Lameness Galore

            Lameness is a major part of any equine practice and I have been learning about the finer points from Dr. Genovese. After 50 years in practice, Dr. Genovese is still seeing appointments six days and taking students from high school through vet school under his wing. He uses a precise and systematic approach to each case, which ensures a complete and detailed evaluation. All of the vets here, including Dr. Genovese, take a very different approach to evaluating lameness than I have been exposed to. When the horse walks into the clinic, a technician takes a detailed history and the students (including me) perform a physical exam. Then Dr. Genovese palpates each limb and the back thoroughly, noting any abnormalities. Following him, we students palpate the horse to get the feel for normal and abnormal. When I began, I could only palpate a digital pulse; now I can identify tenosynovitis, capsulitis, stifle laxity, hock sensitivity, and effusion of the stifle/carpus/carpal sheath/ fetlock/coffin joint. I am still working on differentiating effusion of the specific hock joints and identifying swelling in the suspensory ligament. After the palpations, we take the horse out to jog on the cement. Dr. Genovese usually selects a student to flex all four limbs (I have lost track of the number of horses I have flexed in the last four weeks, but I am now 100% comfortable performing flexions.) Being a truly wonderful teacher, he always takes the time to explain what he sees or hears that indicates lameness. If the case dictates, we then lunge the horse on a soft surface. Depending on the situation, we will then perform diagnostic nerve blocks, take radiographs, ultrasound the limbs, or jump straight to treatment.
            Dr. Genovese was one of the pioneers of using ultrasound to evaluate soft tissue injuries in the equine limb. He, again in a very systematic manner, scans the zones of the “affected” limb and the contralateral “normal” limb in both longitudinal and cross-sectional orientations. Then he takes a split screen side-by-side comparison of each zone in both limbs to identify subtle increases in size. Once he has completed his scan, he gives the probe to me to play with. Some days, he gives me assignments to find specific structure attachments or zones. Other days, he challenges me to replicate his complete scan on the normal limb. Ultrasound is a very tricky art (frustrating for me), but Dr. Genovese is very encouraging and patient, helping me slowly improving each time I put a probe on a leg.
            As a side note, the vets here use many more parameters to evaluate the horse lameness than we were taught in school. The “down on sound” adage in the forelimbs still stands, but here they look for a hip hike to denote hind end lameness. On top of that, they look at the length of stride over all and in the front/hind ends individually. The path and pattern of each footfall, especially in the hind end, can help differentiate a potential problem in the stifle from the hock from the fetlock. It amazes me how accurately they can diagnose a problem by synthesizing the history, palpations, motion, and flexion findings before even blocking the area of suspicion. This is especially helpful on the road when taking the time to systematically block from the foot up is not practical.