Equine Lameness Examination Diagnostics

Equine Diagnostic Nerve & Joint Blocks
Digital Equine Musculoskeletal Ultrasound
Digital Equine Radiography

Equine Diagnostic ​Nerve & Joint Blocks

A dynamic motion and static physical examination lay the foundation that help determine which diagnostic processes will be of value.
Particularly in cases of limb lameness, nerve or joint "blocks" are used to further localize and rule out a myriad of other possibilities.

​Blocking can be a vital part of the diagnostic process. You should expect to have this procedure included in your lameness evaluation.
​After a sterile preparation of the skin called "scrubbing", a small amount of anesthetic, similar to Novocaine that is used by human dentists, is injected under the skin near the nerve or nerve bundles or directly into the joint. The horse is then evaluated in motion to determine if there is improvement due to "blocking" of the pain signal.  The amount of time we wait between administration and evaluation depends on which block. We may evaluate the horse right away or we may wait 15 minutes. If there has been no improvement in lameness, we go onto the next level of blocks. The first block will always be the lowest on the limb and we work our way up the limb as needed. Most nerve blocks and some joint blocks do not require bandaging but some joint blocks are protected by a bandage.

How Long Does It Take?
Blocking can take a half hour or 3 hours, it just depends on how far up the limb we have to go. Occasionally,  it is necessary to block again on another day to prove the location of pain has been adequately identified. If multiple blocks have been done, most horses will get intravenous phenylbutasone "IV bute" to minimize tissue inflammation from needle insertion.

​Marking the location of three separate levels of nerve blocks.  The lowest one, near the hoof, is usually the starting point unless there is clinical indication that the problem does not involve the structures in the hoof.

Equine Musculoskeletal Ultrasound

Equine musculoskeletal ultrasongraphy is one of Dr. Morgan's favorite subjects to talk about, to do, to teach, to research. Under the guidance of Dr. Jean-Marie Denoix and the International Society of Locomotor Pathology  she has learned how to effectively evaluate every joint, tendon and ligament in the horse from the neck, back and pelvis to the entire front and hind limb using ultrasound.
Morgan Equine has a GE LogicE  laptop digital ultrasound machine that is full of features and specialty probes to see detail with extraordinary clarity. We are no longer limited to fuzzy black and white static while ultrasounding the tendons on the back of a cannon bone. Every soft tissue part including the eye, spinal cord and some bone structures can be ultrasounded. Its an extremely sensitive diagnostic tool.

​Once a focal area of concern has been established, usually confirmed by blocking,  the horse's focal area of interest may need to be clipped to be evaluated. Hair does not make a good acoustic window. The quality of the scan may be compromised if not clipped. In the summer time in some areas on the body this may not be necessary. The skin is prepared with warm to hot water and acoustic ultrasound gel.
The appropriate probe (big, little, deep or shallow) is used to evaluate the area. Ultrasound allows us to evaluate the morphological characteristics of soft tissue and bone structures. We can determine the size, shape, echogenicity (whiteness or brightness), fiber pattern and fluid associated with any structure.
Initial lameness ultrasound evaluations may take an hour. Progress evaluations typically take 20 to 30 minutes or less.
​Ultrasound can be used to administer therapies. You may see Dr. Morgan do an ultrasound guided injection of a lesion or into a joint. This technique more precisely delivers treatment to the intended area. Its crucial for the neck, back, sacroiliac, foot and stifle areas and requires advanced ultrasound skills.
To accomplish ultrasound guided injection,  the probe is prepared with a sterile cover, the area to be injected is prepared with surgical scrub techniques and a sterile injection protocol is followed. It is imperative that the horse remains still during this procedure, even if they are so very good, a small amount of sedation may be administered. The preparation and definitive placement can take a half hour. The actual injection part of the procedure is very quick. A bandage may or may not be used depending on the location of the injection. ​

Indications for Equine Ultrasonography

• Diagnosis of soft tissue injuries. These can be  muscular, vascular, tendon, tendon sheaths, ligament, joint capsule, or bursal defects
• Assessment of fluid accumulation
• Evaluation of joint and bony surfaces
• Monitoring  healing progress
• Monitoring the effect of training on soft tissue structures, especially tendons and ligaments

Equine Extremity ​Digital Radiography

Digital radiographic equipment provides consistent image quality and the ability to find small bone and soft tissue detail on a single image. We also have significantly less exposure of radiation to horses and humans and the time it takes to process information is undeniably one of the most attractive features.
We use an Eklin DR system with a minXray generator. We can image limbs, the skull, neck and portions of the back. Pelvic images require a much bigger machine to capture images in the standing horse. Most horses tolerate radiography well. Depending on the nature of the horse; sedation may or may not be necessary to take diagnostic quality images.
Images are obtained by capturing x-rays on a plate that is connected to a computer that processes information with complex logarithms. The best part for clients is that images are taken, viewed and interpreted immediately during the visit. 
Dr. Morgan will interpret the images and explain any unusual findings and their significance. She will take her time making sure you are confident  in your understanding of the findings. It is important to remember that abnormalities found on radiographs might not necessarily be a problem.
​It can take about a half hour to an hour to radiograph a horse. Evaluation of images and consultation will take as long as you need to understand the issues.
Typically, after radiographs are evaluated there are two possibilities. Either more information will be necessary to come to a conclusion or a therapeutic plan begins to develop.
Radiography can be diagnostic for many conditions, but remember it's use is typically confined to evaluating bone structures.
Many people ask about Pre-purchase radiography. What should I have done? How many? How much does it cost?  Taken by Who? Can Dr. Morgan evaluate them?
The answers to those questions are different for each situation. Each horse has a specific job it needs to fulfill. It might take 4 radiographs or 36 to make a decision.  A general rule of thumb is to set aside 5% of the cost of the horse for a pre-purchase exam and diagnostics including radiography. Images or links to images can be sent to morganequine@gmail.com.

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