Primary phenotypic features associated with caudal neck pathology in warmblood horses.

BACKGROUND: Detailed descriptions of clinical signs associated with radiological findings of the caudal cervical vertebral column are not available. OBJECTIVES/HYPOTHESES: Describe the clinical features associated with neck pain or stiffness, neck-related thoracic limb lameness, proprioceptive ataxia consistent with a cervicothoracic spinal cord or nerve lesion, and their frequency of occurrence compared with control horses. ANIMALS: A total of 223 Warmblood horses. METHODS: Case-control study. Controls and cases were recruited prospectively. All horses underwent predetermined lameness and neurologic examinations. The frequency of occurrence of each clinical feature was compared between cases and controls and relative risk (RR) were calculated. RESULTS: Ninety-six cases and 127 controls were included. Forty-seven (49%) of the cases were classified as neurologic, 31 (32.3%) had thoracic limb lameness, and 18 (18.7%) had neck stiffness or pain or both. Focal caudal cervical muscle atrophy (46, 47.9%), hypoesthesia (38, 39.6%), patchy sweating (16, 16.7%), hyperesthesia (11, 11.5%), and pain upon firm pressure applied over the caudal cervical articular process joints and transverse processes (58, 60.4%) were only observed in cases (P < .001). Sideways flexion of the neck was restricted in a higher proportion of cases (47/96, 49%) compared with controls (40/127, 31.8%; P = .009, RR 1.5). Hopping-type thoracic limb lameness was only observed in cases, (30, 31.6%). Deterioration in lameness after diagnostic anesthesia occurred in 13/31 (41.9%) cases. CONCLUSIONS AND CLINICAL IMPORTANCE: Systematic clinical evaluation using the methods described should enable clinical differentiation between horses with caudal cervical lesions and horses with other causes of gait abnormalities.

Congenital variants of the ventral laminae of the sixth and seventh cervical vertebrae are not associated with clinical signs or other radiological abnormalities of the cervicothoracic region in Warmblood horses.

BACKGROUND: There is controversy about the clinical relevance of congenital variants of the ventral laminae of the sixth (C6) and seventh (C7) cervical vertebrae and their relationship with other radiological abnormalities. OBJECTIVES: To document the prevalence of congenital variants of C6 and C7 and that of other radiological abnormalities from C6 to the second thoracic vertebra (T2). STUDY DESIGN: Cross-sectional. METHODS: The study included Warmblood horses ≥3 years of age undergoing clinical assessment at two referral institutions: 127 control horses and 96 cases (neurologic, neck pain or stiffness, or neck-related forelimb lameness). All horses underwent a standardised orthopaedic and neurologic examination. Lateral-lateral and lateral 45°-55° ventral-lateral dorsal (left to right and right to left) radiographic views of C5 to T2 were acquired and assessed blinded to the horse's clinical category using a predetermined grading system. RESULTS: The ventral profile of C7 was abnormal in 54 horses (24.2%). Cases were less likely to have congenital variants than control horses, p = 0.0002, relative risk (RR): 0.63 (95% confidence intervals [CIs]: 0.4, 1.0). There was no association between the presence of a congenital variant of C7 and the presence of modelling of the articular processes (APs) of C6-C7, C7-T1 or T1-T2. Cases were more likely to have severe modelling of the APs at C6-C7, p = 0.01, RR: 1.94, CI: 1.1, 3.5 and C7-T1, p = 0.04, RR: 1.97, CI: 1.2, 3.2 compared with control horses. MAIN LIMITATIONS: Radiographs were read by one assessor independently at each institution. CONCLUSIONS: There was no association between the presence of congenital variants of C7 and any other radiological findings. Congenital variants occurred less frequently in cases compared with control horses. There was no association between the presence or absence of a congenital variant and the type of case.

Determination of Equine Behaviour in Subjectively Non-Lame Ridden Sports Horses and Comparison with Lame Sports Horses Evaluated at Competitions.

