VMED 107 (Equine Medicine)

Reporter: Chinny Lyn D. Salaya

Topics: Physical Examination
Lameness
Common Bacterial and Mycotic Diseases

Physical Examination

Physical Examination
1. Signalment:
Age
Sex
Breed
History
The cause of many primary owner complaints can be identified from a thorough
history and physical examination. Many of your questions should pertain to the clinical problem
at hand, but certain information should be obtained from the owner or trainer of all horses.
 How long have you owned (or managed) this horse?
 What is its intended use?
 What is the schedule for deworming? Vaccination? Shoeing/trimming?
 What is the housing status of the animal? (stall, paddock or pasture; if in pasture,
individually or in a group)
 What is the horse fed? (including amount and frequency of hay, grain, and any nutritional
supplements or medications)

Other questions that pertain to the problem at hand:

  What is the current problem? (including the signs your horse is showing)
 When did you first notice this problem?
 Has the problem gotten better or worse since it was first observed?
 If it happens intermittently, what is the frequency of occurrence?
 Has your horse been examined previously for this problem?
 What treatment has your horse received for this problem?
 Has your horse had any other problems recently or previously?
 Is the problem isolated to the individual, or are other horses on the farm affected?

2. Observation from a Distance

Always stand back and look at the horse, assessing such parameters as:
 Body weight: Is the horse over or under conditioned?
 Symmetry: muscle, abdominal shape etc. Is there muscle mass loss? Is the horse bloated?
 Stance: Does the horse stand normally?
 Attitude and behavior: Evidence of depression, mental status, hyperaesthesia?
 Presence of pain: Is the horse agitated, pawing, restless, etc.

3. Catching a horse
a. Adults in a small paddock: Horses are innately nervous and suspicious animals that are quick
to detect nervousness and lack of confidence in anyone approaching them. They are apt to
misinterpret any abrupt actions and become excited. On the other hand, a direct and confident
approach tends to calm them. Whenever possible one should approach a horse on the near
side (left) as this is the side they are used to being approached. Once in hand, the lead rope
should be applied confidently and deliberately.

b. Catching a foal - Foals should be approached quietly with a second person holding the mare.
One arm should hold the foal in front of the chest and the other arm should hold behind the
rump. The base of the tail can alternatively be used. Whenever possible the foal should be
allowed to follow the mare. When restraining young foals, it is extremely important to hold
or lift the foal in front of the chest and behind the rump. Foals should never be lifted or
restrained by applying pressure to the thorax or abdomen directly. It is also important to
know that foals and mares should always be moved together, even for very small distances, as
separation will result in extreme anxiety.

4. Placing a halter - From the near (left) side the handler should first restrain the horse by placing the
lead rope around the neck. Once this is accomplished, the halter is opened up and with the right arm
placed around the neck (holding the long strap of the halter in right hand) and the halter is applied.

5. Types of restraint - Use the least amount of restraint possible in a given situation and don't become
overconfident with the restraint procedure

 Mechanical Restraint - horses that are unable to be handled for the physical examination,
mechanical restraint can be utilized.
 Chemical Restraint - horses may need chemical restraint due to behavioral reasons.

a. Lead rope – the person holding the horse should always be located on the same side of the horse
as the person performing the procedure.
 b. Skin twitch – the loose skin in the lateral neck region (just in front of the shoulder) is grasped and
rolled forward.

c. Nose twitch (using chain or rope twitch) - handler should stand at the horse's side and in a
position that reduces the chances of injury if the horse were to strike out. Pull the horse's head
toward you and apply the twitch. Handler should be on same side of horse as person performing
procedure

d. Ear twitch - the ear is grabbed and squeezed - afterwards it is rubbed. This will facilitate
reapplication. This procedure is used infrequently for adults.

e. Various uses of chain shank for restraint

i. Over bridge of nose. Young racehorses and stallions are frequently led using a chain
over the nose.
ii. Lip chain. Very commonly used in Thoroughbreds.

6. Examination of Feet: This is useful for basic examination and daily care and is required for most
lameness examinations in the horse.
a. Front feet - pinch the suspensory ligament, which will result in the horse shifting its
weight off of the desired limb. The foot is lifted and placed between the handler’s legs
just above the knees. The handler should be facing towards the horse’s hind limbs. Clean
the frog with a hoof pick.
b. Hind feet - pick up and support the limb on top of the handler’s leg closest to the horse.
The horse’s hind limb should not be placed between the handler’s legs.
c. Apply hoof testers to one foot as directed by an instructor.

