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Pre-purchase and Lameness exams

Terms in this set (93)

The purpose of a pre-purchase exam
provide the buyer with an educated assessment of the horses overall health

aid the buyer in long term investment decision

try to identify or predict and future prroblems the horse may have

Interpret findings relevant to the intended use of the horse
Findings results are only good for
That day and time
The results belong to
The buyer
Three basic steps
1. Basic health evaluation

2. Lameness assessment

3. Ancillary dx
Basic health evaluation includes
Hx including signalment

TPR- at rest and after exercise

Ophthalmic exam

Auscultation of heart and lungs- at rest and after exercise

Oral exam- guesstimate age

Neuro eval

Confirmation
Clinical signs of musculoskeletal dz
Swelling

Discharge

Muscle atrophy
Most common c/s of musculoskeletal dz
Abnormal stance or gait
(Referred to as lameness)
Lameness Assessment caused by
Pain in musculoskeletal system

Mechanical problems

Neuro problems
Medical conditions associated with lameness
Abscesses
Fx
Strained tendons and joints
Bone chips
Laminitis or navicular dz
Arthritis
Back pain
Stringhalt
EPM or wobblers
Wounds or cuts
Exam at rest; look for
Conformational defects

Muscle wasting/atrophy
Exam at rest; preform
Examine hooves w/ hoof testers

Palpate and manipulate each limb
4 basic gaits of a horse
Walk, trot, canter, gallop
What gait is used to evaluate lameness?
Trot (2 beat gait)
What surfaces must be used to examine gait?
Hard and flat
(Soft surfaces will mask lameness)
How does the horse place hooves on the ground?
Where the front foot leads, the hind foot should follow
Head bob means what (forelimb lameness)
Head will go up sharply when the lame leg is wt bearing; when sound leg is wt bearing the head will go down
Irregular rhythm to trot; listen to footfall (forelimb lameness)
Footfall will be louder in the good leg
What does hip hike or drop mean (hind limb lameness)
The rotation will be asymmetrical

The lame leg will move further up and down
Other ways to ID hind limb lameness
Shortened stride

Toe drag
0 on lameness scale
Horse is sound
1 on lameness scale
Subtle, lameness is hard to observe
2 on lameness scale
Lameness seen when worked in circles or under saddle, but not in a straight line
3 on lameness scale
Lameness observed at a trot under all circumstances
4 on lameness scale
Lameness is obvious with marked nodding, hitching, or short strides
5 on lameness scale
Minimal wt bearing in motion and at rest, horse unable to move
Flexion tests are done to
Evaluate joint pain
Joints are manually flexed to stretch joint capsule for how long
Applied from 30 seconds to 2 minutes
Handler immediately trots the horse in a straight line away from vet, how many strides should you see it in?
Within 2 strides or flexion must be repeated
Distal limb flexion test
fetlock and pastern
Proximal limb flexion test
Front: elbow & carpus

Hind: hock & stifle
How many strides is it normal for a horse to be off?
3-4 strides
(Should quickly return to soundness)
What is the most common site of lameness?
The hoof
What is used to confirm and localize the site of pain causing lameness?
Nerve block
Goal of a nerve block
Block pain perception
Nerve blocks are used in moderately lame horses; what grade?
2-3
Drugs used for nerve block
Lidocaine and carbocaine (most common)
Which direction do you start a nerve block in
Start distal and work up
Prep area for a nerve block with
Chlorhexidine or iodine
How many mls for a nerve block
.5-3 ml
What gauge needle is used for a nerve block
25 g
How long does a nerve block take to take effect
15 min
Restraint for a nerve block
Halter and lead rope, nose twitch, hold up the limb
Most distal nerve block
Plamar or plantar digital block

