the less than obvious lameness and the horse that travel unevenly dr. olivier simon, dmv diplomate...
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EHPC- The University of Adelaideadelaide.edu.au
Olivier Simon, DMVDiplomate ECVS
The less than obvious lameness and the horse
that travel unevenly
Northern Horse Forum – Roseworthy 20/04/2017
EHPC- The University of Adelaideadelaide.edu.au
Facts
• Lameness is one of the major causes of poorperfomance in (any level of) horse sport
• It has a major impact on finance and enjoyment
• Horses are not able to speak our language
• Not all lamenesses are foot abscesses
EHPC- The University of Adelaideadelaide.edu.au
What do we consider as lameness?
• Any gait or stance abnormality resulting in asymmetry
• Includes:– Shifting body weight - Head nodding
– Unloading - Hip hikes
– Relieve - Hip dips
– Alleviate
– Drifting
– Dragging
– Falling on one leg
EHPC- The University of Adelaideadelaide.edu.au
What do we consider as lameness?
• Any gait or stance abnormality resulting in asymmetry
• Includes:– Shifting body weight - Head nodding
– Unloading - Hip hikes
– Relieve - Hip dips = LAMENESS
– Alleviate
– Drifting
– Dragging
– Falling on one leg
EHPC- The University of Adelaideadelaide.edu.au
Semi-quantitative
• AAEP (5 grades) lameness scale– Grade 0: not perceptible under any circumstances– Grade 1: Difficult to observe and not consistently
apparent regardless of the circumstances– Grade 2: Difficult to observe at a walk or when
trotting on straight line but consistently apparent under certain circumstances
– Grade 3: Consistently observable at at trot under all circumstances
– Grade 4: Obvious at a walk– Grade 5: minimal weight bearing in motion or at
rest/complete inability to move
EHPC- The University of Adelaideadelaide.edu.au
Semi-quantitative
• AAEP (5 grades) lameness scale– Grade 0: not perceptible under any circumstances– Grade 1: Difficult to observe and not consistently
apparent regardless of the circumstances– Grade 2: Difficult to observe at a walk or when
trotting on straight line but consistently apparent under certain circumstances
– Grade 3: Consistently observable at at trot under all circumstances
– Grade 4: Obvious at a walk– Grade 5: minimal weight bearing in motion or at
rest/complete inability to move
EHPC- The University of Adelaideadelaide.edu.au
Semi-quantitative / subjective
• AAEP (5 grades) lameness scale– Grade 0: not perceptible under any circumstances– Grade 1: Difficult to observe and not consistently
apparent regardless of the circumstances– Grade 2: Difficult to observe at a walk or when
trotting on straight line but consistently apparent under certain circumstances
– Grade 3: Consistently observable at a trot under all circumstances
– Grade 4: Obvious at a walk– Grade 5: minimal weight bearing in motion or at
rest/complete inability to move
EHPC- The University of Adelaideadelaide.edu.au
Other scales
• 1 to 8 (UK)
• 1 to 10 (F)
– Matter of subjectivity
– « Arts » of practice
>>> variability and disagreement => risk of multi-consultations
EHPC- The University of Adelaideadelaide.edu.au
Other classic complains aroundlocomotor system
• Poor lateral translations
• Poor extensions
• Cross galloping
• Bunny hoping / poor dissociation at the gallop
EHPC- The University of Adelaideadelaide.edu.au
Typical stages of a lamenessexamination
• Is the horse actually lame?
• From which leg(s) is the horse lame?
• Which segment of the localized leg(s) is the source of lameness?
• What is the nature of the lesion of the particularregion of the lame leg(s)?
• What is the treatment?
• What is the prognosis?
• What are the costs?
EHPC- The University of Adelaideadelaide.edu.au
Classic assessment
• Observation with naked eye
EHPC- The University of Adelaideadelaide.edu.au
Classic assessment
• Observation with naked eye
• Qualitative
EHPC- The University of Adelaideadelaide.edu.au
Classic assessment
• Observation with naked eye
• Qualitative
• Semi-quantitative (scales)
EHPC- The University of Adelaideadelaide.edu.au
Classic assessment
• Observation with naked eye
• Qualitative
• Semi-quantitative (scales)
• At a trot (most of the time)
EHPC- The University of Adelaideadelaide.edu.au
Why examining horses at a trot?