6. Rectal temperature: Stand on the lateral side of the rear limb, lift the tail with one hand and advance
the thermometer (lubricated) with the other.

8. Pulse rate - pulse rate should be counted for at least 30 seconds. Normal pulse rate is 28-40 per minute.
Location of easily palpable external arteries include the following:
a. Facial artery - most frequent – overlying the ventral border of the ramus of the mandible
b. Transverse facial artery - ventral to the facial crest.
c. Digital artery – over the palmar/plantar and lateral or medial aspects of the fetlock or
pastern

9. Auscultation of the heart: Auscultate the heart primarily on the left side, behind the elbow of the horse.

10. Respiratory system:

a. Respiratory rate - taken while animal is at rest. Normal respiratory rate is 12- 18 breaths/min
b. Auscultation - normal breath sounds. For adult horses, proper thoracic auscultation requires
application of a rebreathing bag. This will be demonstrated.
c. Percussion - normal lung boundaries

11. Examination of the Head and Neck

  Examine the mucous membranes by raising the upper lip. Evaluate for moistness, icterus,
hyperemia, cyanosis, pallor, ulceration and petechial. Capillary refill time is evaluated by
blanching the mucous membrane.
 Evaluate the nares for symmetry and airflow.
 Percuss the maxillary and frontal sinuses.
 The tongue can be isolated through the interdental space to evaluate for oral ulceration.
The normal movement of the tongue should be noted.
 The sclera should be evaluated by placing the thumb over the upper lid and grasping the
bottom of the bottom of the halter. The cornea should be evaluated. Elicit a menace
response by bringing your hand close to both eyes, a normal blinking response should
occur. Pupillary light reflexes can be evaluated with the use of the penlight.
 The ears can be gently palpated for temperature and if there are suspicions of
cardiovascular shock or poor peripheral perfusion.
 The intramandibular space can be palpated for submandibular lymphadenopathy.
 In normal horses the retropharyngeal lymph nodes are not readily palpated. Assess this
area under the mandible for any noticeable swelling.
 The facial artery can be palpated at the ventral aspect of the mandible and a pulse can be
felt.
 The thyroid gland can be palpated in older horses. The left jugular vein can be occluded
and assessed for jugular fill.

12. Examination of Limb

The fore and hind limbs are examined for any signs of swelling heat or pain. Pay particular
attention to joints: knee, fetlock, ankle, pastern and coffin for the front limbs. Stifle, hock, ankle
pastern, and coffin should be evaluated for the hind limbs. Examine the udder, the inguinal area,
penis/sheath, rectum, and perineum of the horse.

13. Thoracic Auscultation

 Lung auscultation
o Compare lung sounds in the ventral, dorsal and middle thorax. A comparison of the left
vs. the right side of the thorax should be completed.
o A rebreathing bag can be utilized to better assess the lungs. The bag should be held away
from the nose so that it does not block the nostrils and inhibit inspiration. Be sure to note
how the horse tolerates this procedure and if any coughing can be elicited. Also note how
quickly the animal is able to recover after the cessation of the procedure.
1. The thorax must be listened to while the rebreathing bag is in place. Deep
breathing can reveal abnormal lung sounds. Normal inspiratory sounds are louder in
comparison to expiratory sounds.
 Cardiac auscultation
o The heart can be auscultated on the left cranial ventral thorax assessing the pulmonic,
aortic and mitral valves. The heart rate can be determined at this time. The right cranial
ventral thorax can be auscultate to assess the tricuspid valve.
o Sounds over each valve can be heard in the following approximate locations:
 Pulmonary (L - 3rd) space at costochondral junction
 Aortic (L - 4th) space just below level of shoulder
 Left AV (L - 4th) space at level of olecranon
 Right AV (R - 3-4th) space between olecranon and costochondral junction
14. Examination of Ventral Thorax and Abdomen
 Assess the animal the ventral thorax and abdomen for any ventral edema by placing
upward pressure on the ventral thorax on midline.
 The abdomen should be ausculted for borborygmus. This can be done by placing the
stethoscope to the left and right paralumbar fossa and ventrally.

15. Musculoskeletal Examination

 The forelimbs and hindlimbs should be evaluated for any signs of swelling heat or pain.
The joints should also be evaluated for swelling, heat and fluid.
 All four limbs should be evaluated for digital pulses.
 Overall musculature of the horse should be evaluated for symmetry.
 can be done to confirm and detect muscle atrophy.

