Once the practitioner has acquired additional information through the clinical examination, further diagnostics (e.g. nerve blocks) should be conducted. Depending on exam results, radiographs, nuclear scintigraphy, computed tomography (CT)
or magnetic resonance imaging (MRI) may be employed if available and warranted.
Imaging may be performed as part of a lameness examination but should never take the place of a thorough physical exam. In
this case, a radiograph revealed a circular lytic lesion in the proximomedial aspect of the cannon bone (see sample lameness
examination report for more details). (RADIOGRAPH COURTESY OF DR. HOGAN)
"A lot of young veterinarians might want to engage various technologies before they have established where the problem is,"
Mitchell says. "I do think imaging is important, but people often leap to imaging too quickly."
Mitchell states that if there's obvious pathology, such as a bowed tendon, a swollen leg that's hot and sore or a weight-bearing
issue—injuries that are readily apparent—it's not necessary to employ nerve blocks. "Nothing replaces a thorough clinical
examination," he says. "That cannot be emphasized enough."
Dr. Richard Mitchell flexes a horse’s front leg as part of a lameness examination. (PHOTO COURTESY OF DR. MITCHELL)
For the average practitioner who may not have advanced diagnostic equipment, Mitchell encourages a thorough workup to establish
the location of the lameness and establish a case for referral to acquire specific imaging.
"Referring lameness cases and being responsible to the client can be a practice builder," he says. "We have built some wonderful
relationships with referring veterinarians. We all help one another out, and we all benefit. When it comes to building one's
business, the relationships between referring veterinarians and other practices can't be overemphasized."
Ed Kane, PhD, is a researcher and consultant in animal nutrition. He is an author and editor on nutrition, physiology and
veterinary medicine with a background in horses, pets and livestock. Kane is based in Seattle.
1. Mitchell, R. Distal limb lameness in the sport horse: A clinical approach to diagnosis, in AAEP Conference Proceedings 2013;59:244.