The Ridden Horse Pain Ethogram (RHpE) was developed to facilitate the identification of musculoskeletal pain. The aim of the current study was to collate behavioural data using the RHpE from horses at competitions assumed by their owners and/or riders to be fit for competition. The objectives were to quantify the frequency of occurrence of behaviours in pain-free horses and those with lameness or abnormalities of canter and to determine any differences between disciplines and levels of competition. The RHpE was applied to 1358 horses competing in Grand Prix (GP) dressage (n = 211), 5* three-day events (TDE) (n = 137), or low-level one-day events (ODE) (n = 1010). The median RHpE score for all horses was 4 (interquartile range [IQR] 2, 5; range 0, 12) and the median lameness grade was 0 (IQR 0, 1; range 0, 4). The Kruskal-Wallis test, followed by Dunn's test for pairwise comparisons, found a difference in median RHpE scores between low-level ODE and GP dressage (p = 0.001), but not between 5* TDE and low-level ODE (p = 0.09) or between GP dressage and 5* TDE (p = 1.00). The median RHpE score was highest for low-level ODE. The Chi-square/Fisher's exact test identified a significant difference in prevalence of most of the 24 behaviours of the RHpE in non-lame compared with lame horses. Recognition of the behaviours of non-lame horses may improve equine welfare and performance, and rider comfort, confidence, and safety.

Magnetic Resonance Imaging, Computed Tomographic and Radiographic Findings in the Metacarpophalangeal Joints of 31 Warmblood Showjumpers in Full Work and Competing Regularly.

There is a limited description of magnetic resonance imaging (MRI) and no information on computed tomographic (CT) findings in the fetlock of non-lame, non-racing sports horses. This study aimed to document comparative CT, MRI and radiographic findings in the metacarpophalangeal joints of showjumpers in full work. Clinical and gait assessments, low-field MRI, fan-beam CT and radiographic examinations of both metacarpophalangeal joints were performed on 31 showjumpers. Images were analysed descriptively. In most limbs (53/62, 85.5%), there were CT and MRI changes consistent with densification in the sagittal ridge and/or condyles of the third metacarpal bone (McIII). Hypoattenuation (subchondral bone resorption) was seen in CT reconstructions in the metacarpal condyle dorsoproximally (n = 2) and dorsodistally (n = 1), in the sagittal groove (n = 2) and medial fovea (n = 1) of the proximal phalanx. The McIII resorptive lesions were detected on MR images but not the proximal phalanx lesions. None were identified on radiographs. In conclusion, MRI and CT abnormalities previously associated with lameness were seen in the front fetlocks of showjumpers without relevant lameness. Densification in the sagittal ridge and the metacarpal condyles likely reflects an adaptive change to exercise. Subchondral bone resorption may indicate an early stage of disease; follow-up information is needed to establish its clinical significance.

Computed Tomographic Evaluation of the Sagittal Ridge of the Third Metacarpal Bone in Young Thoroughbred Racehorses: A Longitudinal Study.

Metacarpophalangeal joint region pain is a common cause of lameness in racehorses. Radiological abnormalities in the sagittal ridge (SR) of the third metacarpal bone have been associated with joint effusion, lameness and reduced sales prices. The aims were to describe computed tomographic (CT) appearance of the SR in racehorses, and to document the progression of these findings over three assessments. Forty yearlings were enrolled at the first examination (time 0). Re-examinations were performed twice, approximately six months apart on 31 (time 1) and 23 (time 2) horses, respectively. Computed tomographic examinations of both metacarpophalangeal regions were performed with the horses in a standing position. Computed tomographic reconstructions were analysed subjectively and objectively. The mean Hounsfield Unit values (Hus) of eight radial segments and location, size and shape of hypoattenuating lesions were recorded. Mean Hus at time 1 were higher than at time 0. There was no difference between mean HU at times 1 and 2. The mean HU values of the dorsal half were higher in the right forelimbs and in fillies. Hypoattenuation was identified in 33/80 (41.3%) limbs at time 0, in 22/62 (35.5%) limbs at time 1 and in 14/46 (30.4%) limbs at time 2. All hypoattenuations were located in the dorsodistal aspect of the SR. The most common shapes were hypoattenuating lesions elongated proximodistally and those extending towards trabecular bone. An increase in attenuation of the SR occurred in the first six months of training. Hypoattenuating lesions could decrease in size and could resolve during early training. In this population, these lesions were not associated with lameness.

