evaluate back pain cases
   • low risk/fairly non-invasive with high yield
   • allows targeted diagnostics
   • not all abnormalities on radiographs/ultrasound cause pain
   • allows diagnostic findings to be linked to pain/lameness
   b. area is prepped, blocked, and gait re-evaluated
   • gait does not improve → move up limb to next level nerve block
   • gait improves in 1st limb, appears in another → block 2nd limb
   • gait improves significantly → proceed to diagnostics
4. Joint Blocks:
   a. similar to nerve blocks
   • anesthetic is injected directly into a joint
   • higher risk, more prep due to possibility of joint infection
   b. used in conjunction with nerve blocks to further localize
   • e.g.: blocks to abaxial nerve block (below fetlock) → block coffin joint or pastern joint to differentiate
   • used to determine if intra-articular therapy will be effective – if anesthetic into the joint does not alleviate lameness → cortisone injected into same joint is unlikely to help
5. Diagnostics:
   a. localize lameness 1st
   b. radiographs evaluate bone, joint alignment, arthritic change
   c. ultrasound evaluates soft tissues: ligament, tendon, t-sheath, joint capsule,
   periosteum, muscle
   d. advanced options: MRI, CT, Scintigraphy, Pet Scan, Arthroscopy
   e. Lameness Localizer, blood/fluid tests
   Lameness Scales:
   AAEP: 0-5

• 0 – no perceptible lameness
• 1 – lameness inconsistent or difficult to observe in all circumstances
• 2 – lameness not observed at straight line W/T but consistently observed under special
  circumstances
• 3 – lameness is observable at a trot consistently
• 4 – lameness is observable at a walk consistently
• 5 – horse is reluctant/unable to bear weight on limb in motion or at rest
  UK/Dyson: 0-8
• 0 – not lame
• 2 – mild
• 4 – moderate
• 6 – severe
• 8 – non-weight bearing
  Variation of above: 0-10
  For us to best evaluate your horse:

1. Conformation photos:
   ▪ whole horse:
   i. standing square on level flat ground
   ii. shot from left, right, front, and behind
   iii. hoof shots:
   ▪ standing square on level flat ground (not grass, deep sand etc)
   ▪ level camera to horizon, photo in good light
   ▪ 4 shots of each hoof from the side, front, back AND sole surface
   ▪ please provide shots of paired limb (e.g.: concern is left hind, 8 shots
   total → 4 from each foot so they may be compared to each other)
2. Videos: try to have someone else video – have the whole horse in the video screen, but the
   horse should not be too far away
   ▪ in hand:
   i. straight walk towards & away from camera on flat hard ground
   ii. straight trot towards & away from camera on flat hard ground
   iii. optional:
   ▪ walk and trot up and down shallow slope/hill
   ▪ walk and trot in hand on soft, irregular, or rocky ground
   ▪ on longe line:
   i. walk, trot, canter in both directions, ideally repeated on both hard and soft ground
   ii. 2-3 circles at each speed
   iii. up/down transitions are very helpful
3. PLEASE NOTE: if horse is 4/5 lame (visible under all circumstances), PLEASE:
   ▪ Do not proceed beyond in-hand work (walk/trot in a line)
   ▪ Call your DVM
   ▪ You are welcome to post as well but these horses need to be examined ASAP By Dr. Karie Vander Werf