In looking back on 45 years of evaluating lameness in the horse, I feel we have not had enough information available to really make a diagnosis in some cases. Historically, I believe veterinarians have been pressured to give opinions based on insufficient information. I base that opinion on what I see evolving with technology and procedures that are expanding the ability to more fully evaluate the situation.
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Expectations of horse owners have been part of the problem. An anxious owner of a lame horse wants an answer to the problem sooner rather than later. Oftentimes, I have been at a roping or rodeo, and someone will want me to “look” at their “sore” horse and give them a diagnosis. There are times when that is certainly possible. An obvious ringbone, a swollen and painful tendon, or an abscess in the sole of the foot can be diagnosed on the spot. However, the more subtle or vague lameness problems may require a succession of diagnostic procedures to come up with a substantive diagnosis.
When I graduated from veterinary school, we had basically three modalities to work with in evaluating a lameness. They included a basic physical examination, diagnostic nerve blocks to localize the area or source of pain, and radiographs to evaluate bone pathology. Those three areas are still critical in lameness evaluation today, and they are often all that is needed.
But with advances in new techniques, we become aware that further diagnostics can be indicated to truly evaluate a situation. Ultrasound imaging of structures such as suspensory ligaments, tendons and soft tissue components of joints are examples not only of diagnosing problems more correctly, but can be used in evaluating the healing process to help decide when a horse can go back to work.
Another example I see evolving as a diagnostic aid is the use of the arthroscope. In some of the larger joints, such as the stifle, arthroscopic examination is the ultimate means to accurately evaluate the condition. The procedure also has the advantage of allowing sometimes curative surgical corrections to be done at the same time. Other imaging techniques, such as MRI and CAT scans, are also becoming available in the equine field.
Great strides are being made in the ability to more fully evaluate soundness problems in the horse. Rely on your veterinarian to advise as to when these procedures may be indicated.