How we help your horse
Evaluation, diagnosis and treatment of equine illness, injury or disease requires a mix of experienced clinicians alongside facilities, equipment, and experienced staff. The equine clinic can offer expert, caring and conscientious clinicians and staff, alongside superb facilities and state of the art equipment. Various procedures may need to be undertaken, depending on the type of problem, ranging from minimal to multiple. Please see a comprehensive list and details below to see which may apply to your horse, or client.
Clinical Examination | Orthopaedic Examination | Lameness Examination | Prepurchase Evaluation | Nerve Blocks | Radiography | Ultrasonography | Scintigraphy | MRI | Iridium Wire Treatment | Treadmill | Endoscopy | Farriery | Physiotherapy | Euthanasia
Clinical Examination
A full clinical examination is performed on any horse admitted to the clinic, examining each body system. If there is a suspected problem with any body system, then detailed examination of this will be undertaken.
Orthopaedic/Lameness Examination
If there is a potential lameness problem, a detailed musculoskeletal examination will also be undertaken, including palpation and mobilisation of the different structures, followed by a complete gait evaluation. A gait evaluation is likely to include examination in a straight line, on the lunge on both soft and hard surfaces, in trot and sometimes in canter. A ridden examination is very important, as many lameness or poor performance problems look different under saddle.
Pre-Purchase Evaluation
Pre-purchase evaluations can be carried out on an out patient basis. We need to know as much as possible about the horse, its age and intended use, whether or not the purchaser has any reservations about the horse and if it is to be insured for either all risks of mortality or loss of use prior to the examination. We also need to know in advance whether examinations additional to the standard 
5 stage pre-purchase examination are required. For example are radiographs (x-rays) required and if so of what areas? Is an endoscopic evaluation of the upper airways required? Is it necessary to perform an ultrasonographic examination of the tendons or ligaments? Should a blood sample be collected for either storage or immediate testing for the presence of drugs, either for commonly used anti-inflammatory drugs or a whole screen?
It is helpful if both the vendor and purchaser can be present for the evaluation. We ideally require the vendor to sign a declaration relating to the horse’s previous medical history, work status and management history. The vendor or their agent also has to give permission for collection of blood or sedation. If any unexpected findings materialise these can be discussed with the purchaser if they are present and, if appropriate, the vendor. Failing this, we need a contact telephone number for the purchaser so that we can speak with them if examination is necessary.
The horse will be required to be ridden for the examination. We can provide a skilled rider if necessary. If the horse undergoes radiography it will need to be sedated. If radiographs of the front feet are required the shoes will be removed. If we know in advance, it may be possible to arrange for the horse to be reshod.
We can also provide interpretation of radiographs or other images obtained elsewhere as part of a pre-purchase examination. The standard x-ray protocol varies between countries and we can provide a list of the views that we consider necessary. You are advised to contact us in advance.
Nerve Blocks
A nerve block is used to identify the site of pain in a horse’s limb. When a nerve block is performed, a volume of local anaesthetic solution is injected either around a nerve (perineural analgesia) or into a joint (intra-articular analgesia). When injected around a nerve, the areas supplied by this nerve are temporarily desensitised. When injected into a joint, the joint becomes temporarily desensitised, so any pain at that location is not perceived by the horse. This can be useful for identifying where a horse is painful if a lameness is eliminated following a specific nerve block.
What happens when a horse is nerve blocked?
The hair may be clipped and the skin is cleaned with disinfectant solution to reduce contamination. Small amounts of local anaesthetic solution are then injected carefully into standard sites for nerves or joints. Following a block, the horse will wait for a short period and then be assessed clinically to determine whether there has been an improvement in gait.
Radiography
Radiography is an imaging modality that is now an essential component of an orthopaedic diagnostic evaluation. It is made possible by the production of useful, high-energy photons (x-rays) that pass through the area of interest and are used in the production of the resultant image on the specially sensitised film screen.