Magnetic Resonance Imaging, Computed Tomographic and Radiographic Findings in the Metacarpophalangeal Joints of 40 Non-Lame Thoroughbred Yearlings.

Most catastrophic injuries in Thoroughbred racehorses involve the fetlock. There is no description of comparative imaging in Thoroughbreds entering racehorse training. The aim was to describe MRI, CT and radiographic findings in the metacarpophalangeal joint of non-lame Thoroughbred yearlings. Forty Thoroughbreds underwent low-field MRI, fan-beam CT and radiographic examinations of both metacarpophalangeal joints. Images were assessed subjectively. A hypoattenuating lesion of the sagittal ridge of the third metacarpal bone (McIII) was identified in 33/80 limbs in CT reconstructions. Cone-shaped mineralisation in the sagittal ridge was detected in MR images (n = 17) and in CT images (n = 5). Mild hyperattenuation was common in trabecular bone in the dorsomedial (36/80) and palmarolateral (25/80) metacarpal condyles in CT reconstructions. A focal lesion in the subchondral bone was seen in the proximal phalanx (n = 19) and in McIII (n = 11). Enlarged vascular channels were detected in the metacarpal condyles in 57/80 limbs and in the proximal sesamoid bones in all limbs. Signs of bone modelling are seen in yearling Thoroughbred fetlocks. Sagittal ridge lesions were common and are likely associated with osteochondrosis or other developmental osteochondral defects. Focal lesions in the subchondral bone of McIII and proximal phalanx can indicate developmental abnormalities or subtle subchondral bone injuries.

Application of the Ridden Horse Pain Ethogram to 150 Horses with Musculoskeletal Pain before and after Diagnostic Anaesthesia.

The Ridden Horse Pain Ethogram (RHpE) was developed to facilitate the recognition of musculoskeletal pain. The aim of this study was to document changes in RHpE scores before and after diagnostic anaesthesia was performed to alleviate pain ± when the saddle was changed. One hundred and fifty horses underwent ridden exercise as part of an investigation of poor performance. The RHpE was applied before and after the interventions. Fifty-two (34.7%) horses exhibited a bilaterally symmetrical short step length and/or restricted hindlimb impulsion and engagement. Fifty-three (35.3%) horses had episodic lameness; only forty-five (30.0%) horses were continuously lame. The median maximum lameness grade when ridden was 2/8 (interquartile range [IQR]: 0-3; range: 0-4). Fifty-six (37.3%) horses had an ill-fitting saddle, which was considered likely to influence performance. The median RHpE scores after the interventions (2/24 [IQR: 1-3, range: 0-12]) were significantly lower than before the interventions (9/24 [IQR: 8-11, range: 2-15]) (Wilcoxon signed-rank z = 10.6, p < 0.001). There was no correlation between the RHpE score and maximum lameness grade before diagnostic anaesthesia (Spearman's rho = 0.09, p = 0.262). It was concluded that the absence of overt lameness does not preclude primary musculoskeletal pain. Gait quality and performance can be improved by diagnostic anaesthesia, with substantial reductions in RHpE scores.

Magnetic Resonance Imaging Measurements of the Proximal Palmar Cortex of the Third Metacarpal Bone and the Suspensory Ligament in Non-Lame Endurance Horses before and after Six Months of Training.

