title: Which anatomical region determines a positive flexion test of the distal aspect of a forelimb in a nonlame horse?
abstract: BACKGROUND
  The flexion test is used routinely as part of lameness and prepurchase examinations. However, little is known about the mechanisms that cause a positive response to a flexion test.
  
  
  OBJECTIVE
  To determine which anatomical regions play a role in a positive outcome of a flexion test of the distal aspect of a forelimb in a nonlame horse.
  
  
  METHODS
  Eight clinically sound Dutch Warmblood horses were subjected to a standardised flexion test (force 250 N, time 60 s) inducing a consistent lameness. To discriminate between different areas of the distal aspect of a forelimb, effects of various nerve blocks on the outcome of the flexion test were investigated. Low palmar digital, palmar at the abaxial aspects of the base of the proximal sesamoids, high palmar, ulnar and low 4-point nerve blocks were performed. Flexion test induced lameness was scored before and after each nerve block in separate sessions.
  
  
  RESULTS
  The low palmar digital nerve blocks and nerve blocks of the palmar nerves at the abaxial aspect of the base of the proximal sesamoid bones had no significant effect on the flexion test induced lameness score. The ulnar, high palmar and, most dramatically, the low 4-point nerve blocks all caused a significant (P<0.05) reduction in the flexion test induced lameness score.
  
  
  CONCLUSIONS
  Anatomical structures (soft tissue nor synovial structures) located distal to the metacarpophalangeal joint appear to contribute only minimally to the outcome of a positive flexion test of the distal aspect of a forelimb in a clinically nonlame horse. The structures in the region of, and including, the metacarpophalangeal joint appear to contribute most to a positive flexion test of the distal aspect of a forelimb in a nonlame horse.
  
  
  CONCLUSIONS
  The flexion test of the distal aspect of a forelimb may be sensitive for investigating the metacarpophalangeal joint region in horses free from lameness, but may be less relevant for structures distal to this region.
authors: Veterinary Clinical Studies, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Ireland. clodagh.kearney@ucd.ie
authors: C M
authors: CM
authors: Kearney
authors: P R
authors: PR
authors: van Weeren
authors: B P M
authors: BP
authors: Cornelissen
authors: P
authors: P
authors: den Boon
authors: P A J
authors: PA
authors: Brama
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D005552:Forelimb / Q000033:anatomy & histology*; D006736:Horses; D007794:Lameness, Animal / Q000175:diagnosis*; D009407:Nerve Block / Q000662:veterinary; D010808:Physical Examination / Q000662:veterinary*; D016059:Range of Motion, Articular