16. Neurologic Examination

a. Evaluation of Mental Status
Observe the horse in its stall or pasture before entering the enclosure. Encephalopathic
behavior, such as compulsive circling, head-pressing, cortical/central blindness, seizures, or
significant change in mentation, is generally obvious. Normal horses are alert and responsive,
although the spectrum encompasses very calm, placid horses to overly alert, anxious
individuals.

b. Cranial Nerve Examination

There are many different ways to perform a cranial nerve (CN) examination; the following
description uses a regional approach.
 Start with the eyes: perform a menace response, evaluate pupil size, perform pupillary light
reflexes, assess eye position, look for normal physiologic nystagmus, and ensure that there
is no abnormal nystagmus. Assess the palpebral fissure for size and symmetry and evaluate
the palpebral reflex. Look at the prominence of the third eyelid (sympathetic nerves).
 Evaluate the horse for normal facial expression and ability to move ears, blink, and wiggle
muzzle/lips.
 Assess the size of the muscles of mastication through palpation and observation of the
horse eating as well as facial sensation by touching all regions of the head. Open the
horse’s mouth to assess jaw tone and remove the tongue to assess the horse’s tongue
strength (ability to retract) and symmetry of tongue muscle. Observe the horse eating and
drinking to assess ability to swallow. Endoscopy allows direct visualization of the pharynx,
larynx, and swallowing ability and may be useful if dysfunction is suspected in CNs 9 and
10.
 CN 1 (olfaction) is rarely specifically tested, but most horses with interest in food have
normal olfaction.
 CN 11, which innervates cervical muscles, is also not usually specifically tested. For
practitioners accustomed to performing CN examinations on small animals, note that the
equine exam is similar with a few minor differences.
 o Pupillary light reflexes subjectively appear slower, particularly if a penlight is
used. ● The eyelids of normal horses audibly snap shut when the palpebral reflex
is tested—if no snapping sound is heard, eyelid weakness should be suspected.
o Mild ptosis can be detected by examining the horse’s eyelash angles, which
should be bilaterally symmetrical, usually with the eyelashes perpendicular to the
globe and parallel with the ground.
o Mild bilateral ventral strabismus is expected when the head is elevated; as long
as this strabismus is symmetrical, it is considered normal.
o The gag reflex is not routinely checked manually—either the horse is observed
eating and drinking or endoscopy is used to evaluate the horse’s pharynx and
larynx.
o Loss of sympathetic innervation will cause profuse sweating (e.g., Horner’s
syndrome).

3. Spinal Reflexes and Muscle Evaluation (Tone and Size)

Tendon reflexes should be performed in recumbent adult horses but may be difficult to
interpret. Withdrawal reflexes should be assessed in recumbent horses. Reflexes that the
practitioner should assess in the standing horse include:
 cervicofacial/auricular and cutaneous trunci (panniculus)
 tail tone
 perineal reflex
 anal tone.
All horses should be carefully inspected for any signs of muscle atrophy.

4. Gait and Posture Examination Plus Postural Reactions

Posture (head, neck, and body position) can be evaluated in the stall or outside. All but the most
ataxic horses should be taken outside for gait evaluation.
 walk the horse in a straight line
 trot the horse in a straight line
 walk the horse in serpentine
 walk the horse with head elevated
 walk the horse while pulling the tail in each direction
 spin the horse in tight circles
 walk the horse backward
 walk the horse on uneven ground (back and forth over a curb or cavaletti and up and
down a hill).

Other Examination
1. Appetite and Water Consumption
Normal horses eagerly anticipate the daily feeding. Horses that exhibit disinterest in their
food, become picky eaters or go off feed completely may be developing a problem and this
needs to be investigated. The horse will generally drink roughly equivalent amounts of water
daily, with adjustments for temperature, diet, seasonal and exercise changes. It is important to
monitor water consumption daily for optimal health.
 2. Manure/Urination
The manure should be formed into moist balls. If the manure is too dry, or too loose, this
may be an indication of a problem or change in diet, water consumption, or other factors. The
amount of manure passed each day is also important to notice. The amount, colour and
frequency of urination should be noted as well as posture while urinating.

3. Skin/Mane/Tail
The skin should be observed for flaking, oozing or signs of irritation. Hair loss should also
be noted.

4. Cardiac Recovery Index (CRI)

The cardiac recovery index is a useful indicator of a horse’s condition, especially if it is
used at rest intervals during or after exercise/competition. The Cardiac Recovery Index was
initially developed for monitoring endurance horses but it is an effective tool that can be used
on other athletic horses. It can help determine if the horse has been over-worked or if the horse
is overly fatigued.