Proximal metacarpal injury is common in endurance horses, yet exercise-induced changes in this region have not been described. This study aimed to document objective exercise-induced changes in the proximal palmar cortex of the third metacarpal bone (PcMcIII) and the suspensory ligament (SL). Low-field magnetic resonance (MR) images of both proximal metacarpal regions were obtained from six novice and six experienced horses, before and after six months of endurance training. Measurements were acquired in T1-weighted transverse MR images at four levels and included the thickness of the PcMcIII, the mediolateral width, and the dorsopalmar depth of the entire SL and its lobes. We used t-tests or their nonparametric equivalents to compare the measurements from the two examinations and both novice and experienced horses. The medial aspect of PcMcIII was significantly thicker in experienced horses than in novice horses at 2 and 3 cm distal to the carpometacarpal joint. This likely reflects the cumulative effect of long-term exercise and possibly age. The PcMcIII was significantly thicker medially than laterally. There was no significant difference between pre- and post-season measurements. Six months of endurance training were not sufficient to induce changes in the thickness of PcMcIII or the SL that are detectable in low-field MR images.

Complications following diagnostic and therapeutic sacroiliac joint region injections in horses: A study describing clinicians' experiences.

BACKGROUND: There are no detailed data on complications of sacroiliac (SI) joint region injections or on the variability of the methods and circumstances of injections among clinicians. OBJECTIVES: To describe complications following diagnostic, therapeutic and combined SI joint region injections and the details of how these are routinely performed by a large number of clinicians. STUDY DESIGN: Cross-sectional questionnaire survey. METHODS: Clinicians (members of American and European specialist colleges and veterinarians known to the authors), invited by email, who had performed ≥1 SI joint region injection, completed an online questionnaire. Data collected included the clinicians' experience in diagnostic, therapeutic and combined SI joint region injections, details of the injection technique, volume and substance used, and the type of complications seen following SI joint region anaesthesia, medications and combined injections, respectively. Descriptive data analysis was performed and the association between any complications seen and the clinicians' experience, technique, volume and substance used were assessed using binary logistic regression. RESULTS: Of the 212 respondents, 110 had performed diagnostic, 187 therapeutic and 49 combined injections. More clinicians experienced complications after diagnostic (53/110) than after therapeutic (33/187) or combined (6/49) injections (p < 0.01). The most common complications were hindlimb weakness/ataxia after all types of injections (diagnostic: 44/110, 40%, 95% confidence interval [CI]: 30.8-49.8; therapeutic: 15/187, 8.0%, CI: 4.6-12.9; combined: 2/49, 4.1%, CI: 0.5-14.0). Death or horses requiring euthanasia were reported (after therapeutic injections: 5/187; diagnostic injections: 1/110). MAIN LIMITATIONS: No prevalence of complications was established; no detailed descriptions of complications were available. Results may be influenced by selection and recall biases. CONCLUSIONS: Complications were experienced by more clinicians following diagnostic injections than after therapeutic or combined SI joint region injections, but the types and distribution of complications were similar. Results should be interpreted considering the previous reports of low prevalence of complications.

Application of the Ridden Horse Pain Ethogram to Horses Competing in British Eventing 90, 100 and Novice One-Day Events and Comparison with Performance.

The Ridden Horse Pain Ethogram (RHpE) was applied to 1010 competition starts at British Eventing (BE) 90, 100 and Novice one-day events and compared with performance. The overall median RHpE score was 4/24 (IQR 2,6; range 0,12). There were moderate positive correlations between RHpE scores and dressage penalties (Spearman's rho = 0.508, 0.468, 0.491, all p < 0.001 for BE 90, 100 and Novice, respectively). There were weak positive correlations between RHpE scores and final placings (Spearman's rho = 0.157, p = 0.033, BE90; rho = 0.263, p < 0.001, BE 100; rho = 0.123, p = 0.035, Novice). In showjumping, 1.7% of starters were eliminated or retired, compared with 9.8% of cross-country starters. Horse or rider falls occurred in 2.6% of cross-country starts. Horses placed first, second or third had lower median RHpE scores (2/24, IQR 1,4; range 0,8) than other horses that finished (p < 0.001), those that were eliminated or retired (p < 0.001) or were withdrawn (p < 0.001). The RHpE score was ≥8/24 for 9.3% of starters; horses with a RHpE score ≥8/24 had higher total penalty scores (p < 0.001) than horses with a RHpE score <8/24. The overall low median RHpE score supports the social licence to compete, but 9% of starters had a RHpE score ≥8/24. Investigation and treatment of these horses may improve both welfare and performance.