The resultant radiographs we produce with our recently installed computerised, radiography system are globally regarded as being of outstanding diagnostic quality and have significantly contributed to the AHT’s status of a Centre of Excellence.
Our equipment enables our skilled imaging team to obtain diagnostic images of the entire axial and appendicular skeleton. Our examinations are performed in the standing horse, meaning the horse, although sedated to ensure a calm and efficient examination, can remain conscious throughout.
Preparation for x-ray
Before entering the x-ray room, the area of interest on the horse is prepared by cleaning thoroughly to avoid the appearance of artefacts on the radiographs. The shoes are removed for foot X-rays to provide the best possible images. Our experienced farriers will replace these before the horse is collected if required.
The horse is given an initial dose of sedation outside the X-ray room, which is calculated according to their bodyweight and taking into account the horse’s type and general temperament.
During x-ray examination
The horse is positioned in stocks. The stocks are utilised as a positioning aid by helping to keep the horse as still as possible, as well as being an important safety feature for our staff. The horse is allowed a short period to become accustomed to its surroundings while the horse handler assesses the horses’ reaction to the sedation. When they are satisfied that the horse is content, the x-ray tube is moved into position.
The x-ray plate holder has the choice of 3 sizes of imaging plates, selected depending on the area of anatomy being examined. These are positioned as close to the horse as possible to provide optimum resultant radiographs. Great care is taken in positioning the plate by making the horse gradually aware that the hard object will be placed against them. The radiographer will obtain several projections of each area of anatomy from varying positions, to ensure a thorough and accurate radiographic assessment can be made. Depending on the length of the examination and the horse’s reaction, a further sedative may be required.
After x-ray examination
The x-ray equipment is moved away to allow the horse-handler to lead the horse safely out of the x-ray room and back to its stable. The horse is monitored over a period of time to ensure they are fully recovered from the sedation, before given hay.
The radiographs obtained are assessed by the clinician and a report is generated, which will be combined with the results from any other diagnostic tests and discussed with the owner and referring veterinary surgeon.
Ultrasonography
Ultrasonography is a method of imaging which is widely used for evaluation of soft tissues and the surface of bone. A probe emits ultrasonographic waves, which are then reflected by the tissues back towards the probe, where they are detected. The ultrasonographic waves are reflected differently depending on what tissue structure they contact and it is these differences that are used to create an image where soft tissue structures and the surface of bone can be visualised.
Preparation for ultrasound
Once inside the ultrasound room, the horse is given an initial dose of sedation, which is calculated according to their bodyweight and taking into account the horse’s type and general temperament.
During ultrasonographic examination
The horse is positioned in the room according to the area that is to be examined. The area of interest is clipped and scrubbed to remove any surface grease and dirt which could affect image quality. Gel is then applied to the area as ultrasonographic waves do not travel through air and the gel provides a contact medium between the probe and the horse. The horse is allowed a short period to become accustomed to its surroundings while the horse handler assesses the horse’s reaction to the sedation. When they are satisfied that the horse is content, the ultrasound machine is moved into the room and the examination takes place.
After ultrasonographic examination
The gel is wiped off the area and the area is cleaned to ensure no traces of gel are left on the skin. The horse-handler then leads the horse safely out of the ultrasound room and back to its stable where it is assessed to ensure it is fully recovered from the sedation.
At the time of examination, the clinician assesses the images obtained and a report is generated, which will be combined with the results from any other diagnostic tests and discussed with the owner and referring veterinary surgeon.
Scintigraphy
Nuclear scintigraphy is an invaluable diagnostic imaging modality. While scintigraphic examination can be used to assess a variety of body systems, the most frequent use is to assist in evaluating orthopaedic or lameness problems. Many horses are referred to us specifically for this procedure. Research at the AHT has pioneered its use, which has revolutionised equine veterinary practice.
