Page 1028 - Adams and Stashak's Lameness in Horses, 7th Edition

994 Chapter 9

fetlock joints creating some degree of synovitis, requir­ Hindlimb lameness Causing a Compensation musCle spasm
ing intra‐articular medication of the joint and in certain in tHe tHoraColumbar area
VetBooks.ir Axial Skeleton Pain tion of the back pain within a few weeks. Treatment of
cases arthroscopic debridement of the branch lesions.
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Treating the lameness usually will result in the resolu­
the muscle spasm and pain will speed up the return to
Cervical Pain optimal performance and might be needed depending
on the timing of shows.
Cervical facet OA is an increasingly recognized con­
dition affecting horses in several disciplines but more suboptimal saddle Fit Creating pressure points or restriCting
common in event horses and jumpers. A wide range of
clinical signs can be linked to this condition including tHe Horse’s movement
decline in jumping quality, resistance to sharp turns, and Horses need to be comfortable in their tack to be able
advanced dressage figures involving exaggerated latero­ to provide optimal performance. The saddle should ide­
flexion such as canter pirouette, resistance to work in a ally be fitted to the individual horse. Adjustments should
frame, resistance to the bit, abnormal head carriage, be made when the horse is in a state of fitness, and the
forelimb lameness, neck stiffness, and in the most fitting should be evaluated at rest but most importantly
advanced cases neurological proprioceptive deficits. during work when the muscles are tighter and more
Evaluation of range of motion (lateroflexion, ventro­ voluminous to ensure that the saddle is not constrictive.
flexion, and extension) should be performed with min­ Saddle should have a good area of contact with the
ute attention to any range limitations, hesitation, or horse and should not create pressure points. A veterinar­
slowness. Some horses will compensate and avoid maxi­ ian or saddle fitter experienced in the particular disci­
mal flexion by turning their heads at the level of the pline should perform the evaluation and recommend/
atlantoaxial joint. Radiographs of the cervical column perform the adjustments as the movements that the
can be difficult to interpret as many horses will have saddles need to allow will vary depending on the disci­
evidence of some degree of OA of the last two intercervi­ pline. Some saddle companies provide pads with pres­
cal facets (C5–C6 and C6–C7). Nuclear scintigraphy sure sensors to help evaluate the fitting of saddles.
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will confirm the suspicion or reveal the sites when evalu­ Alternatively, thermography could be used.
ating a horse for either poor performance or forelimb
lameness that does not block out to the most commonly
performed blocks. rider
Ultrasound is useful to evaluate the articular facets Evaluating the rider as a potential cause of back pain
and identify osteophytes and effusion but is most often is always a delicate task and requires the veterinarian to
used to guide needles for therapeutic joint injections. be very knowledgeable about the particular discipline.
Horse with cervical pain associated with cervical fac­ Horses will have back issues that will be treated but
ets OA can respond to physical therapy and osteopathic would recur regularly. This situation presents itself most
and chiropractic work. The vast majority will respond often with lower level riders that either sit crookedly or
to intra‐articular injections of corticosteroids using are heavy (relatively to the horse) and unbalanced.
ultrasound guidance.

primary musCle strain and or spasm
Back Pain Primary muscle strain is usually acute, most common
Back pain is frequent in performance horses and can in jumpers and eventers, and presents with significant
manifest clinically through various performance limita­ pain, swelling, and spasm. It usually is appreciated
tions. The riders and trainers most often recognize it shortly after a significant workout. Treatment will
when it is accompanied by sensitivity to palpation, involve anti‐inflammatory therapy (icing and NSAIDS
grooming, saddling, reactivity to tightening the girth or a systemic dose of corticosteroids depending on the
and to the rider’s weight, and bucking. Horses with severity), rest, and muscle relaxants.
chronic back pain will often loose some of their epaxial The more insidious and also more frequent muscle
muscle mass. spasm requires finer back palpation to identify.
Evaluation of reported behavior, back palpation and Treatments are varied and include NSAIDS, muscle
manipulation (inducing lateroflexion, dorsiflexion and relaxants (methocarbamol), and epaxial muscle injec­
extension at various levels), and observation of the horse tions of trigger points or mesotherapy.
lunging at the canter on soft ground (to evaluate the Epaxial muscle injection can be performed using
amplitude of the dorsiflexion) as well as the observation of 80 mL of sarapin, 10 mL of DMSO, and a dose of short‐
the horse ridden will provide significant information. acting corticosteroid, injected using a 1.5‐inch 21‐g nee­
Treatment of back pain will involve treatment of the dle, following three parallel lines on either side of the
initiating cause if identified, treatment of the primary dorsal spinous processes spaced inch apart, from mid‐
lesion, and treatment of the associated muscle spasm thoracic level, caudally to the sacroiliac area.
and pain. Chiropractic work, physical therapy, and acu­
puncture, along with training modification, are comple­
mentary to the medical management. Kissing spine
The most common causes for back pain include the Kissing spines or dorsal spinous process impingement
following. is one of the most common causes of primary back pain.