Lameness
Lameness refers to an abnormality of a horse's gait or stance. It can be caused by pain, a
mechanical problem, or a neurological condition. Lameness, most commonly results from pain in
the musculoskeletal system (muscles, tendons, ligaments, bones, or joints) leading to abnormal
movement at the walk, trot, or canter.
Signs and Symptoms: 
Lameness can range from being very mild (i.e. may not be easy to see but can be felt while
riding the horse) to severe (the horse won’t bear any weight on the leg). With more subtle
lameness issues you may notice a decrease in your horse’s performance or a change in their
behavior or attitude even though you can’t see or feel an obvious lameness. Sometimes horses
will “stand off” of a lame leg or point that leg more often than usual. Horses with chronic
problems may develop compensatory gait abnormalities to deal with the primary problem. This
may complicate the lameness evaluation and possibly its treatment. Therefore, it is important to
have a lameness evaluated as soon as it is recognized.

Diagnostics: 
If your horse is lame, it should be evaluated by your primary care veterinarian as soon as
possible. In some cases the examination may be simple; in others it may be more extensive,
requiring nerve or joint blocks & diagnostic imaging to make a diagnosis. Your veterinarian may
choose to do some or all of the following if your horse is lame:
 Take a thorough history; certain lameness issues are more common in different breeds or
disciplines of activity
 Physical Exam:
 Palpation of the entire horse to check for any areas of heat, pain, or swelling
 Hoof testers - to see if there is a painful response to pressure on the feet
 Lameness Exam: The horse is evaluated at various gaits to determine if lameness can be
seen by your veterinarian. This may be done with an assistant trotting the horse in hand,
on a lunge line, or occasionally while the horse is being ridden.
 Flexion Tests: May be helpful if the lameness is subtle or there are no obvious signs of a
problem; they involve bending or "flexing" a joint for up to 1-2 minutes. The horse is
then immediately trotted off & evaluated for an increase in lameness. If a particular
flexion test increases the lameness, your veterinarian may want to do further testing on
that body part to determine if it is the cause of the lameness.
 Nerve or Joint Blocks (“Diagnostic Analgesia”): A local anesthetic is injected either
around nerves or directly inside of a joint to desensitize specific structures on the horse’s
limb. The horse is then evaluated again to watch for lameness. If the lameness improves
after an area is desensitized, then the lameness is assumed to be coming from that
location.
 Diagnostic Imaging: Once a specific part of the limb is isolated as the cause of the
lameness, some type of imaging test is usually recommended. Depending on the body
part involved your veterinarian may recommend radiographs, ultrasound, nuclear
scintigraphy (aka “bone scan”,), CT or MRI.
 Quantitative Assessment: The use of specially placed motion detectors on the limbs and
trunk of the horse can aide in the detection of subtle gate asymmetries and responses to
the aforementioned diagnostic tests. 
Treatment: 
Treatment varies widely depending on the cause of the lameness. However, treatment for
common lameness issues often includes joint injections and administration of medications aimed
at decreasing inflammation. For some lameness conditions specific, shoeing recommendations
may be made and a period of rest and rehabilitation may be needed. Some causes of lameness
can be treated surgically. If so, your veterinarian may choose to consult an ACVS board-certified
veterinary surgeon on possible surgical or adjunctive therapy for your horse’s problem.
Aftercare and Outcome: 
Varies widely with cause of the lameness and the treatment given.

Lameness of the Carpus

Synonym(s): Lameness of the knee

The equine carpus, often referred to as the “knee,” consists of three main joints.
 The radiocarpal (antebrachial) joint, the most proximal joint,, is composed of
the radius proximally and the proximal row of carpal bones distally.
 The middle carpal joint is located between the proximal and distal row of carpal
bones.
 The carpometacarpal joint is composed of the distal row of carpal bones
proximally and the second, third, and fourth metacarpal bones distally.

EPIDEMIOLOGY
SPECIES, AGE, SEX
 Injury to the carpus can occur at any age. Thoroughbred and Quarter Horse
racehorses are predisposed to some of the injuries mentioned below, but they can
happen to any breed.
 Angular limb deformity (ALD) is primarily seen in young foals and is associated
with developmental orthopedic disease.
 RISK FACTORS
 Any athlete that undergoes highly repetitive loading, such as a racehorse, is
predisposed to injury to the carpus.

