page_title: Lameness (equine)
section_title: Physical examination and palpation
hierarchical_section_title: Lameness (equine) / The lameness evaluation / Physical examination and palpation
caption_attribution_description: English: Splint from fracture
context_page_description: Lameness is an abnormal gait or stance of an animal that is the result of dysfunction of the locomotor system. In the horse, it is most commonly caused by pain, but can be due to neurologic or mechanical dysfunction. Lameness is a common veterinary problem in racehorses, sport horses, and pleasure horses. It is one of the most costly health problems for the equine industry, both monetarily for the cost of diagnosis and treatment, and for the cost of time off resulting in loss-of-use.
context_section_description: One of the first steps of the lameness examination is to evaluate the horse at rest. A good evaluation of conformation, including overall body type, can help the practitioner determine the potential cause of lameness. Certain conformational defects can predispose a horse to injury, and knowledge of correct conformation can help narrow down possible causes of injury, especially when combined with the horse's history. The horse's stance is also evaluated. Frequently resting a particular leg, "pointing" a foot (holding a leg out in front of the body), or standing in an abnormal position can indicate compensation for an injury. Shifting of weight is normal in the hind legs, but frequent shifting of weight in the front legs, or placing both front feet in front of the body, can indicate bilateral forelimb lameness. Stifle pain sometimes causes a horse to stand with the stifles rotated out. Hip and pelvic pain can produce a toe-out, stifle out, hock-in stance and that remains present at the walk.
  Asymmetry of the muscular structure, due to muscle atrophy, usually occurs on the side of the lame limb. Hind limb lameness or pelvic fracture can cause unilateral atrophy of the middle gluteal or gracilis muscles. Damage to the suprascapular nerve can lead to atrophy of the muscles of the shoulder (supraspinatus and infraspinatus). Neck muscle atrophy can be seen with cervical vertebral malformation (Wobbler's disease), articular facet osteoarthritis, and neurologic causes of lameness. Asymmetry in a limb can also occur due to swelling of a joint or soft tissue. For this reason, each leg should be compared to its partner.
  After a visual exam, the practitioner palpates the horse, feeling for heat, swelling, and sensitivity to pressure indicating pain. Palpation is usually most thoroughly performed in the lower limb, but a comprehensive exam will include palpation of the back, pelvis, and neck. Joints should be palpated for pain, effusion of joint pouches, thickening of the joint capsule, and checked for range of motion. Major ligaments and tendons, such as the superficial and deep digital flexor tendons, inferior check ligament, suspensory ligament, and distal sesamoidean ligaments, should also be palpated along their entire length. Individual bones may be palpated if injury is suspected, such as a fracture, bucked shins in racehorses (cannon bones), or splints (splint bones).
  Specialized manipulative tests can be used to help identify specific areas of pain:
  The Churchill test: pressure is applied to the plantar surface of the head of the medial splint bone. A painful horse will flex and abduct the limb, indicating hock pain.
  Peroneus tertius rupture: The hock is pulled into extension while the stifle is flexed. A positive test (the ability to extend the hock) indicates a ruptured peroneus tertius muscle.
  Patella displacement: the patella is pushed laterally and proximally, to test for upward fixation of the patella.
  Cruciate test: the examiner moves the tibia sharply caudally, to feel for movement away from the femur or crepitus. Excessive movement can indicate cruciate rupture.
  Test for stifle collateral ligament damage: the stifle is held still, while the distal limb is abducted (to test for damage to the medial collateral ligament) or adducted (to test for lateral collateral ligament damage). Excessive movement by the distal limb relative to the stifle suggests rupture of the collateral ligament. Sprain of these ligaments can be evaluated by repeating this test multiple times, before trotting the horse off an looking for lameness.
caption: Splints can be palpated on physical examination.
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