Dr. Mark Martinelli of California Equine Orthopedics examines and treats sport horses, oftentimes discovering neck problems as the culprit for a variety of unsoundness in the limbs.
The third is the horse with what Dr. Martinelli terms
“connection issues.” “Sometimes they’re not even lame,” he says. “But the rider will say that the horse is losing its hind end or perhaps they are seeing obscure lamenesses that come and go or migrate from one limb to another.” Dr. Martinelli likens it to lengths of network computer
cable—the longer the cable, the more difficulty there can be getting information from one end to the other. “That’s what I think is happening with some of the horses with neck issues,” he says. “They’re sending the signal through to the hind legs, and it has to go so far that sometimes the signal doesn’t get through properly. The results can be that the horse loses its hind end, he can stumble, and it may eventually lead to some lame- ness issues.” When riders experience this type of lameness, often
they treat it as a lower-limb problem. Because it’s inter- mittent, the rider and even a veterinarian may think the problem has been solved. But Dr. Martinelli says with these cases, the lameness will keep recurring until the neck is treated. Because bone scans show “hot spots” where activity is
occurring, they can help veterinarians pinpoint which facet joint in the neck is causing the problem. Horses have seven vertebrae in their neck, with the one at the poll designated as C1 and the one at the shoulder as C7. The facet joints are between the vertebrae. Neck problems can be particularly tricky because they
can develop over time, often without an incident or injury that definitively caused it. Dr. Martinelli theorizes that young horses playing in a pasture as they grow up could injure their necks slightly without anyone realizing it. “I’m not saying they should be raised in any other way because that’s the best way to raise a Warmblood, on a pasture the way they do it in Europe,” Dr. Martinelli empha- sizes. “But young horses can injure their neck at that time and not show any clinical signs.” Years later, those injuries may start causing other prob-
lems. The time of onset tends to be much later in Warm- bloods than in some other breeds, such as Thoroughbreds.
38 November/December 2013 Dr. Martinelli says that Thoroughbred racehorses usu-
ally develop neck problems at 18 months to two years of age. That’s when racehorses are broken, receive their early training and begin to race. Warmbloods, usually not put under saddle and training that early, correspondingly don’t manifest neck problems until years later, and then it can depend on their discipline. “Usually, it will be between five and eight for a jumper
and between seven and ten for a dressage horse,” says Dr. Martinelli. “I think it’s because of how they have to use their necks. The dressage horses technically shouldn’t be using their necks much until they get to second level. So they are going to be older when they start to use their neck.” Dr. Martinelli doesn’t believe that these disciplines cre-
ate neck problems. Rather, what jumping and dressage maneuvers require of a horse will exacerbate any problem that already exists. “We tend to see these things when horses are going over higher fences and higher levels of competition within dressage,” he says. “Both of those will ask for neck flexion, extension and movement.”
Tricky Business Because of the distance between the neck and the legs, it can be very difficult to figure out where to treat the horse to solve the problem. This is where radiographs and bone scans can help because they can indicate where the abnor- malities are within the neck. But it isn’t always that simple. Sometimes something
that shows up on a radiograph or bone scan may not have any clinical significance. And, of course, the horse cannot tell us when and where it hurts. Dr. Martinelli says that in his experience, most of the
problems occur in facet joint C6-7 (between C6 and C7). But in many cases, he has had more dramatic improvement when treating both C6-7 and C5-6. “If we do a bone scan and see only a hot spot at C6-7,
we’ll usually just treat that facet joint,” he says. “But in most cases, there is a gradation going up the cervical spine, with C6-7 being most active on the bone scan, although an in-
Photos courtesy Dr. Mark Martinelli
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