Application of the Ridden Horse Pain Ethogram to Horses Competing at the Hickstead-Rotterdam Grand Prix Challenge and the British Dressage Grand Prix National Championship 2020 and Comparison with World Cup Grand Prix Competitions.

The Ridden Horse Pain Ethogram (RHpE) comprising 24 behaviours was developed to facilitate the identification of musculoskeletal discomfort, with scores of ≥8/24 indicating the presence of pain. The median RHpE score for 147 competitors at World Cup Grand Prix events from 2018 to 2020 was three (interquartile range [IQR] 1-4; range 0-7). The aim of the current study was to apply the RHpE to 38 competitors at the Hickstead-Rotterdam Grand Prix Challenge and 26 competitors at the British Dressage Grand Prix National Championship in 2020. The median RHpE scores were four (IQR 3-6; range 0-8) and six (IQR 4-7; range 1-9), respectively, which were both higher (p = 0.0011 and p = 0.0000) than the World Cup competitors' scores. Ears back ≥ 5 s (p = 0.005), intense stare ≥ 5 s (p = 0.000), repeated tail swishing (p = 0.000), hindlimb toe drag (p = 0.000), repeated tongue-out (p = 0.003) and crooked tail-carriage (p = 0.000) occurred more frequently. These were associated with a higher frequency of lameness, abnormalities of canter, and errors in rein-back, passage and piaffe, canter flying-changes and canter pirouettes compared with World Cup competitors. There was a moderate negative correlation between the dressage judges' scores and the RHpE scores (Spearman's rho -0.66, p = 0.0002) at the British Championship. Performance and welfare may be improved by recognition and appropriate treatment of underlying problems.

Gross post-mortem and histological features in 27 horses with confirmed lumbosacral region pain and five control horses: A descriptive cadaveric study.

BACKGROUND: There is a lack of understanding of the pathological and/or physiological nature of lumbosacral region pain. OBJECTIVES: To describe the gross variations of the osseous and soft tissues of the lumbosacral region and report the histological findings of sections of nerve tissue in affected and control horses. STUDY DESIGN: Descriptive post-mortem case series. METHODS: All horses had undergone full clinical and gait assessment, including ridden exercise. Horses with a substantial response to infiltration of local anaesthetic solution around the sacroiliac joint regions were included in the affected group (n = 27). Horses for which the source(s) of pain was confirmed by diagnostic anaesthesia to be distant to the lumbosacral region were included in the control group (n = 5). The pelvic regions were isolated and the soft tissues were assessed grossly. Sections of the lumbosacral plexus and cranial gluteal, sciatic and obturator nerves were examined histologically. The osseous specimens were evaluated for anatomical variants and abnormalities. Data were analysed using descriptive statistics. RESULTS: Gross discolouration of the sciatic or obturator nerves was observed in 7 (26%) affected and no control horses. Grade 3/3 histological abnormality scores were assigned in 22% of nerve sections from affected horses compared with 3% from control horses. Several osseous variants (bifid sacral spinous processes, straight-shaped sacroiliac joint surface, short arrow-shaped sacral alae, left-right asymmetry of sacral alae, sacral curvature, absence of the fourth to fifth and ankylosis of the fifth to sixth lumbar articular process joints, left-right asymmetry of caudocranial position of the fourth to fifth and lumbar-sacral articular process joints) and abnormalities (sacroiliac enthesopathy, extra ventral sacroiliac joint surface, lumbosacral symphyseal periarticular modelling, lumbosacral intertransverse joint pitting lesions) were more frequently observed in affected horses. MAIN LIMITATIONS: Both control and affected horses may have had preclinical abnormalities. CONCLUSIONS: Lumbosacral region pain may reflect the presence of a number of pathological changes. Neural pain may play an important role in some horses.

