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Diagnosing Equine Neck Conditions

Munroe recommends a full lameness and a full neurologic examination when evaluating a horse with a potential neck problem.

Photo: Stephanie L. Church, Editor-in-Chief

Editor's Note: This article is part of TheHorse.com's ongoing coverage of topics presented at the British Equine Veterinary Association's 51st annual Congress, held Sept. 12-15 in Birmingham, U.K.


When your horse's performance is not quite up to par--his stride is short, he lacks his usual impulsion, and he's reluctant to bend--you might instinctively call up your veterinarian and inquire about a lameness exam. However, a neck condition might actually be the root cause.

"Neck conditions have a wide variety of clinical signs which may overlap in individual cases and make differential diagnosis difficult," said Graham Munroe, BVSc(Hons), PhD, CertEO, DESM, Dipl. ECVS, FRCVS, of Flanders Veterinary Services, in Scotland. He discussed how to best pinpoint different equine neck problems at the British Equine Veterinary Association's 51st annual Congress, held Sept. 12-15, in Birmingham, UK.

The many clinical signs of neck conditions are not black and white and can include neurologic signs, neck pain, and forelimb lameness. Munroe stated that horse owners often initially present their horses for reasons such as poor performance, fore- or hind limb lameness, weakness, toe dragging, abnormal head carriage, lack of neck bend, or having the neck stuck in a fixed low position.

Adding to the diagnostic challenge, Munroe explained that neck conditions can be complicated by other concurrent orthopedic problems (e.g., low-grade hind limb lameness, back or pelvic problems) or neuromuscular disease, confused with rider issues (e.g., lack of riding ability, excessive expectations), or due to a horse's young age (e.g., poor muscling, behavioral problems). Thus, when he examines a horse with a potential neck problem, he conducts a full clinical examination, including:

  • Assessing head/neck posture, conformation, and musculature, noting atrophy (wasting) or overdeveloped muscles in any area;
  • Palpating the neck for signs of heat, pain, and swelling;
  • Performing neck movement tests to determine flexion and range of motion;
  • A full lameness examination; and
  • A full neurologic exam.

He notes that diagnostic imaging such as radiography (X ray), scintigraphy (bone scan), ultrasonography, thermography, and possibly computed tomography are all helpful in trying to identify a neck problem's specific cause, what treatment could be effective, and the horse's likely long-term prognosis.

Depending on the horse's clinical signs (forelimb lameness, neck pain, neurologicl signs, etc.) Munroe narrows down the list of possible neck problems into the most likely causes for each case. For instance, neck conditions veterinarians and owners should consider with signs of forelimb lameness include:

  • Localized muscle soreness, which Munroe said can result from an asymmetrical rider, poor equipment fit, a fall, or pulling against restraints;
  • Osteoarthritis of the small articular joints in the neck (facet joints);
  • Cervical vertebrae fracture;
  • Tumors of the vertebrae, muscles, or ligaments ;
  • Cystlike lesions in the cervical vertebrae;
  • Borrelia burgdorferi, the causative bacteria of Lyme disease; and
  • Nerve root injury associated with first rib trauma or abnormalities.

If the horse shows signs of neck pain, Munroe suggested veterinarians and owners consider:

  • Trauma to the soft and/or bony tissue of the neck or poll;
  • Inflammatory disease such as lymph node or muscle abscessation, muscle damage, spinal nerve impingement, or damage to the jugular vein;
  • Degenerative conditions such as osteoarthritis of the cervical facet joints or rarely, disc disease between the neck vertebrae; and
  • Rarely, tumors within the neck.

With neurologic signs related to the neck region, consider causes such as:

  • Equine herpesvirus;
  • West Nile virus;
  • Cervical vertebral compressive myelopathy (also called Wobbler syndrome);
  • Vertebral trauma;
  • Liver failure;
  • Tumors of the nervous system; and
  • Equine degenerative myelopathy.

With this long list of potential causes and the complicated signs of neck conditions, Munroe said it's essential that owners and their veterinarians always consider neck problems when confronting poor performance, gait changes and lameness, weakness, and abnormal head carriage and neck positions. He added that neck-related conditions appear to be more common than ever and are being increasingly diagnosed in young as well as older animals, particularly Warmblood breeds.

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