Lameness Work-Ups at the Equine Hospital

This information sheet is designed to try and help you, as a horse/pony owner, understand what a lameness work-up at B&W Equine Hospital may entail. Hopefully this will help to reduce the worry you may have about bringing your horse/pony to us.

When a horse/pony is lame, with no obvious cause for the lameness, we often advise a lameness investigation, or ‘work-up’, to try and determine what the cause of the lameness is.

What does a lameness ‘work-up’ entail? 

We will allocate a vet to look at your horse/pony. He/she will take some history from you regarding your horse/pony’s background, such as

• What your horse/pony is used for
• How he/she is managed
• Shoeing etc

They will also ask questions about the nature of the current lameness:

• Duration
• Severity
• Previous treatment
• Response to rest/treatment etc

We will then perform an initial lameness examination; this may include:

• Walk and trot in a straight line
• Flexion tests
• Lunging on both firm and soft surface
• Palpation of the limbs/back/neck
• Possibly a ridden examination, dependent on the history and nature of the problem

If, following this examination, there is something that suggests a cause of the lameness we may elect to perform the relevant diagnostic imaging procedure straight away such as X-rays and/or ultrasound examination.

If there is no obvious cause of lameness, then we commonly embark on performing a series of ‘nerve blocks’:

• We will place small volumes of local anaesthetic, using small needles, in specific places on the leg to numb the nerve supply to a specific area
• If your horse/pony is sound after this nerve block then we know that the cause of lameness is coming from somewhere within the numbed region.
• If your horse/pony remains lame then we will perform the next nerve block up the leg, as we generally start at the bottom of the leg and work our way up

Once we have localised the lameness we may:

• Let the nerve block wear off, so your horse/pony is lame again, and perform a more specific block (e.g. into a joint, tendon sheath, bursa). This helps to provide us with a more accurate localisation of the site of pain
• Take x-rays to look for bony abnormalities
• Perform ultrasound examination to look for soft tissue abnormalities

How long does a lameness work-up take?

This is hard to predict!

It depends on:

• How quickly we localise the lameness i.e. how many nerve blocks we need to perform
• If we need to wait for the initial nerve blocks to wear off before we perform more specific blocks
• If we need to take x-rays and if so how many
• If we need to perform an ultrasound examination

You are welcome to stay for as much, or as little, of the lameness work-up as you want. We are happy for you to wait with your horse/pony and we will explain what we are doing with each test. It is common for our vets to be working on more than one case at a time and there are periods of time you will have to wait e.g. whilst a nerve block is taking time to work (~10 minutes)

It is possible for you to drop your horse/pony off with us and not stay if this suits you best.

Sometimes it may be necessary for your horse/pony to stay with us overnight (if work-up is taking a long time or we want to perform treatment the following day).

 If this is the case, we will discuss how your horse/pony is managed and provide a husbandry form to be completed to ensure your horse is looked after as you request.

What might we advise following a lameness work-up?

We would always discuss the outcome of a lameness work-up with you before undergoing any treatment. The type of treatment is very dependent on the diagnosis but may include:

• Medication of a structure with an anti-inflammatory drug e.g. placing steroid into a joint
• Rest +/- controlled exercise
• Alterations in shoeing
• Systemic treatment with an anti-inflammatory (e.g. ‘bute’)
• Surgery to treat specific conditions and/or to provide us with more diagnostic information

We may advise more advanced diagnostic tests to provide us with additional information e.g. MRI, CT or bone scan (nuclear scintigraphy).

How much does a lameness work-up cost?

This is very hard to predict as it depends on how many nerve blocks we perform and what other diagnostic tests we do. It can cost anything from £300+. Insurance companies generally cover lameness work-ups, unless you have a relevant pre-existing exclusion. It is worth informing your insurance company that your horse/pony is under going a lameness work-up.

When wouldn’t we do a lameness work-up?

• If there is an obvious cause of lameness that does not require nerve blocking. We may still perform x-ray and/or ultrasound with these case.
• If your horse/pony is so lame that we are concerned about making matters worse by walking/trotting around. We may elect to x-ray/ultrasound/bone scan/MRI these cases in the first instance.
• If there is a history of trauma and there are concerns about a fracture etc. We may elect to perform a bone scan with these cases in the first instance.

We hope this helps to explain the lameness work-up procedure but if you have any queries then please contact the hospital on 01453 811867 or enquiries@bwequinevets.co.uk and one of our vets will be happy to talk to you.