Withers vertical movement symmetry is useful for locating the primary lame limb in naturally occurring lameness

Background During orthopaedic assessment of lame horses, a head nod is commonly present in both primary forelimb and hindlimb lame horses. Additional motion metrics that could assist clinicians in correctly differentiating between these two scenarios would be of great clinical value. Objectives The primary objective of this study was to examine whether withers movement asymmetry can be used in a clinical setting to distinguish primary forelimb lameness from compensatory head movement asymmetry due to primary hindlimb lameness. Study design Retrospective, multicentre study. Methods Movement asymmetry of head, withers and pelvis was measured using multi‐camera optical motion capture, as part of routine lameness investigations at four European equine hospitals. Vertical movement asymmetry parameters from 317 horses trotting in a straight line were compared before and after successful diagnostic analgesia of a single limb. Descriptive statistics, t‐tests and linear models were used to analyse the data. Results In forelimb lame horses, 80%–81% showed head and withers asymmetry both indicating lameness in the same forelimb. In hindlimb lame horses, 69%–72% showed head asymmetry ipsilateral to the lame hindlimb and withers asymmetry diagonal to the lame hindlimb, thus, head and withers asymmetry indicated lameness in different forelimbs. A large (>15 mm) compensatory head nod was seen in 28%–31% of the hindlimb lame horses. In 89%–92% of these, head and withers asymmetry indicated lameness in different forelimbs. Withers asymmetry decreased linearly with reduced head or pelvic asymmetry for both forelimb and hindlimb lame horses. Main limitations Compensatory strategies were evaluated on group level to identify common patterns, potentially ignoring uncommon individual strategies. Conclusions Withers vertical movement asymmetry metrics can be useful in helping to locate the primary lame limb during quantitative lameness assessment. Head and withers movement asymmetry parameters generally indicate the same forelimb in forelimb lame horses, but different forelimbs in hindlimb lame horses. Zusammenfassung Hintergrund Während der orthopädischen Untersuchung lahmer Pferde tritt häufig bei primär lahmenden Vorder‐ und Hintergliedmaßen ein Kopfnicken auf. Zusätzliche Bewegungsmetriken, die den Kliniker bei der korrekten Unterscheidung dieser beiden Szenarien unterstützen könnten, wären von großem klinischem Wert. Ziele Das Hauptziel dieser Studie war zu untersuchen, ob d