There are 4 basic signs of tendon/ligament injury:
1. Lameness
2. Heat
3. Swelling
4. Pain
Checking your horse's legs everyday is a very important step to recognizing signs of injury. If you are familiar with the feel of your horse's legs, you will immediately be able to pick up abnormalities to the leg. The earlier you are able to identifying the better. These injuries are easier to treat when in the early stages.
Lameness
Not all injuries will produce lameness as a sign. In mild cases the horse will usually limp or bob it's head. In severe cases the horse won't be able to put any weight on the leg or will severly bob his head while walking.
Heat
This is often caused by inflammation. The increased blood flow to the area causes it to become hot.
Swelling
This is a common sign of acute tendon/ligament injury. It is caused by inflammation. The blood vessels dilate and fluid leaks into the tissue to repair damaged tissue. Bleeding (hemorrhage) into the tissue can also cause swelling.
Pain
The inflammation process causes the area to become painful, making them painful to touch. You can detect the pain through palpation (feeling the injured leg with your fingers).
The Lameness Exam
When the vet is called out he/she will ask you about the horse's history, age, competition, level, activity preceding the injury, training schedule and medications. This will all help to give the vet a clearer picture of what may have happened.
The vet will start off observing the legs by running his/her hands down each leg. Conformation and shoeing is noted, and all joints, tendons and ligaments observed. The back, rump and leg muscles are checked for swelling or atrophy (degeneration). Each hoof will be tested with hoof testers to rule out any hoof abnormalities.
The vet will then ask an assistant to walk and trot the horse in a straight line and in circles in both directions. When observing the front legs the vet will look for signs of a bobbing head. Every time the horse steps on the injured leg, he will lift his head. It is thus important that the horse can move his head freely when being observed. If the horse does not appear lame at the walk it has to be trotted (each leg has to carry more weight so horse more likely to show lameness). Lameness at the walk is indicates a severe injury. When observing the back legs the vet will look for signs of the hips dipping. If weight is placed on the injured leg, the hip on that side will usually appear to fall down.
Once the vet identified the injured leg he/she may palpate the lower leg to help isolate the problem. Each tendon/ligament will be palpated one at a time, starting below the knee. The vet will run his/her fingers down inch by inch, carefully testing for any pain.
To accurately diagnose the lameness the vet will need to perform one or more diagnostic tests. These tests includes:
1. Flexion Tests
2. Nerve Blocking
3. Thermography
4. Ultrasound
5. Radiographs (X-Rays)
Flexion Tests
This is used by the vet to identify joint problems and can be useful in diagnosing tendon/ligament injuries as well. Flexion tests involves stressing of the joint by bending (flexing) it for 30 seconds to 2 minutes. The horse is then trotted out. If the lameness is more pronounced than before, the problem lies in that joint. Care should be taken, because by stressing the joint further injury can be caused, especially with DDF tendon injuries. A positive flexion test does not rule out a tendon/ligament injury. To rule out fetlock joint problems the vet may use nerve blocks.
Nerve Blocks
A local anesthetic is used to block the nerves to one of the tendons/ligaments. The horse is trotted out again and if the lameness disappears then that particular tendon/ligament is the cause of lameness. This test can lead to complications such as septic and infectious arthritis.
Thermography
This is used to measure and record the temperatures in the horse's legs. These tests aren't always very accurate, because thermography is very sensitive to changes in surface temperatures. It also has limited value in diagnosing a tendon/ligament injury, because it can't show what is going on in the deeper tissue. Thus, thermography is seldom used today.
Ultrasound
Ultrasound waves are used to create a picture of what the leg looks like on the inside. On ultrasound bone looks white, tendons gray and fluid black.
Radiographs (X-Rays)
These help to diagnose bone conditions, such as arthritis and fractures, that could lead to lameness. Tendons/ligaments do not readily appear on radiographs.
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