Application of the Ridden Horse Pain Ethogram to Elite Dressage Horses Competing in World Cup Grand Prix Competitions.

There is considerable debate about the social license to compete with horses and controversy about training methods for dressage horses. The objectives were to: 1. apply the Ridden Horse Pain Ethogram (RHpE) to dressage horses competing at elite Grand Prix level; 2. compare RHpE and judges' scores; and 3. document deviations in gaits from Fédération Equestre Internationale (FEI) guidelines. Video recordings of 147 competitors from nine World Cup competitions were assessed. Spearman's rank correlation coefficient tested the correlation between RHpE and judges' scores. The median RHpE score was 3 (IQR 1, 4; range 0, 7). There was a moderate negative correlation (Spearman rho -0.40, p < 0.001) between the RHpE scores and the judges' scores. Mouth open with separation of the teeth for ≥10 s (68%), head behind vertical ≥10° ≥10 s (67%), an intense stare for ≥5 s (30%) and repeated tail swishing (29%) were the most frequent RHpE behaviours. Deviations from FEI guidelines were most frequent in passage, piaffe, canter flying-changes, canter pirouettes and "halt-immobility-rein back five steps-collected trot". In conclusion, most horses appeared to work comfortably for the majority of the test. Further investigation of the influence of a double bridle compared with a snaffle bridle on head position and mouth opening is merited.

Predicting self-compassion in UK nursing students: Relationships with resilience, engagement, motivation, and mental wellbeing.

Self-compassion, being kind towards oneself, has been identified as a key protective factor of mental health. This is consistent with students' experiences in the study of nursing, which attracts many students in the United Kingdom. Despite the importance of self-compassion, knowledge in how to enhance self-compassion is under-researched: approaches commonly entail meditative exercises. To suggest alternative approaches, relationships between self-compassion and more established constructs need to be appraised. Accordingly, this study evaluated predictors of self-compassion, examining its relationships with more established constructs examined in other healthcare student populations: resilience, engagement, motivation and mental well-being. An opportunity sample of 182 UK nursing students at a university in East Midlands completed self-report measures about these constructs. Correlation and regression analyses were conducted. Self-compassion was positively related to resilience, engagement, intrinsic motivation and mental well-being, while negatively related to amotivation. Resilience and mental well-being were identified as significant predictors of self-compassion. As resilience and mental well-being are relatively familiar to many nursing lecturers and students, educators can incorporate a self-compassion component into the existing resilience training and/or mental well-being practices.

Access and Accessibility in Domestic and Family Violence Services for Women With Disabilities: Widening the Lens.

Women with disabilities experiencing violence can face challenges accessing domestic and family violence (DFV) services. Our research explored how these services understood and operationalized access for women with disabilities. In this article, we use Levesque, Harris, and Russell's access framework to show how to be accessible to women with disabilities, and DFV services can widen the lens of access and accessibility to respond to women's own priorities. These centered around appropriateness, approachability, and acceptability. Addressing these broader issues of access in policy and practice alongside disability-specific needs can better align what services offer and what women need.

Sidewinder gait in horses.

