Covid-19 (Coronavirus) – an update for our clients

Lameness

Our orthopaedic team take a modern approach to diagnosing equine lameness, using evidence based medicine, working with our clients to achieve the best desired outcome. With portable equipment, purpose-built facilities and many years of experience, clients trust Towcester Equine Vets to keep their horses healthy.

Our lameness and performance examinations

Certain lameness’s present in a recognisable and repeatable manner, however a complete and thorough clinical examination is carried out which involves the following;

  • The horse is walked and trotted in a straight line, assessing movement in front and behind and evaluation of footfall, movement and straightness.
  • All 4 limbs undergo a flexion test. Our vets use this technique to identify subtle lameness and to help isolate the affected region.
  • Lungeing on a hard and soft surface – this allows the vet to assess your horse’s movement on a circle and on different surfaces. Usually, when the affected limb is on the inside of the circle the lameness is observed as being worse.
  • Examination under saddle – Certain, specific lameness’s and poor performance problems are exacerbated when the horse is ridden. In this way the vet is able to observe changes in head carriage, poor upward/downward transitions or tail swishing through transitions.

Please note, this type of examination is not always appropriate for horses who are non weight bearing lame, unhandled or un-broken. If you horse is lame, call the clinic on 01327 811007 to discuss your case needs with a member of our orthopaedic team.

Full lameness and performance workups will need to be completed at one of our equine practices. We have the appropriate facilities at both our Towcester and Onley practices including access to a large treatment room, a separate X-ray room, suitable hard and soft surfaces for lungeing and also an area for trot-ups and flexion tests.

We are happy for owners to be part of the lameness/performance assessment however, if work or other commitments do not allow this, our nursing team are more than happy to ride on your behalf for the ridden assessment. We have a selection of competent, sensitive riders who help the vets to assess the horse’s gait whilst under saddle. These assessments can be recorded.

Estimating the length or cost of complex lameness evaluations is difficult as each case requires a tailored approach, however estimates can be provided as a guideline. To discuss insurance further, please call our clinic and ask to speak to Emma Haywood who leads our insurance department.

 

Diagnosing the cause of lameness

Nerve blocks may be used as part of the lameness examination in order to help isolate the site of pain which involves injections containing short acting local anaesthetic. These are administered by the vet at specific anatomical points on the limb, usually around a joint or soft tissue structure. As the nerve block takes effect the horses will not ‘feel’ pain and appear more clincially sound when re-evaluated. This helps to localise where the pain originates from, after which further diagnostic imaging can be carried out.

Digital radiography captures bony changes or lesions in the limb, whereas ultrasound is used to examine soft tissue structures. Coupled with clinical presentation, the vet is able to ascertain the overall picture and be able to discuss and formulate a treatment plan for your horse. In some instances more advanced imaging may be required and a member of our orthopaedic team may choose to refer your horse to a referral level hospital.

MRI scans can be useful particularly for foot related problems, and scintigraphy scans (bone scan), can help in complex lameness, poor performance, neck and back pain cases where ‘hot spots’ associated with pain are localised. Towcester Equine Vets has built up good relationships with numerous referral clinics over the years, and our reception team will be happy to help to organise the referral on your behalf.

 

Lameness in the dressage horse

Dressage combines balance, suppleness and power and is considered to be an incredibly demanding athletic test for the horse. As horse and rider move up the levels, the horse must improve its collection and lateral movements. This places additional pressure on the hindlimbs to allow more airborne movement through the forelimbs. Lateral and twisting movements also place unnatural strains on the spine, pelvis and joints, resulting in an increase in poor performance cases for these athletes.

 

Lameness in the showjumper

Showjumping requires explosive power with a meticulous athleticism. Often, poor performance is the first sign that your showjumper may be suffering with a low-grade lameness, as well as other issues which may include dental problems or equine gastric disease. Resistance on one rein, uncharacteristic stopping or rushing at the fences are early signs that there might be a problem and we recommend that you contact your vet if you are experiencing any decreased performance with your horse. We understand that riders know their horses best so we ask you to be vigilant with performance/behavioural changes, ensuring that your athlete is always in top condition.

Take a look below at the common causes of lameness:

 