Scintigraphic imaging uses a radiopharmaceutical, or radioactive marker, as a marker for metabolic activity in a number of tissues. Detection of osteoblastic activity is the most common use of scintigraphic imaging in horses, hence the term ‘Bone Scanning’. Scintigraphy is much more sensitive to subtle bone changes than radiography, therefore highlighting problems before they can be detected radiographically. This is particularly useful in competition horses that may have suffered a problem such as a stress fracture.
Both our gamma cameras are designed to enable quick and efficient acquisition of scintigraphic images of any area of the axial and appendicular skeleton in the standing horse, meaning no general anaesthesia is required.
Preparation for scanning
The night before the scan, the forelimbs and/or hindlimbs are bandaged. These are left on until the horse enters the scintigraphy room. The bandages help maintain a constant temperature in the limbs which will assist in the radiopharmaceutical uptake.
On the day of the scan, a catheter is inserted into a vein in the horse’s neck. This ensures the minimum of irritation to the patient for the remainder of injections throughout the course of the scan. Depending on the level of lameness, the horse is then either lunged or walked for 15 minutes. Exercise has been proven to increase the level of radiopharmaceutical uptake. The horse is then injected with the radiopharmaceutical marker. For musculoskeletal imaging we generally use the isotope called Technetium99.
During scanning
The actual scan begins 2 ½ hours after the injection of radiopharmaceutical. The horse is given an initial dose of sedation, which is calculated according to their bodyweight and taking into account the horse’s type and general temperament. The horse wears ear plugs and blinkers to make him/her less susceptible to the noise and movement of the large gamma cameras. The leg bandages are removed at this point
On entry to scintigraphy, the horse is placed in stocks. Stocks are utilised as a positioning aid by helping to keep the horse as still as possible, as well as being an important safety feature for our staff. The horse handler assesses the horse’s reaction to the sedation before the first image is acquired. A constant level of sedation is maintained throughout the scan.
Each image acquisition takes approximately 2 minutes and the camera is repositioned at the level of the next area of interest. Left and right images are acquired of each area of anatomy, regardless of the side displaying visible gait abnormalityto provide useful comparison. The scan varies considerably in length, depending on the behaviour of the horse and the number of images required
After scanning
The horse is allowed to recover from sedation and the catheter and desensitisation aids are removed. The horse is returned to its stable and has limited contact with staff, until the following morning when the radioactivity will have sufficiently decayed to allow normal handling.
The images acquired are assessed by the clinician and a report is generated, which will be combined with the results from any other diagnostic tests and discussed with the owner and the referring veterinary surgeon.
Magnetic Resonance Imaging
MRI stands for Magnetic Resonance Imaging, and is an imaging technique that uses a strong magnet to create detailed images of bones and soft tissues within a patient. MRI is a non-invasive technique used widely in humans, and increasingly in horses for detection of damage to a wide range of tissues. MRI is particularly useful for orthopaedic injuries affecting bones, joints and soft tissues. Unlike x-rays, MRI does not require the use of ionising radiation. MRI is very versatile in the ability to provide images sliced in many planes, and is capable of producing 3-dimensional images in a variety of orientations. It is possible to visualise structures within the foot and up to (and including) the knee or hock on most horses. It is possible to acquire images using a high field system under general anaesthesia or standing and sedated using a low field system. For safety reasons, if your horse has a pacemaker or metallic implants, then MRI scanning may not be possible.
MRI has led to considerable advances in our ability to diagnose and manage horses with pain localised to the foot, pastern, fetlock and further proximally. The most frequent reason for MRI remains foot pain, to identify both osseous and soft tissues damage, including damage to the deep digital flexor tendon, collateral ligament, joint and laminae. We routinely scan horses with proximal metacarpal and metatarsal pain, and are detecting damage to single lobes of the suspensory ligament, osseous changes or interosseous ligament pathology. MRI of horses with fetlock region pain may show joint and osseous damage, pre-fracture pathology, distal sesamoidean ligament or intersesamoidean ligament abnormality. MRI of horses with pain localised to the carpus or tarsus has allowed us to identify subtle joint or intertarsal/intercarpal ligament abnormalities.