• Only symmetric natural gait of the horse
– Two symmetric impact « times » with an intermediate gliding (suspension) time
Lameness is by definition asymmetry
EHPC- The University of Adelaideadelaide.edu.au
Limitations of this classic approach
• Naked eye have a reduced sampling capacity– about 10 samples/seconds vs min.200 s/s for
videocamera recorder
• Multiple lamenesses– Primary and secundary lameness– Primary and compensatory lameness
• Hind limb lameness is always more difficult to assess
• What about gaited horses?• What about axial skelettal (« back ») injuries?
EHPC- The University of Adelaideadelaide.edu.au
Limitations of « naked eye » exam
• Need of objective gait / lameness evaluationmodalities
– No or less bias
– More sensitive : higher data sampling capacity
– Repeatable
– Quantitative
EHPC- The University of Adelaideadelaide.edu.au
Objective evaluation of lameness types
• Kinetic technique: study of the forces thatproduces or are produced by the movement
• Kinematic : descriptive analysis and quantification of the movement
• Electromyography: mesurement of the muscular activity during movement
UC Davis, Ca
EHPC- The University of Adelaideadelaide.edu.au
Objective evaluation of lameness types
• Kinetic technique: – Stationary force plate: measures vertical, horizontal
and transverse forces
Lameness generally => decrease in vertical forces
UC Davis, Ca
EHPC- The University of Adelaideadelaide.edu.au
Objective evaluation of lameness types
• Kinetic technique alternatives:
– Pressure mats and « in-shoe » systems
• Not durable not as repeatable as force plate
– Force measuring horse shoes
• None commercially available
– Force measuring treadmill
• One-of-a-kind U. Zurich
EHPC- The University of Adelaideadelaide.edu.au
Kinematic
Eadwaerd Muybridge 18th century
EHPC- The University of Adelaideadelaide.edu.au
Eadwaerd Muybridge Sally Gardner at at Gallop 1878
EHPC- The University of Adelaideadelaide.edu.au
Modern motion capture systems
Qualisys AB, Göteborg Sweden
EHPC- The University of Adelaideadelaide.edu.au
Combination of kinetic and kinematic
EHPC- The University of Adelaideadelaide.edu.au
Body-mounted inertial sensors
• Giroscopic sensors (1 – 3 – 8 – 18) attached to the horse’s body and wireless transmittingdatas to evaluator
• Multiple systems on the market allowing use in natural environment
EHPC- The University of Adelaideadelaide.edu.au
Equimetrix®
EHPC- The University of Adelaideadelaide.edu.au
Equusys®
EHPC- The University of Adelaideadelaide.edu.au
Equinosys® Lameness Locator®
EHPC- The University of Adelaideadelaide.edu.au
Lameness Locator®
EHPC- The University of Adelaideadelaide.edu.au
Clinical case
• 10 years old riding poney mare
• Pleasure riding
• Was operated 1 year before for OC RF fetlock
• Lost of condition
• Locking movement right hind downhill
EHPC- The University of Adelaideadelaide.edu.au
Clinical case
EHPC- The University of Adelaideadelaide.edu.au
Clinical case
EHPC- The University of Adelaideadelaide.edu.au
EHPC- The University of Adelaideadelaide.edu.au
EHPC- The University of Adelaideadelaide.edu.au
EHPC- The University of Adelaideadelaide.edu.au
EHPC- The University of Adelaideadelaide.edu.au
EHPC- The University of Adelaideadelaide.edu.au
EHPC- The University of Adelaideadelaide.edu.au
Flexion test
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EHPC- The University of Adelaideadelaide.edu.au
Local anaesthesia DBLPN LH
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Local anaesthesia DBLPN RH
EHPC- The University of Adelaideadelaide.edu.au
Conclusion
• Subtle lameness evaluation can be very tricky
• Subjective qualitative evaluation alone is toolimited
• Objective kinematic systems commerciallyavailable BUT have also some limits
– They can not substitute practitionner
– Bilateral symmetric lameness
– Back and neck problems
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