Plan of action

Our plan of action/ diagnostic workup for this foal is as follows:

Manipulative tests:  Since we are not sure which joints were manipulated during the 
initial examination, we want to do these tests to localize the lameness to the right hind 
fetlock.  We would either flex the joint for 30-90 seconds (flexion test) or apply digital 
pressure to the ligaments, being sure to keep the other joints stable. A positive response, 
exacerbation of the lameness, indicated that the problem is with that joint.  These tests are 
subjective and to further localize the lameness, w e must do diagnostic anesthesia.

Diagnostic anesthesia:  Nerve blocks also can be used to localize the lameness to a 
specific area. Reduction /resolution of lameness following block of a certain region is a 
positive response.

Orthopedic exam:  Does foal exhibit pain more on flexion or extension of the joint?  This 
may be important in diagnosis.

Radiographs:  Once the lameness is localized, presumably to the right rear fetlock, we 
would proceed with radiographs. We would be looking for radiographic signs consistent 
with our hypotheses.  A fracture to the distal metatarsal bone, proximal long pastern, or 
sesamoid bones would be apparent.  Dislocation also would be apparent.  Radiographic 
signs associated with septic arthritis include perarticular soft tissue swelling, distension of 
the joint, subchondral bone lysis, periosteal proliferation at the joint margins.  Congenital 
changes may include incomplete ossification or asymmetric growth.  If no bony 
abnormalities are noted, we would want to assess the joint by ultrasound.

Ultrasonography:  This method is preferred for assessing soft tissue injury, such as to 
ligaments and tendons.  The location, nature, and extent of the injury can be determined. 
We could recognize tendon lesions associated with tendinitis or tenosynovitis, tendon 
lacerations from trauma, ligament desmitis.

Joint tap- A normal joint tap would rule out localized septic arthritis.

CBC:  A complete blood count could be done to rule out systemic illness/infection.  
Would see inflammatory leukogram with infection.