vet focus
Examination and treatment of acute lameness is often multifactorial and it may take some time to establish the cause of the problem
Case study
During this first assessment it is important to provide the vet with a good history of the horse, which will vary depending on the individual circumstances, but include: • Has it recently recovered from an injury and was a diagnosis reached?
• Does the horse have a history of tying up?
• Was it performing normally when the injury happened?
• Was there a kick or did it collide with a fence or any other object?
There are particular injuries that tend to be associated with different activities, for example harness racing compared with eventing or national hunt racing and being aware of more likely injury mechanisms can help with a lameness investigation.
In a competition environment, wounds can be cleaned and lavaged to remove any debris and during this process, the extent of deeper damage can be assessed. They can then be closed, or partially closed, using sutures or staples and bandaged appropriately. Bandaging may be needed to provide support for the journey home or to a treatment centre and this may include splinting if a fracture or severe tendon or ligament injury is suspected. As well as improving the comfort of the horse, this will minimise the risk of making the injury worse over the following few hours. Particular attention should be paid to the shoe and foot. Has the shoe moved or been pulled off and has the horse trodden on the shoe or nails? Medical treatment can also begin at this stage and is most usually in the form of antibiotics and anti inflammatory medication. The
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site and nature of the injury can dictate how aggressive the treatment needs to be; for instance, even quite deep cuts to the face will heal quickly and without complication compared to a minor cut on the pastern. It is worth bearing in mind that a horse that has injured both fore limbs may be reluctant to move but may appear to be less severely affected than those with an injury to one leg alone. A careful examination of the whole horse is essential, even in cases where there is an obvious injury to one area. Most horses can be made comfortable enough to be moved to a centre where further treatment or diagnostic work can take place.
The same process applies to the injuries sustained at home. These horses may be brought in from the field, lame and with no apparent cause. In some there may be a history of recent competition that can help to reveal a cause.
The horses with no obvious cause for the lameness can pose a challenge and it may take some time to establish the cause of the problem. The examination has to be thorough, and the vet will indicate how urgent they feel the need for investigation must be. For instance a mild forelimb lameness where the horse appears to be comfortable can be treated with box rest and may resolve over a short period of time. By contrast, a relatively comfortable horse with a hind limb lameness may go on to reveal over the next few days, a fractured pelvis, which may require the horse to be tied up or supported in slings.
The foal’s swollen knee was clipped before aspiration of fluid from the swelling for laboratory analysis
This recent case was that of a two week old foal, which had been doing well since birth but was found lame one morning by his owner. He was brought in to the surgery and deteriorated over the course of a day to become non weight bearing on the near fore. There was a hot swelling on the front of the knee and fetlock, and the foal did not like flexion of the leg. With a young foal, as well as worrying about any trauma to the leg, we have to consider the possibility of joint ill, and infection within the joint itself. Laboratory analysis of fluid from the swelling showed it to be blood, confirming that this foal had a haematoma on the front of the knee. So
with the possibility of infection out of the way, we just had to consider how much traumatic damage there had been. A support bandage made him more comfortable and over the course of three days he improved steadily to become comfortable enough to canter behind his mother, taking away any need to investigate further. The support bandage remained on for a further four days and he and his mother were kept in a small paddock until he was moving normally again.
This is a good example of how a severe lameness can be investigated in a step by step way, treating symptomatically.
More comfortable with a correctly applied support bandage the foal improved steadily over the course of a few days
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