Current Trends and Approaches in Lameness Diagnosis

At the AAEP Blue Ribbon Panel Research meeting, in Ft. Collins, Colo., Andy Bathe, MA, VetVMB, DEO, Dipl. ECVS, MRCVS, of Rossdale & Partners in the United Kingdom, spoke on improvements in technology to aid in lameness diagnosis. He said lameness is the most important cause of wastage in the equine industry.

Diagnostic techniques are often subjective and based on practitioners' experience, and Bathe speculated whether gait analysis could become more objective in its application to lameness.

When using diagnostic nerve blocks, he said it is important to record findings and data as one progresses through the exam. With the advent of digital radiography, there is improvement in radiographic quality, but he expressed concern that technique is still the most important factor, and technique is dependent on veterinarian skill and understanding of the areas being imaged. However, digital ultrasound equipment is able to image more structures than ever before, so operator proficiency to acquire good images is not as crucial as in previous decades.

In reviewing other diagnostic tools, Bathe recommended nuclear scintigraphy as an excellent technique for identifying suspected fractures, but it should not be used as a "black box" to evaluate a low-grade lameness. Rather, the lameness should be worked up in a systematic manner with a thorough clinical exam, diagnostic nerve blocks, and radiology and/or ultrasound as appropriate. Any images obtained through high-tech equipment must be correlated with the horse's clinical presentation.

Bathe said magnetic resonance imaging (MRI) has revolutionized foot diagnostics; however, it is easy for images to be over-interpreted. He urged accurate localization of the pain-causing area first, then the significance of imaging studies is corroborated with the clinical exam.

Computed tomography (CT) scans are feasible in the standing horse for the head, but limb studies require general anesthesia.

Endoscopy requires general anesthesia and is indicated for persistent pain in synovial structures, such as joints or tendon sheaths.

Bathe examined three different approaches to lameness diagnostics:

  • Sequential Start Begin at the bottom of the limb and work up with diagnostic nerve blocks, followed by imaging of localized areas of concern.
  • Targeted Pick Select the most likely location that could cause the lameness and pursue imaging diagnostics in that area
  • Survey Attack Examine both ends of the horse from head, neck, forelimb, and pelvis, then perform diagnostic nerve blocks after imaging all areas.

Bathe concluded that our understanding of lameness conditions has improved dramatically with improved imaging techniques, and we should implement advanced technology to improve our basic techniques. He stressed it is important to determine the significance of clinical presentation as it relates to imaging findings. The weakest link in work-up is the interpretation of findings.

In the future, there might be opportunities for more genetic profiling to determine heritability of musculoskeletal disease. We continue to learn from MRI studies, and it would be beneficial to improve epidemiology by looking at our data that is readily available. In addition, more evidence-based medicine in diagnostics can be used to integrate clinical and objective data.

About the Author

Nancy S. Loving, DVM

Nancy S. Loving, DVM, owns Loving Equine Clinic in Boulder, Colorado, and has a special interest in managing the care of sport horses. Her book, All Horse Systems Go, is a comprehensive veterinary care and conditioning resource in full color that covers all facets of horse care. She has also authored the books Go the Distance as a resource for endurance horse owners, Conformation and Performance, and First Aid for Horse and Rider in addition to many veterinary articles for both horse owner and professional audiences.

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