Making sense of flexion tests

Flexion tests are often used as part of a prepurchase examination or a lameness work-up to evaluate lameness or assess the likelihood of future lameness problems. But what does a positive flexion test tell us about which structures are involved?

Research published in the Equine Veterinary Journal suggests that the fetlock is probably responsible for a positive response to flexion test of the lower limb. Structures below that joint are less likely to be involved.

Dr Clodagh Kearney and colleagues conducted a study on eight warmblood horses. These were all clinically sound, but had gone lame after being subjected to a flexion test of the lower limb. Flexion tests were performed under standardised conditions.

The response to the flexion test was assessed after performing various nerve blocks, which desensitised different regions of the limb. One clinician performed the nerve blocks; others performed the flexion tests and assessed the degree of lameness. So the clinicians assessing the lameness did not know which nerve block had been carried out (or on which leg).

They found that a nerve block of the palmar digital nerves, just above the cartilage of the distal phalanx, had minimal effect on the lameness induced by the flexion test. A nerve block just below the fetlock at the level of the distal abaxial sesamoid bones produced a similar response. However, there was a marked improvement in flexion test induced lameness following a low four point block just above the fetlock.

The researchers conclude that the fetlock joint and surrounding structures contribute strongly to the outcome of a flexion test of the lower limb in a non lame horse. "From a clinical point of view, it is reasonable to suggest that the flexion test of the distal limb may be sensitive for investigating the metacarpophalangeal joint region, but may be less relevant for structures distal to this joint."

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