Use of the flexion test of the distal forelimb in the sound horse: repeatability and effect of age, gender, weight, height and fetlock joint range of motion.

The flexion test of the distal limb is a commonly used clinical tool in both lame and sound horses. In the latter use it is given some predictive value. In recent studies it has been shown that examiner-related factors (force, time) may strongly influence the outcome of the test. In the present study, the possible influences of a number of horse-related factors and short- and long-term repeatability were investigated. Flexion tests were performed by the same researcher in 100 clinically sound horses under standardized conditions. The outcome of the test was scored on a 9-point semiquantitative scale. The maximum flexion angles of the fetlock joints were measured and the range of motion (ROM) of the fetlock joint was calculated. In the second part of the study, flexion tests were repeated, at intervals of 10 min, 30 min, 48 h and 6 months in 23 horses to assess repeatability. Over 60% of the 100 sound horses had a positive flexion test. Of these, about 50% showed a slight lameness, 35% a mild lameness, and 15% a distinct lameness. There was no influence of weight, height or ROM on the score of the flexion test. The outcome of the flexion test increased significantly with age and was significantly higher in mares than in geldings. When repeating the flexion test with short intervals of 10 and 30 min, the score increased significantly after the second test. Repeated flexion after 48 h did not result in a significantly different outcome. Over a 6-month period, the outcome of the test decreased significantly and the ROM increased significantly. It is concluded that most clinically sound horses have a (slightly) positive flexion test of the distal limb. This and the lack of long-term consistency of the test cast doubt on the presumption that a positive flexion test may be an indication for subclinical joint disorders and question the possible value of the test as a predictor of future joint-related problems. There exists a wide individual variation in ROM of the fetlock joint with, in sound horses, no relationship between ROM and the outcome of the flexion test. The factors age and gender should be taken into account when interpreting the results of a flexion test.