LamenessinHorsesAlongwithDiagnosingTechniquesandTheHigh

PalmarNerveBlockProcedure

Lamenessisanabnormalstanceorgaitinahorsecausedbyaninjury.Lamenessisnot
adiseasebutasymptomandmanifestsitselfasmechanicalrestrictionsor,mostlikely,pain.
Thiscausesthehorsetonotstandormovenormally.Painrelatedlamenessesareeither
classifiedasweightbearing(deficitisshownwhenthehorsesputsweightonthelimb)or
nonweightbearing(horseavoidsputtingweightonthelimb).Themostcommonclinicalsigns
oflamenessareheadbobbingassociatedwithforelimblamenessorapelvicrise,associated
withthehindlimbs.Thesesignsareeasilynoticedatthewalkortrot,solungingisstandardto
helpdiagnose.Lamenesscanbecausedbytrauma,disorders(eithercongenital,acquiredor
metabolic),infectionornervous/circulatorysystemdisease.Somefactorspredisposehorsesto
lameness,factorsincludingphysicalimmaturity,variousorthopedicdiseases,poorconformation
andimproperbalanceorshoeing.Alsorepetitivestressesonbones,tendons,ligamentsand
jointsaswellashard,rockyworksurfacesandextremeathletics.
Onceyouhaveestablishedwhichleg(s)islame,theareaisblockedsothatitbecomes
numbtopain,revealingwhichstructuresareinvolvedincausingthelameness.Whenblocking
outalegyoustartatthebottomandworkyourwayupbecauseablockwillnumbthearea
down.Localanestheticsaredrugsthatblockthenerves'abilitytoconductanerveimpulse.In
addition,theseanestheticsareeffectiveonlyatthespecificlocationwheretheyweredeposited,
leavingtheaboveareaofthenervefunctioningnormally.Lidocaineandmepivacainearethe
twomostcommonanestheticagentsusedtoinduceregionalanesthesiaduringthelameness
examination.Lidocaineisgenerallyusedfornerveblockswhilemepivacaineisusedforjoint
blocksbecauseitislessirritatingandhaslesstissuereaction.Thesedrugshavearapidonset
ofaction(around5minutes),goodefficacy,longdurationofaction(1.5to2hours),andvery
fewsideeffectsotherthanswellingintheareaoftheinjection.
Legblocksgointheorderof:thepalmardigitalnerve,semiringblock,basisesamoid
nerveblockandlowpalmarnerveblock(low4pointblock).Thehighpalmarnerveblock,or
high4pointblock,isperformedwhenallblocksuptothelow4pointblockfailtoimprovethe
lameness.
Whenbeginningtheprocedure,thesiteofinjectionisusuallycleanedbywipingwith
cottonorgauzesoakedinisopropylalcohol.Ifthehorseissensitivetoneedlestheycanbe
restrainedwithanosetwitch.Tobegintheblock,drawupabout20mlsoflidocaineinasyringe
fittedwitha25or22gauge,oneinchneedle.Theneedleshouldalwaysbeinserteddetached
fromthesyringethishelpsavoidbrokenneedlesduringtheadministrationoftheanesthetic.
Thisblockconsistsofinjectingfournerves(medialandlateralpalmarandpalmarmetacarpal
nerves)with5mlsofanestheticeach.Themedialandlateralpalmarnervesarelocatedjustin
frontofthedeepdigitalflexortendon,andthemedialandlateralpalmarmetacarpalnervesare
locatedonthebacksurfaceofthecannonbone.Blockingthepalmarnervebeginswiththe
horsebearingweight,inserttheneedlejustdistaltothecarpometacarpaljointand
perpendiculartothepalmarolateralorpalmaromedialaspectofthelimb,advancingtheneedle
tothedorsalsurfaceofthedeepdigitalflexortendonandlocationofthepalmarnerve.Toblock

thepalmarmetacarpalnerve,thelimbisheldinhand.Again,justdistaltothecarpometacarpal
joint,theneedleisinsertedbetweentheaxialsurfaceofthesplintboneandthepalmarthird
metacarpalbone.Afterabout5minutes,skinsensationischeckedbypressingthetipofa
ballpointpenorsimilarlysharpitenovertheskincoveringtheregionintendedtobe
desensitized.Afteritisestablishedthattheareaisnumb,thehorseislungedagaintoseeifthe
lamenessisresolved.
Ifthelamenessisresolvedfromthenerveblock,theclientcaneitheroptforasteroid
injectiontotreatthelameness,orcontinuediagnosis.Thistypeofnerveblockallowsforvarious
typesoffurtherdiagnosticteststobeperformed.Testssuchasradiography,ultrasonography,
CT,scintigraphy,orMRI.Additionally,useofregionalanesthesiaallowssomesurgical
procedurestobeperformedwithouttheneedforgeneralanesthesia,anditcanbeusedto
providetemporarypainrelief.

Citations
RegionalAnesthesiainEquineLameness.
LamenessinHorses:MerckVeterinaryManual.
N.p.,
n.d.Web.07June2016.

Peloso,John.NerveBlocksoftheLowerLimb.
TheHorse.com.
N.p.,1Oct.1996.Web.07June
2016.

Ivis.com.
Proceedingsofthe13thInternationalCongressoftheWorldEquineVeterinary
AssociationWEVA
.N.p.:n.p.,2013.Web.7June2016.