Why send a horse to the AHT for MRI?
First class image acquisition and interpretation with a highly skilled and experienced team
- We have 10 years experience interpreting equine MR images using high and low systems.
- We have validated MR images in horses against post-mortem, histology, radiography, ultrasonography and scintigraphy so can provide a clinical service based on real facts.
- We are consulted on MRI image acquisition and interpretation by equine clinics worldwide.
- We have published and presented more papers on equine MRI than any other equine practice.
- We have ongoing research improving understanding of applications of MRI.
- The AHT is the only clinic worldwide to have both high and low field MRI systems.
We are able to consistently obtain high quality standing or anaesthetised images of:
- Foot and pastern
- Fetlock
- Metacarpus/metatarsus
- Carpus- standing only in most cases
- Tarsus- standing only in most cases
- Head under general anaesthesia only
We offer a personable service for complete work up including imaging as necessary or direct referral for imaging only
We will contact your veterinary surgeon directly to discuss the findings and send a report within 24 hours, including images on CD, email or printed.
Standing MRI
What will happen when my horse is coming to the AHT for a standing MRI?
Before you arrive
You will need to make sure your horse’s front shoes are removed (for forelimb scans) or hind shoes (for hindlimb scans) before you arrive. Any nail fragments or iron filings also need to be removed or they will interfere with the scan picture.
When you arrive
Your horse will be taken to a stable to settle before the scan. You will meet the clinician looking after your horse and will be able to ask any questions at that time. Your horse will have a brief examination to confirm that he/she is well after travelling and able to have the scan.
Preparation for scanning
Before a horse is taken up to the standing MRI room a number of procedures must be carried out to prepare him/her for the scan. Firstly, the horse is brushed off and his/her feet picked out. If the horse has shoes on they must be removed from the legs that are being scanned. Even if we are just scanning one front leg, we will remove both front shoes. This is important as, being metal, they could cause a hazard to the horse as he/she moves towards the magnet. Also, any metal objects positioned within a certain distance from the magnet will cause disturbances on the MR images, known as artefacts. It is not necessary to remove all four shoes as the opposite end of the horse is far enough away from the magnet not to cause a problem. Once the shoes are removed we place a catheter in the horse’s vein in his/her neck through which the sedation will be given via a drip system. The horse is then taken to the MRI room and his/her feet are scrubbed with warm water to remove any dirt from the hooves, which could cause artefacts on the images, particularly if scanning the horse’s feet. Outside the MRI room the horse is given an initial dose of sedation which is calculated according to his/her bodyweight. We also take into consideration the horse’s type and general temperament.
During the scan
On entering the room the horse is positioned to face towards the magnet if scanning the forelimbs, or away from the magnet if scanning the hind limbs. We then allow the horse a few minutes to settle while we assess its reaction to the sedation. When scanning above the pastern area, we apply stable bandages to both legs to reduce the horse’s sensitivity while the leg is in the magnet. Before we move the horse into the magnet we attach the drip to the catheter which allows sedation to be on a constant flow to the horse, with the aim of keeping a steady sedation level. The horse handler is responsible for monitoring the sedation and for making sure the horse is as comfortable as possible throughout the scan.
Positioning the horse for standing MRI requires him/her to stand with the leg to be scanned inside the magnet and the opposite leg to the side of the magnet. The leg is lined up with a centre cross on the magnet and then the magnet can be adjusted so that we have the leg in an optimum position for scanning. A coil is placed around the leg in the area being imaged. The coil emits a signal which creates the MRI image.
Depending on the temperament of the horse, it can take a variable amount of time to acquire the images. Each set of images can take anything from 10 seconds to 15 minutes to acquire, and various sets of images are acquired to give different information or cover different areas.
