What does your equine vet really mean?

Equine vets are notorious for using veterinary terminology that can leave horse owners feeling confused and unsure what that really means for them and their horse. So, in order to help demystify their language, we’ve selected four of the more common sayings and explained what exactly they mean…

Lameness Work-Up

Lameness is where the horse changes its way of going to try and reduce the pain it feels when moving or because of a mechanical issue. A lameness work-up is where the vet looks for the source of pain so that they can then suggest the most effective forms of treatment to get the horse back to normal and out of pain.

There are six different stages to a lameness work-up:

1. History

This is where the vet sits down with the owner and discusses the horse’s history, such as when did the horse first start presenting with the lameness or behaviour change, what activities they use the horse for, how long have they owned the horse, has the horse had any relevant injury and/or subsequent treatment in the past, and other changes in the horse that could be contributing to the problem.

2. Static examination

During a static exam (the horse is stood still), the vet will look closely at the horse’s feet, discuss its shoeing history and look for evidence of imbalance in the feet and other conditions such as side bone (bony formations on the coffin bone). They will also feel the legs, looking for any heat or swelling, blemishes or splints on the cannon bone, and any thickening in the tendons and ligaments that might indicate recent or historic injury. The vet will also feel all over the horse, squeezing and palpating certain areas such as the tendons in the legs and the muscles in the back to see if they can elicit any pain responses – it could give a good idea of where the lameness is coming from before they’ve seen the horse move.

3. Dynamic examination

The vet then watches the horse move in a straight-line trot. We choose trot because it’s active enough to put the limbs under pressure so that a lameness or source of pain will be invited to show itself, however, it’s not so quick that it’s a blur to the eye. The other advantage is that trot is a two-time gait, which gives you a chance to compare sides. This is vital in determining where the lame limb is. The vet may then perform a flexion (see separate section on flexion tests).

4. Lunge

Once the flexion tests are done, the horse is lunged in a circle on both a soft and hard surface, on both reins. The relevance of the different surfaces is that, if the horse is worse on the hard surface, the problem is probably, but not always, in the foot. This is because the limb is coming against a more unforgiving surface, and any painful parts in the feet will induce a pain response in the horse. If a horse is worse on the soft, it is often the ligaments and tendons that are the cause of pain, as soft surfaces ask more from those structures.

5. Ridden exercise

This isn’t always required as the vet may have already identified the issue during the other stages, but if the horse hasn’t shown anything obvious to note, we may ask to see the horse ridden. If the horse is worse under saddle, then that could point to the back being the cause of pain, such as a badly fitting saddle, a painful sacroiliac region, mid-back pain or potentially a bitting problem.

6. Nerve blocks

Once we have identified a region where the lameness is coming from, we will regionally block out (numb) the area to try and further pinpoint exactly where the pain is. This will remove some of the pain, so when the horse is represented for the trot up, lunge and ride, you should see an improvement in their lameness. That then enables us to focus our imaging on the correct area and hopefully identify the cause of the lameness and the most effective and appropriate treatment.

None of these individual parts will be a complete answer in their own right, but they give us extra information and help us to create an overall picture to find out what is potentially going wrong.

Flexion Test

Flexion tests are often performed during a lameness examination, and are where the vet holds the horse’s leg up for 45–60 seconds to apply pressure on the structures inside the limb, before the horse is trotted away in a straight line. If a horse takes more than three to five steps to return to a normal gait, it is classed as positive and could indicate an issue within a joint and/or the soft tissue. A flexion test can focus on the lower limb and the upper limb separately, which narrows it down further.

Medication

This is where a vet directly injects a type of medication into a joint to remove pain and improve function. There are a variety of different medications available, but the most commonly used is a long-acting steroid with strong anti-inflammatory properties. This removes or reduces inflammation, preventing a pain trigger to the nerves.

In joints where there are no structural changes, medication can be incredibly helpful. If there is a cartilage lesion or something wrong with the function of the joint, however, introducing steroids would stop the pain but encourage the horse to use the joint, which in this case could make the problem worse.

Therefore, medications have to be used carefully and in an informed way. There are also products containing Hyaluronic acid, which can be injected to help repair cartilage in the joints. They don’t have such a profound impact on the horse’s pain response as a steroid does, but it can improve the long-term health of the joint.

We also have stem cells that can be injected, creating an environment for healing and morphing into the joint tissue that is damaged.

Scoping

A scope is a long tube with a camera on the end that a vet inserts into the horse to investigate certain structures within their body.

There are two types of scope:

Respiratory scope

With a respiratory scope, we look at the structures in the horse’s throat such as the larynx. If there is an abnormality or paralysis in that area, it can obstruct inspiration of air and impact the horse’s ability to breathe properly, especially when being exercised. We can then move the camera down the windpipe into the lungs to look for any discharge, dust or infection present, which is vital for horses with persistent coughs, a heavy breathing rate or those making a noise during exercise. We can take samples from those areas and have those assessed at a laboratory to identify any issues present and help inform treatment. Some horses don’t need to be sedated for a respiratory scope and most horses are back to normal straight after the procedure.

Gastroscopy

A gastroscopy involves a small camera being inserted through the horse’s nose enabling a vet to see its stomach, and is often used to check for stomach ulcers which are a potentially serious ailment that cause the horse discomfort, particularly at ridden exercise. Ulcers can result in the horse showing discomfort when being groomed, tacked up and ridden, having a dull coat and suffering episodes of colic. Recovery can take many months depending on the severity and location of the ulcers. The gastroscope is longer than a respiratory scope, because the oesophagus is longer, and we go through the nose and drop down into the stomach rather than through the mouth. To be gastroscoped, a horse is sedated as the first three inches of the scope going in can be uncomfortable for the horse. The horse will also need to be starved 12–14 hours prior to a gastroscopy so that the stomach is empty, enabling the vet to see the lining.