Sports management

ANAMNESIS

A good and detailed anamnesis is invaluable and the first step in detecting ‘true’ from ‘false’ veterinary pathology. Rider induced resistance to work, bad riding or training or behaviour problems are not uncommon. Good communication is important and it’s not always easy to convince the rider as being a potential cause of the problem. Often preliminary to further diagnostic procedures, the horses are trained under non-steroidal anti-inflammatories. In case of significant improvement the focus of the examination is the search for musculoskeletal inflammation or pain. A strictly behavioural malfunction will not improve after administration of pain-killers. Often is an abrupt change in behaviour triggered by a period of pain and can even persist when the pain has already disappeared.

 

CLINICAL EXAMINATION

 

The focus of the examination is on the locomotor apparatus. Cardio-respiratory causes of poor performance are not included in this talk. Routinely a standard orthopaedic work up is performed. Close attention is paid to subtle swellings or localised muscle atrophy, pain responses to pressure, extension or flexion, lack of mobility or low grade lameness. Often horses are sound while being lunged on hard and soft surfaces and an evaluation while being ridden is necessary. Subtle soft tissue injuries, e.g. proximal suspensory desmitis, often give more pronounced lameness when the horses are ridden. Diagnostic anesthesia can be evaluated under the saddle as well. The first intention of any poor performance examination is to rule out any obvious lameness or orthopaedic condition. Examination of the axial skeleton (neck and back) requires specific knowledge and expertise. Back mobility is evaluated at stance, while being lunged and while being ridden.  

 

DIAGNOSTIC IMAGING

 

Gamma scintigraphy is a valuable tool in detecting potentially underlying causes of poor performance. Especially for proximally located and back related problems bone scintigraphy is of major interest in giving objective information. Together with its high sensibility, the low specificity of the modality should be assessed and a good correlation with the clinical examination and the anamnesis is crucial. Often in the examination of those cases we have no starting point and so gamma scintigraphy is an excellent first screening tool. Once scintigraphy has highlighted a region of increased uptake, radiography and ultrasonography are the invaluable tools to visualize and diagnose the lesions. In cases of (low grade) lameness, MRI might contribute as well to deliver the diagnosis. Thermography is a nice tool to document a case, but will rarely deliver crucial information.

 

TRANSCRANIAL MAGNETIC STIMULATION (= MMEP TEST)

 

Low grade ataxia is a common cause of lack of performance and is until today often not diagnosed because the clinical assessment can be very difficult, especially in subtle cases. Transcranial magnetic stimulation (TMS) is invaluable in the objective determination of the presence of ataxia and will be discussed in detail later.

 

TREATMENT

A successful treatment is of course dependent on the exact diagnosis. In some cases the correlation between diagnostic imaging findings and the anamnesis is only made by installing a diagnostic treatment. Good follow-up and reliable feedback from the rider are helping to solve future cases.