Common conditions causing lameness

  • Proximal Suspensory Desmitis (PSD) – affecting both forelimbs and hindlimbs and often appears bilaterally. Rquires specific nerve blocks alongside ultrasound imaging of the affected area. There is a high risk of injury recurrence where PSD in hindlimbs is observed copared to forlelimb PSD which has a better prognosis.
  • Suspensory branch lesions – ultrasound (US) scanning is used to image and evaluate the suspensory branch and its link to the proximal sesamoid bone. Treatment of these cases involves a combination of rest, shockwave therapy and a graduated exercise programme. Our orthopaedic team can help to formualte this with you and your instructor.
  • Coffin joint pain – unfortunately these cases are common across many sports horse disciplines. The coffin joint is situated between the pedal bone and pastern bone and is often successfully treated with joint medication and remedial farriery. The coffin joint communicates directly with the navicular bone and the tendons inside the hoof capsule. Gold standard diagnostic imaging involves MRI imaging, evaluating bony and soft tissues structures in the foot. This allows for quick and effective diagnosis followed by precise treatment.
  • Desmitis of the accessory ligament of the deep digital flexor tendon – often referred to as the ‘check ligament’ this lameness often presents with sudden onset and is commonly found in horses that overextend the knee. These cases tend to resolve using conservative management for an extended period of time however, prognosis is guarded.
  • Distal hock joint pain – hock joint pain often presents bilaterally, sometimes in conjunction with SI (sacroiliac) pain. Shortened strides, reluctance to work in an outline/engage from behind, or toe-dragging may be suggestive of hock pain. Management of these cases involves nerve blocks, digital radiography and if indicated; medicating of the affected joints.
  • Middle carpal joint/ knee pain – young horses that struggle with balance and synchronised paces may struggle with this problem. These cases resolve well with joint medication and a specifically tailored exercise programme.
  • Fetlock joint pain – this problem is common in sport horses competing in both dressage and showjumping. Fetlock joint pain is caused by inflammation within the fetlock joint or the sesamoid bones at the back of the joint.
  • Palmar/plantar annular ligament desmitis and tenosynovitis of the digital flexor tendon sheath – these cases usually present as sudden onset lameness. Cases can be treated medically but some do require surgical intervention. This depends on the outcome of specific nerve blocks and ultrasonography evaluation. Our orthopaedic team will be able to discuss this further with you.
  • Stress fractures of the cannon bone – these fractures can occur in young horses but with the correct treatment and management moving forward, there is usually a fair prognosis for return to work.
  • Back and sacroiliac pain – these are frequent causes of poor performance in dressage horses but usually occur secondary to lameness. Sacroiliac (SI) pain often is found hand-in-hand with hock pain, and so a full lameness evaluation is recommended.
  • Stifle pain – this is often caused by arthritic changes in one of the three stifle joints or an injury affecting the cruciate ligament or cartilage. These cases are usually treated with rest and joint medication, however in some instances, surgical intervention is needed.
  • Croup & hip region pain – This usually originates from inflammation of the hip joint or a muscle strain in the gluteal muscle group. This can present as the primary problem however, often it is secondary to lameness issues. Our team will work alongside your physiotherapist to create a specific treatment plan for your horse to follow.
  • Osteoarthritis or trauma of pastern joint – the pastern joint is put under significant strain whilst jumping so these problems can occur commonly. This first present as stiffness and we may also find damage to the ligaments surrounding the sesamoid bones upon further diagnostic imaging.
  • Cervical osteoarthritis/pain – this can present as generalised neck pain, reduction in performance, trouble bending or stumbling when ridden. Forelimb lameness can also contribute to neck pathology. Cases require radiographic evaluation of the cervical vertebrae and ultrasonography of the associated facet joints.

Our orthopaedic team can work closely with your farrier and physiotherapist to provide your horse with the best chance of returning to work. During the admission process you will be asked for details about the external professionals which you use. Please remember to arrive with your horse’s passport, their details and your insurance documents (if relevant).

 

Joint Injections

Joint injection, involving medicating the joint capsule, is a clinically sterile procedure and has many benefits. Joint medication will often be used as a response to arthritic changes in the joint or to reduce joint inflammation/soft tissue swelling. Where possible, we always try to complete these procedures in clinic as the affected joint requires meticulous aseptic preparation.

Osteoarthritis is the most common indication to medicate a horse’s joint. There are a number of different drugs that our orthopaedic team may choose to use; each preparation is slightly different. Some of the therapies available are listed below:

Corticosteroids are anti-inflammatories which cause a rapid and significant reduction in pain. Historically, corticosteroid use has been controversial due to negative effects associated with high doses used in the past. One possible side effect is the occurrence of steroid-induced laminitis. However, clinical trials have shown the risk of this at therapeutic doses is very small. Our team are careful to stay within the safe dose range and will always advise clients of the risks of any treatment option before proceeding under owner consent.

Aquamid is a substance that was founded in the human medicine market. It has proven to have positive effects in equine joints and has grown in popularity over the last few years. This silicone-based substance is injected into the joint capsule where it acts as a supportive, cushioning lining to the joint.

Hyaluronic acid is a naturally occurring substance within joints which can be produced synthetically. It acts as a lubricant but also has anti-inflammatory and cartilage-protecting effects.

Platelet-Rich Plasma (PRP)  is produced by processing blood to increase the number of platelets. Platelets release growth factors so PRP is often used to promote repair of soft tissue injuries. PRP can be harvested from your horse’s blood and processed in clinic whilst you wait.

Stem Cells mesenchymal stem cells can mature and differentiate to become bone, tendon, and cartilagenous cells and are used via injection to promote, repair and regenerate tissue following injury. Arti-Cell Forte which is a synthetically produced stem cell that comes ready prepared for injected into the joint or soft tissue structure.

Polysulphated Glycosaminoglycans  (PSGAGs/AdequanTM) and  Pentosan Polysulphate  (CartrophenTM) reduce cartilage damage and have anti-inflammatory properties. They can be injected into joints but are more commonly used as intra-muscular injections.

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