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Blocks and XRays

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  • Blocks and XRays

    After having watched quite a few lameness exams, I began to wonder how much was done that perhaps could have been skipped and cut straight to the chase...

    It seems like more often than not, the vet blocks the horse but still ends up deciding to take films. Why wouldn't they just skip straight to the films?? Maybe block after if it's still deemed necessary? Or is there something I am looking over here?

  • #2
    Well, you could x-ray and find all sorts of things but not know that those are really the cause of the lameness. You really have to use the blocks to zero in on the area that is causing the problem. And it may not be something that will show up on x-ray.

    Say horse is lame and you think it is the foot. You x-ray the foot (what's that, 5 films @$50 each so $250?). Maybe you see something on the x-rays, maybe you don't...but if the problem is up higher, and you key in on something on that foot x-ray that really isn't the issue, you are getting no where. But you block the foot ($30, $50, whatever it is) and the horse is still lame, you know to look higher.


    • #3
      Originally posted by PaintedMonkey View Post
      After having watched quite a few lameness exams, I began to wonder how much was done that perhaps could have been skipped and cut straight to the chase...
      How many of these exams involved getting an accurate, detailed hoof care history and clinical observations directly from the attending farrier? IME, this part is already skipped in most lameness exams including the ones requested BY the attending farrier.

      It seems like more often than not, the vet blocks the horse but still ends up deciding to take films. Why wouldn't they just skip straight to the films??
      There is a specific order.
      1. History.
      2. Clinical observation.
      3. Palpation.
      4. Flexion tests.
      5. Nerve blocks.
      6. Diagnostic imaging.
      7. Diagnosis.
      8. Treatment.
      9. Followup.
      Maybe block after if it's still deemed necessary? Or is there something I am looking over here?
      At any point in the process of elimination outlined above a practitioner could find a possible diagnosis, implement treatment, followup on the treatment to confirm the diagnosis or rule out the diagnosis in the followup review. In the event the diagnosis is ruled out during review, the process would go further into more detailed diagnostic modalities.

      Most often the areas I see skipped are getting an accurate history and followup to confirm or rule out a diagnosis and treatment. These steps are cerebrally time consuming and most horse owners aren't familiar with their value and may not see a justification to pay for something "intangible." OTOH, nerve blocks and radiographs are physical, tangible things. A vet gets paid for these "tests" whether or not they get results.


      • #4
        All a block does is localize what segment of the leg the lameness is coming from.

        All an X-ray does is show joint and/or bone pathology. Which may or may not even be relevant to the lameness at hand.

        Neither can stand by itself as a complete evaluation of lameness.
        Click here before you buy.


        • #5
          Like others have noted, x-rays don't show you everything. If you jump straight to x-rays, you may miss something in the softer tissues. Also, one does not always lead to the other, the owner or vet can make recommendations based on the findings of the nerve block without going to xray.

          For example, my horse came up suddenly lame last fall, I treated him for an abcess. After two weeks of soaking and wrapping the foot, nothing really changed except my horse was not longer 3 legged lame. Somedays he seemed totally sound, other days just a little "ouchy." I called the vet to make sure it wasn't something higher up in the leg and to get another set of eyes on him. Vet thought it was the foot, but since hoof testers gave no "positive" result she questioned abcess. We blocked, yep it was the foot. Did I want xrays? No, the only thing they could show that would be helpful would be a coffin fracture... 6 weeks after initial lameness, farrier finds an old pus pocket from a deep abcess. X ray would have been a waste of time and money in this case.