"Heel block or PDN block"
Where to inject for the most distal block
Outside aspect of the pastern
What parts does the most distal block, block?
Heel, frog, Barrs, navicular bone, coffin bone, distal P2
Abaxial sesamoid block aka
Fetlock block
Where to inject for a fetlock block
Outside edges of sesamoid bones
What does a fetlock block, block?
Everything below the fetlock
Low Palmar Nerve Block aka
Low four point block
Where to inject for a low palmar block
Distal aspect of splint bones
What does a low palmar block, block?
Distal splint bones and down
High palmar block aka
High four point block
Where to inject for a high palmar block
Just distal to the carpus
What does a high palmar block, block?
Metacarpus and down
Position radiology equipment how far from patient
30-60 cm
Be sure to wear PPE when taking rads, this includes what?
Gloves, gowns, thyroid protector, dosimeter
Mobile rad units
Large

Rolled from room to room

Useful for thicker body parts

Hospital setting
Fixed rad machines
Mounted to the ceiling or floor

Highest output

Louder than other machines

Hospital setting
Portable rad machine
Most common

Limited kVp (90)

Long exposure time

Unable to penetrate thick structures
Digital radiography
Stored in computer and images can be enhanced

Saves time and money
Most common motion error on an x- ray
Long exposure times

Produces a blurred image- blurrogram
Sources of motion on radiograph
Patient

Machine

Cassette
Labeling for a radiograph
All four legs are indistinguishable

Must have right/left, and front/hind

Named by direction of primary beam

Location of x-ray machine

Location of film cassette
Height of the primary beam
Anatomical part of interest must be positioned in the center of the x-ray beam
Patient prep for rad
Clean surfaces of debris

Topical medications can be radioopaque

Sedation may be needed

Bandages removed if possible, although rad can penetrate through bandages and casts
Foot radiographs
Clean hoof with hoof pick

Remove shoes

Pack grooves with play dough
scintigraphy
Locates areas of metabolic activity in soft tissue or bone associated with inflammation and trauma
Gamma camera
Detects radiation emitted by a radioactive substance
Technetium isotope (TC-99m)
Radioactive isotope
Methylene diphosphate salt
"Bone seeker"
Nuclear medicine is helpful with
Detecting lesions when radiography and ultrasound have not confirmed a dx or cannot penetrate deeply enough
Handling of radioactive substances
2 pair of gloves

Handle patient as little as possible

Eliminated by urine

Bedding radioactive

Radioactive for 72 hrs
Calculate dose of radio pharmaceutical based on
Patients wt
Older horses require what because of slower rate of bone remodeling
Higher doses
Patient Preparation for scintigraphy
Cold ambient temperatures may reduce blood flow to distal limbs (heated stalls, leg wraps)

Place jugular catheter

Tape hooves with sturdy tape
(To prevent contamination of any areas)
The three phases of nuclear medicine
Vascular phase- 90 seconds

Soft tissue (pool) phase- 2-20 minutes

Bone phase- 2 1/2-4 hours
What is thermography
Special camera that scans the body surface temperature of a patient
Thermography
Non-invasive

Uses infared radiation

Locates "hot-spots" which indicate inflx

High chance of false positives
(The sun, blankets, bandages, insect bites)
Ultrasound transducer
2-13MHz transducer
Ultrasound uses in equine
Reproductive management

Thoracic and cardiac evaluations

Abdominal evaluation

Musculoskeletal structures
Hyperechoic
White
Anechoic
Black
Homogenous
Uniform shades
Heterogenous
Mixtures of grey
Preparation of the patient for ultrasound
Clip area with 40 blade

Skin should be cleaned with water and alcohol

Coupling gel
Edoscopy (rigid and flexible endoscopes)
Primary use in equine:
Respiratory dz

Guttural pouch

Gastrointestinal tract disorders

Urinary tract disorders
Why can you bend an endoscope
Breaks fibers
What do you clean an endoscope with
Mild sx soap
How do you sterilize an endoscope
Cold sterilization
MRI
A universal 0.25 Tesla magnet
MRI is valuable for detecting
Soft tissue lesions in the tendons and ligaments encased within the hoof capsule

Bone inflx

Sinuses within the skull
Is GA required for MRI
Yes
CT scan major advantages
Superior resolution

Particularly good for examining hard tissue
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