After the scan
The horse is allowed to wake up slightly in the MRI room, and then returned to his/her stable to wake up from the sedation. The intravenous catheter is removed from the horse’s neck and the area cleaned. Provided the horse has travelled to the AHT in less than 3 hours and there are no complications, in most cases the horse can return home on the day of the scan, following a period of 3-5 hours recovery (unless further investigation/treatment is required). If the horse travelled poorly or travel time exceeds 3 hours, then we advise the horse is admitted or discharged the day before or after the scan respectively to avoid any associated complications such as spasmodic colic. After returning home, the horse should be watched for normal behaviour. Although we have not seen any complications following standing MRI, it has been reported that very rarely horses may show mild colicky signs after sedation, so if you have any concerns then your veterinarian should be contacted.
Results of the scan
Your veterinary surgeon has requested that your horse be referred only for MRI examination of a specific region based on their clinical assessment of your horse. We cannot take responsibility for the clinical work leading to the decision to examine this area, however the results of MRI should assist your veterinary surgeon in making decisions about how to manage your horse in the context of their clinical assessment. As there are a considerable number of images (in some cases over 1000 images) to evaluate from an MRI examination, detailed interpretation is a vital part of the procedure and may take some hours to complete. A report on the MRI interpretation will be sent direct to, and discussed with your veterinary surgeon within 24 hours of the MRI examination. You will then be able to discuss the findings with your veterinary surgeon, who can make a treatment plan in the context of both the MRI findings and results of their clinical assessment.
Iridium wire treatment
From August 2007, radiotherapy using Iridium-192 wires has been available at the Animal Health Trust. This treatment can be used for multiple skin tumours that do not respond to other types of treatment, or for tumours where recurrence is a major problem, including sarcoids, fibrosarcomas and periocular squamous cell carcinomas and melanomas. Iridium-192 treatment is a form of intralesional radiotherapy that is particularly applicable for tumours that are in locations unsuitable for surgical or other forms of topical or systemic treatment. Sarcoids are tumours of the skin and are the most common form of cancer in the horse, donkey and mule. Although sarcoids are unlikely to spread to other body systems, they can be locally invasive and frequently recur following standard treatment options. Often they are not only unsightly, but can become painful related to trauma and therefore limit the work capability of the horse. In the case of periocular tumours the function of the eye may be affected. Iridium-192 wire brachytherapy offers the greatest likelihood of success for many horses with sarcoids, with resolution in 87% and 98% of cases reported (Theon and Pascoe 1994, Knottenbelt and Kelly 2000).
Treatment at the AHT:
Horses admitted for Iridium-192 brachytherapy are likely to be in the hospital for approximately 7- 10 days. Admission on day one will be into a standard stable as routine and will involve examination of the horse and a consultation with the owner. Wherever possible information about tumour size and location will be established prior to offering an appointment to allow for treatment to be planned and appropriate wire activity calculated and ordered, this can usually be done using digital photography over email. The exact treatment protocol will vary according to the size and location of the tumour, and will be calculated based on tumour type as well as location and on activity required to treat the calculated fixed volume of the tumour.
For placement of the wires the horse will be taken into the stocks in the treatment box. The wires will usually be placed and removed under sedation, using local anaesthetic as appropriate, however the option of a general anaesthetic may sometimes be necessary. The preparation of the horse will be completed before the wires are brought into the treatment box. Following placement the horse will be taken to the isolation yard and settled into a deep litter bed.
During treatment contact with your horse will need to be kept to a minimum to minimize staff exposure to radiation. As a result your horse will be “deep littered” and the stable will not be mucked out during the treatment time. However, a member
of staff will check on your horse regularly as for all hospitalised patients and feeding and watering will be carried out as routine.
Once the wires are removed there will be no residual radiation within the horse and so horses can be discharged shortly after removal. Following treatment the tumour will gradually reduce in size over the forthcoming weeks. On average, the tumours resolve by three months post treatment. In horses with dark coats there is often some white hair regrowth at the site of the tumour but otherwise there is minimal scarring post treatment.
