Page 151 - Adams and Stashak's Lameness in Horses, 7th Edition

Examination for Lameness 117

performed when an abnormality in the elbow region is
found on physical examination.
VetBooks.ir SHOULDER/UPPER FORELIMB FLEXION

Manipulation of the upper forelimb can be performed
either by pulling the limb cranially and upward or by
pulling the limb caudally. The cranial approach is simi­
lar to flexing the elbow; only the limb is pulled forward
and will flex the elbow and extend the shoulder. This is
usually performed by standing in front of the limb,
grasping the antebrachium, and lifting the limb up and
forward (Figure 2.104). This exacerbates lameness prob­
lems in the caudal aspect of the elbow and the cranial
aspect of the shoulder. The more the limb is elevated, the
more pressure is applied to the cranial aspect of the
shoulder. The position is maintained for 30–60 seconds
(or as long as the horse tolerates it), and the horse is
jogged off. Horses with supraglenoid tubercle fractures
of the scapula, and horses with bicipital bursitis often
respond to this type of shoulder manipulation.
Figure 2.103. Hand and limb positioning to perform distal limb The caudal approach to flex the shoulder joint can be
flexion (phalangeal and fetlock joints) of the hindlimb.
performed by placing one hand on the olecranon pro­
cess and pulling the limb caudally. Alternatively, the cra­
a potential problem in the area. However, false‐positive nial antebrachium may be grasped and pulled caudally
fetlock flexion tests do occur, especially in horses in together with the distal limb instead of applying pres­
work, and many horses may show a positive response if sure to the olecranon (Figure 2.105). The position is
a large amount of force is applied to the fetlock/distal maintained for 30–60 seconds (or as long as the horse
limb. One study in normal horses evaluating the force tolerates it), after which the horse is jogged off.
applied for the fetlock and phalangeal flexion test by
different examiners found that the force varied consid­ TARSAL/HOCK FLEXION
erably and was frequently too high. 18
The tarsal flexion test or spavin test is somewhat of a
CARPAL FLEXION misnomer because it flexes the fetlock, stifle, and hip in
addition to the hock (Video 2.6). A positive response to
The carpal flexion test is very useful to help isolate a hock flexion is not synonymous with a tarsal problem
problem to the carpus. A negative response does not but can be used together with other physical examina­
rule out a problem in the carpus (many horses with tion findings to suggest a problem in the tarsus. Hock
osteochondral fragmentation are not positive to carpal flexion is performed by placing the outside hand when
flexion), but a positive response is highly suggestive of facing the rear of the horse on the plantar surface of the
a carpal problem (few false‐positive responses). This is distal third of the metatarsus and elevating the limb to
in contrast to the fetlock, where false‐positive responses flex the hock (Figure 2.106). The opposite hand is then
are much more common. Carpal flexion is performed placed around the metatarsus, and the limb is held with
by grasping the metacarpus with the outside hand both hands while facing the back of the horse. The grip
while facing the horse, pulling up on the distal limb
(Figure 2.71). The foot should be able to contact the
caudal aspect of the olecranon in normal horses. The
carpus is held in this position for 30–60 seconds, after
which the horse is jogged away and observed for
increased lameness.

ELBOW FLEXION
It is difficult to completely separate the elbow from
the shoulder when performing upper limb flexion tests
in the forelimb. This is analogous to the tarsus and stifle
in the hindlimb because flexion of one area often affects
the other. However, flexion of the elbow can be performed
by lifting the antebrachium (forearm) so that it is parallel
to the ground but not pulled forward (Figure 2.75). This
flexes the elbow and causes the carpus and distal limb to
hang freely. The limb is held in this position for 30–60
seconds and the horse is jogged off. Elbow flexion is Figure 2.104. Upper limb flexion test in which the limb is pulled
usually not part of a routine lameness evaluation and is cranially and upward to “stress” the shoulder region.