hindlimb examination

• The start of the examination is a distant examination from the side. To do this, the horse needs to be standing square, this means that the hindlimbs are together, the back is straight and the forelimbs are together. You want to perform a distant examination from both sides and look for…

  • Conformation
  • Asymmetry
  • Muscle wastage indicates disuse of a muscle
  • Swelling
• swayback = lordosis
• roach back = very straight back
• assess the flexural hock conformation, look at the angle of the joints and abnormalities within this. A very straight angle or an exaggerated one can both contribute to lameness.
• fill in the blanks

  A) straight

  B) upright

  C) long toe and long heel

  
• Then look at the pelvis from behind, the horse must be square as then any asymmetries noted are true. Assess the symmetry of the gluteal muscles (blue) and the bones e.g., the tuber sacrum (*) tuber coccyx (circle) and tuber ischium (@).

  
• label the image

  A) bow

  B) varus

  C) cow

  D) valgus

  
• Palpation and reaction in the tuber sacrum indicates pain in the sacro-iliac area.
• with palpation, you are looking for the cardinal signs of inflammation heat, pain and swelling.
• The femur and the thigh are hard areas to identify heat and swelling. In the stifle, you can palpate the femoral-patella joint and the medial femoral-tibial joint. The lateral femoral-tibial joint is hard to palpate but an obvious swelling may be identified.
• Use your fingertips on the medial aspect of the leg to try and identify effusion in the medial femoral-tibial joint, this can be subtle
• To assess the femoral-patellar joint, a finger and thumb is placed on either side of the middle patella ligament to identify an effusion in the femoro-patella joint

  
• The tarsus is a common area of concern so pay attention here. The tibio-tarsal joint does most of the bending and hence this may be where an effusion can be felt. Bony abnormalities may be felt over the distal tarsal joint e.g., in cases of distal tarsal arthritis.

  • It may be helpful to palpate from the contralateral side
• Effusion in the tibio-tarsal joint on the LHS = bog spavin
• Bony swelling on the medial aspect of the hock at the level of the distal intertarsal joint and tarsal metatarsal joint = seat of spavin
• what name is given to this effusion?

  bog spavin

  
• what name is given to this bony swelling?

  seat of spavin

  
• seat of spavin is associated with advanced stages of tarsal arthritis. This is most common in older horses with poor hock conformation e.g., cow hocks. A corrective shoe is used for treatment
• bog spavin is a painful condition that can be caused by trauma, poor conformation, joint infection, joint or connective tissue disorders. Fluid can be removed and corticosteroids may be injected into the joint as treatment but these cases can recur
• A squared off toe indicates that the foot has been dragged along the ground.

  
• in the hindlimb, the fetlock, tarsal and stifle regions are more common sites of pain.

  • Out of the 3 the fetlock is the least common
• fill in the blanks

  A) perineural

  B) synovial

  
• fill in the blanks

  A) stifle

  B) tarsal

  C) digital flexor tendon sheath

  
• The tibial and peroneal nerve block goes in at the level of the mid tibia, this can be useful to identify if lameness if from tarsus and below or stifle and above.
• The DBLPN (deep branch of the lateral planter nerve) nerve block is a fairly specific block for the proximal suspensory ligament and is very important. To perform…

  • Limb is held flexed (as it allows the ligament to be closer to the needle) and rested on the vets knee
  • The flexor tendons are pulled medially to open up the injection site
  • Needle is advanced along the axial surface of the lateral splint bone
  • 3ml of local anaesthetic solution is injected (resistance should be low)
  • The horse is re-examined after 10 minutes
• label the image

  A) tibial

  B) deep branch of the lateral plantar

  C) low 4 point

  D) abaxial sesamoid

  E) plantar digital