What to Expect During a Lameness Exam

by Boehringer Ingelheim/March 22, 2023

Whether a horse "feels off" under saddle or has a noticeable limp, a lameness exam helps to pinpoint the source of the problem and sets the foundation for a treatment plan. Consulting with a veterinarian right away, even in minor cases, decreases lost riding time and increases the chance of recovery.

Start the process with a phone call to your veterinarian’s office. In most cases, your veterinarian will want to examine your horse at their earliest opportunity, which depending on their schedule may be days away. If so, follow their advice for what to do in the meantime regarding giving any anti-inflammatory medications, if the horse can be turned out, or have any exercise. If the horse is unable to bear weight on the leg or seems painful in both front feet as seen with laminitis, those are worthy of an emergency call.

Finding the pain

Identifying the source of the lameness is like a scavenger hunt—it is not necessarily in the part of the body suspected. For example, a horse may have visible swelling in one area due to an old injury, but that may not be the current source of lameness.

Another example: a rider with a horse that is unable to bring his limb forward in a normal stride believes it is shoulder lameness. However, shoulder issues are rare in adult horses unless it is secondary to trauma. That means the pain could be further down the leg or even in the neck.

That is why it is so important to allow your veterinarian to perform a complete exam, even in horses that have had previous issues localized to one area. The lameness exam informs a veterinarian's diagnosis and treatment plan. Here's what to expect when the veterinarian arrives.

Visual and physical observations

Veterinarians begin every exam by visually observing the horse and by palpating or feeling each part of the horse's body. In this step, veterinarians look for heat or inflammation, flinching at the touch, or a decreased range of motion.

Putting their hands on the horse helps them focus on areas that may be the source of the pain.

Next, they will ask to see the horse move at a walk and trot in a straight line and a circle on hard and soft ground. Watching the horse move this way allows veterinarians to grade the severity and help localize the region of pain to one or more limbs.

“Identifying the specific causes of lameness can be challenging,” says Sarah Reuss, VMD, Boehringer Ingelheim Technical Manager. “Horses can’t tell us where they hurt and often the way they move doesn’t always reveal the exact source of lameness. That’s where additional testing can be beneficial.”

Diagnostic tests

To confirm what a veterinarian sees in a visual exam, they systemically move through a series of diagnostic tests to pinpoint the source of the issue. These tests include:

Flexion test: The veterinarian "flexes" or puts stress on a specific joint or region of the body and watches how the horse moves after the pressure is applied. Veterinarians are looking to see if the lameness increases and how it compares with movement in the other limbs.
Diagnostic blocks: A nerve block is used to pinpoint the location of pain. The veterinarian injects a short-acting numbing medication either into a joint or around the nerves and then watches the horse move again. When the horse's movement improves, it signals the source of pain to be in that joint or in the area that those nerves reach. If no difference is made, the pain originates higher up the leg, and the nerve block may be repeated higher up the leg until the precise location can be confirmed.
Imaging: Radiographs (x-ray), ultrasound, MRI (magnetic resonance imaging), CT (computed tomography), and nuclear scintigraphy (bone scan) are all tools that can be utilized for additional diagnostics depending on the situation. Looking “inside” the horse can help collect additional valuable information for treating the lameness.

Rider observations

Horse owners know their horses best and can often feel the slightest change in gait or performance. Be proactive and share this information with the veterinarian to help determine next steps. Have whoever rides the horse present for the veterinary exam, and in some cases be prepared to ride the horse for your veterinarian. In today’s day and age, collecting cell phone videos of your horse can be very helpful if the lameness is very intermittent or only under certain conditions.

Addressing a subtle issue as soon as it is noticed can help prevent the lameness from progressing. Thanks to advancements in veterinary medicine and technology, some of the most serious lameness issues can now be addressed, helping horses continue living healthy and productive lives.