BACKGROUND: Sidewinder gait in horses is poorly understood and characterized by walking with the trunk and pelvic limbs drifting to 1 side. HYPOTHESIS/OBJECTIVES: To report causes, clinical and diagnostic features. ANIMALS: Horses examined at 2 institutions. MATERIALS AND METHODS: Retrospective study (2000-2019). Cases with sidewinder gait, neurological and orthopedic examination, and diagnostic work up or postmortem evaluation were included. Descriptive statistics were performed. RESULTS: Twenty-four horses (mean age 18.9 years) of various breeds and both sexes were included. Onset was acute (N = 10), subacute (N = 6), and insidious (N = 8). Electromyography and muscle biopsy supported neurologic disease and further aided in localizing site of lesion (N = 9/9). Neurologic causes included dynamic thoracolumbar spinal cord compression (N = 5), equine protozoal myeloencephalitis (N = 4, confirmed and presumed [2 each]), thoracic myelopathy of unknown etiology (N = 4), gliosis (N = 2), and thrombosis of thoracic spinal cord segments (N = 1). Non-neurologic causes included osteoarthritis of the coxofemoral joint (N = 4), multiple displaced pelvic fractures (N = 2), bilateral rupture of the ligamentum capitis ossis femoris (N = 1), and severe myonecrosis of multiple pelvic limb muscles (N = 1). Case fatality was 79%. CONCLUSION AND CLINICAL IMPORTANCE: Sidewinder gait is usually observed in older horses and can have neurologic or musculoskeletal etiologies. Electromyography can be used as a diagnostic aid to determine neurologic versus non-neurologic disease and further localize those of neurologic origin. The condition often has a poor prognosis for function and life.

Development of nurse education in Saudi Arabia, Jordan and Ghana: From undergraduate to doctoral programmes.

Doctoral programmes in nursing have a long history in the US where traditional research based PhDs and more clinically based doctoral programmes are common. In the rest of the world PhDs are better accepted though professional doctorates with a thesis component are common in the UK. In countries with newly established or planned doctoral programmes in nursing the research PhD seems the degree of choice. Here we discuss developments in Jordan, Saudi Arabia and Ghana. This study used official documents, strategic plans, curriculum developments and other documentary evidence from Saudi Arabia, Jordan and Ghana. We compared doctoral programmes and development with other countries by reference to the literature. We offer the example of public health and non-communicable diseases in particular as one area where doctorally trained nurses applying international standards in collaboration internationally may be of benefit.

Application of a Ridden Horse Pain Ethogram and Its Relationship with Gait in a Convenience Sample of 60 Riding Horses.

A Ridden Horse Pain Ethogram (RHpE) comprising 24 behaviours has been developed to facilitate the identification of musculoskeletal pain. The aim was to further test the RHpE by its application to a convenience sample (n = 60) of sports horses and riding school horses in regular work and assumed by their owners to be working comfortably. All horses performed a purpose-designed dressage-type test of 8.5 min duration in walk, trot and canter, with their normal rider. The RHpE was applied retrospectively to video recordings acquired in a standardised fashion. Seventy-three percent of horses were lame (≤ grade 2/8) on one or more limbs; 47% had gait abnormalities in canter. Ridden Horse Pain Ethogram scores ranged from 3 to 16/24 (median 9); rider skill score ranged from 2.5 to 8/10 (median 4.75). The effect of horse age, breed, sex, work-discipline, epaxial muscle hypertonicity or pain, an ill-fitting saddle, rider skill score, the presence of lameness or gait abnormalities in canter on the RHpE score was assessed using Poisson regression. Two variables were retained in the final multivariable analysis, rider skill score as a continuous variable (p < 0.001), and lameness (p = 0.008). A RHpE score ≥8 was a good indicator of the presence of musculoskeletal pain.

Management of Primary Injuries of the Medial Collateral Ligament of the Carpus in Two Horses.

This case report describes the successful management of two horses with medial carpal collateral ligament injury. This is a rare cause of forelimb lameness and existing reports indicate a poor prognosis for return to athletic function with conservative management. Both horses were treated with a combination of box rest with controlled exercise and high-intensity laser therapy (HILT). Both horses returned to previous athletic function, one at Grand Prix level dressage and one at Novice level eventing. With appropriate management, the prognosis for carpal collateral ligament injury may be good. From this report, it is unclear whether a rehabilitation program including HILT offers improved prognosis compared with a rehabilitation program alone.