Endoscopy
An endoscope is a device which employs fibre optics in order to visualise some of the internal structures of the horse, such as the airways and upper gastrointestinal tract. The endoscope is a long, thin, flexible device which can be inserted into the horses airways or gastrointestinal system via the nose. The direction the endoscope takes is controlled by a hand-held system, which allows precise control of the endoscope to obtain views of the required structures. The images obtained are relayed to a television screen and recorded.
At the Animal Health Trust, endoscopy is most commonly employed to visualise the larynx during treadmill testing. However, it is also used to assess the larynx and the upper airways at rest. It can also be used to visualise the guttural pouches, the remainder of the upper airways, the oesophagus and the stomach.
What happens when endoscopy is performed?
The endoscope is sterilised to ensure that its use is as safe as possible. The horse is in a room with stocks, unless it is to be assessed on the treadmill, in which case the horse will be taken to the treadmill room. Unless the horse is to be assessed on the treadmill, he/she may be given a dose of sedation calculated according to the horse’s bodyweight, breed and temperament.
The endoscope is inserted gently into one of the horse’s nostrils. The direction of the endoscope is then guided by the clinician while an assistant guides the endoscope further into the airway or the gastrointestinal tract. Once the area of interest has been located, the clinician can control the view obtained by the endoscope using the controls to guide the tip of the endoscope. The image acquired appears on a television screen and is recorded.
After endoscopy
After the endoscope is gently removed, the handler removes the horse from stocks and takes him/her back to their stable where they are given time to recover from sedation. The endoscope is washed thoroughly and sterilised ready for its next use.
The images obtained are assessed by the clinician and are used in conjunction with the clinical signs of the horse and other diagnostic techniques to reach a diagnosis. The results are then discussed with the owner and veterinary surgeon.
Stem Cell Treatment
Stem cell treatment is a novel, and as yet, not fully proven method of treatment of tendon and ligament injuries. The technique involves first of all harvesting bone marrow, from which the stem cells will be cultured. Bone marrow is extracted from the sternum (breast bone) using a special needle. The horse is sedated for this procedure. The bone marrow is collected into special receptacles in order to protect the cells, which are sent away for culture. Culture takes 2 to 3 weeks. We are informed when sufficient cells have grown and our secretaries contact the owner of the horse to arrange a date for stem cell implantation. This is done on an out patient basis. The horse is sedated and the injured tendon or ligament is reassessed ultrasonographically, and then the cells and various growth factors are injected into the damaged tissue under ultrasound guidance.
This treatment aims to improve the quality of repair, to reduce the risk of re-injury, and does not influence healing time. Treated horses will be in a controlled exercise programme for up to 12 months before resuming work. During this time progress is assessed periodically by repeated ultrasonographic examinations. Preliminary results show that acute injuries are probably those that are treated most successfully, so early diagnosis is important.
Farriery
Mark Rose has been a farrier for 35 years and has been at the AHT Equine Clinic for 20 years, he has his AWCF which means he is an Associate of the Worshipful Company of Farriers, he achieved this in 1989.
Mark does remedial work alongside veterinarians under their instruction for rebalancing of feet, which are a cause of a lot of equine problems. Mark also does specialist shoeing during the ongoing treatment of our patients.
He is also an ATF (approved training farrier) which means he can train apprentices to their Diploma standard (DipWCF).
Physiotherapy
Horse & Rider assessments and treatments for management of orthopaedic and poor performance problems with Jo Spear MCSP, BSc Category A ACPAT registered physiotherapist
Rider
- Deep muscle stabilisation
- Personal exercise programme
- Sports massage
- Ultrasound/laser therapy
Horse
- Muscular injuries
- Tendon/ligament injuries
- Neck & Back problems
- Saddle problems
- Degenerative joint management
- Pelvic problems
- Exercise programmes
- Veterinary reports
Euthanasia
In the unfortunate circumstance that humane destruction is necessary, we provide a supportive and empathic service. It is possible for individual cremation to be arranged.