Page 154 - Adams and Stashak's Lameness in Horses, 7th Edition

120 Chapter 2

trotted off. Although these tests are often used for horses
with suspected navicular syndrome, one clinical study
VetBooks.ir lar region pain from other causes of palmar heel pain.
found that they were not helpful in differentiating navicu­
13
Any cause of heel/foot pain may be exacerbated with
these tests.

DIRECT OR LOCAL PRESSURE PLUS MOVEMENT

The premise for applying direct pressure to a specific
site and watching the horse trot is to confirm the signifi­
cance of palpation findings. A positive response to static
palpation does not necessarily indicate the site of the
problem. However, increasing the baseline lameness by
deep palpation of a suspicious area or anatomic struc­
ture will often confirm the potential of a problem in the
area. Direct pressure is usually applied manually, but
hoof testers can be used to apply pressure to the sole of
the foot. The limb is usually elevated, the site is com­
pressed for 15–30 seconds, and the horse is trotted off.
Exacerbation of the lameness by one or more grades is
2
considered a positive response. The direct pressure test
Figure 2.109. Positioning to perform a full‐limb flexion of the is most commonly performed over swellings of the splint
forelimb. All of the joints in the limb are flexed simultaneously. bones, dorsal metacarpus, flexor tendons, suspensory
body and branches, and medial aspect of the tarsus. It
also may be used to assess pain in the proximal suspen­
sory region of both the forelimb and hindlimb and sev­
eral areas of the axial skeleton.

Rectal Examination
A rectal examination may be indicated in some horses
with upper hindlimb lameness. It is most commonly per­
formed in horses with suspected pelvic fractures or
problems in the sacral region. Information also may be
obtained rectally in horses with iliopsoas myositis, frac­
tured vertebrae, or thrombosis of the iliac arteries.
15
Rectal examination is usually performed with the horse
standing still, but it may be beneficial to walk the horse
while performing the rectal exam (so‐called walking rec­
tal). The examination is often performed in a cranial‐to‐
caudal direction. Pressure should be applied to the
iliopsoas muscle located cranial to the pelvic brim. The
aorta and iliac arteries should be checked for normal
pulsation. The symmetry of the pelvis is palpated by
comparing one side to the other (Figure 2.112). With
displaced ilial fractures, an obvious asymmetry may be
present, and rocking the horse from side to side may
reveal crepitus or movement of the bones. The ventral
aspect of the sacral vertebral bodies should be checked
for alignment and any depression or protrusion into the
pelvic canal, which may indicate fracture or subluxa­
tion. Rectal ultrasound of the pelvis may be performed
Figure 2.110. Positioning to perform a full‐limb flexion of the at the same time as palpation to further document
hindlimb. abnormalities.

elevated position in relation to the heel by placing a Neurological Examination
wooden wedge under the toe (Figure 2.111). This serves
to increase the tension on the DDFT and increase pres­ Any horse with a suspected neurological problem
sure over the navicular bone. The wedge may also be should have a complete neurological examination per­
applied to the medial or lateral aspects of the foot to formed (see Chapter 12 for this description). However,
12
manipulate the soft tissues of the digit. The opposite determining the presence of hindlimb weakness and cor­
limb is elevated for 30–60 seconds, and the horse is rect limb placement can be performed quickly and may