CLINICAL PRESENTATION
HISTORY, CHIEF COMPLAINT
 Most commonly, horses present with a history of front limb lameness.
Occasionally, the chief complaint is carpal joint effusion or the horse is “moving
wide,” and the owner may not appreciate a noticeable lameness.
 Horses with ALDs, whether they are foals or adult horses, present with a history
of abnormal angulation to the front limbs.

PHYSICAL EXAM FINDINGS

 On palpation, joint effusion in the radiocarpal joint or middle carpal joint may be
evident.
 Decreased range of motion of the carpus may be noted.
 A positive response to flexion of the carpus during a lameness examination also
indicates that the carpus or the soft tissues around the carpus is the source of
lameness.

DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
 Carpal bone fracture
 Carpal bone chip (osteochondral) fragment
 OA of the radiocarpal joint or middle carpal joint
 Subchondral bone sclerosis
 ALD
 Injury to intercarpal ligaments

INITIAL DATABASE
The initial evaluation should include a thorough lameness evaluation, including
flexion tests. If the carpus is suspected as the source of lameness, then a full series of
carpal radiographs should be obtained.

TREATMENT
THERAPEUTIC GOAL(S)
 Stabilize fractures
 Remove fragments
 Stimulate healing (microfractures)
 Assess the full extent of injury with arthroscopy
 Control synovitis

ACUTE GENERAL TREATMENT

  Very rarely do injuries to the carpus require immediate treatment. Situations that
require immediate treatment are often related to traumatic fractures that result in
severe instability of the carpus.

CHRONIC TREATMENT
 Synovitis related to OA can often be controlled with intraarticular medications
such as hyaluronic acid and corticosteroids, autologous conditioned serum (ACS)
or interleukin-1 receptor antagonist protein (IRAP) or polysulfated
glycosaminoglycans.
 Often rest and nonsteroidal antiinflammatory drug therapy are the most important
aspects of a treatment regimen for horses with carpal injuries.

PROGNOSIS AND OUTCOME

 Prognosis for injury to the carpus depends on a number of factors, including but not
limited to the severity of clinical signs, severity of cartilage damage, duration of
lameness, and level of competition.
 Horses in the early stages of mild to moderate disease can often be managed with a
favorable prognosis.
 Advanced OA or severe disease warrants a guarded prognosis.
Lameness of the Elbow and Shoulder
Injuries and lameness associated with the upper forelimb, cubital joint, or scapulohumeral
joint.

EPIDEMIOLOGY
SPECIES, AGE, SEX
 Young horses are predisposed to osteochondrosis and cystlike lesions.
 Osteoarthritis is usually found in mature horses.
 Traumatic injuries may occur in any age group.

CLINICAL PRESENTATION
HISTORY, CHIEF COMPLAINT
 Acute, severe lameness of the elbow or shoulder region may be associated with a fall
or crashing into a solid object.
 In motion, the horse may have a shortened anterior phase to the stride, especially if
the biceps tendon or bicipital bursa is affected.
 Upper forelimb fractures usually result in non–weight-bearing lameness. If nerve
injury has occurred, the primary complaint may be muscle atrophy over the shoulder,
abduction of the shoulder during weight bearing, or dropped elbow

DIAGNOSIS
DIFFERENTIAL DIAGNOSIS
  Osteoarthritis:
 Fractures:
 Luxations:
 Osteochondrosis:
 Osseous cyst:
 Stress fracture:
 Enostosis (stress reaction, bone islands):
 Collateral ligament desmitis of the elbow:
 Bicipital bursitis:
 Biceps tendinitis
 Nerve injury to the suprascapular nerve, brachial plexus, or radial nerve
 Septic arthritis
INITIAL DATABASE
 Comparative palpation of the contralateral limb often provides a baseline to determine the
significance of findings.
 Diagnostic anesthesia should be used to rule out the lower limb and then intraarticular
anesthesia of the upper limb synovial structures should be done to localize the lameness.
 Radiography of the affected area should always be performed

ADVANCED OR CONFIRMATORY TESTING

 Nuclear scintigraphy should be performed if diagnostic anesthesia does not help localize
the lameness and evaluation of radiographs does not lead to a diagnosis.
 Ultrasonography helps determine if soft tissue injury is a component of the lameness.

TREATMENT
THERAPEUTIC GOAL(S)
 Reduce inflammation to reduce pain.
 Identify and stabilize recognized fractures.
 Provide appropriate rest and rehabilitative exercise
CHRONIC TREATMENT
 Horses with osteoarthritis may require long-term supportive care as described for
acute treatment.
POSSIBLE COMPLICATIONS
 Any injuries involving the articular surfaces may result in osteoarthritis.