Pre-Purchase Evaluations

A. Kent Allen, DVM, Cert. ISELP | Virginia Equine Imaging | Published: Issue 2, 2024

Tags:

Editor's Pick

Communication with veterinary colleagues is crucial to the success of a pre-purchase examination. The components of communication components among all involved team members during the multi-faceted pre-purchase exam will be detailed in the following sections.

What is involved in a PRE-PURCHASE EXAM?

The pre-purchase exam calls on the detective and intuitive skills of the veterinarian to reveal any potential lameness or medical problems. The first part of the exam is the clinical part. An ophthalmic, dental, and brief neurologic exam is performed at the head. The heart, lungs, and gastrointestinal systems are evaluated and auscultated.

The musculoskeletal examination is conducted, with thorough palpation of the joints, back, tendons, and ligaments of the distal limbs. This is also when the blood work will be done. Typically, this will include the Coggins Test and screening for any medications in the bloodstream that could significantly affect the horse at the time of the examination.

Next, the dynamic aspects of the examination begin. The horse is first examined freely at a walk and trot on a straight, flat surface. Then, he is moved on a lunge line and/or under saddle at a walk, trot, and canter, usually on firm footing with a good surface. Any indications of lameness can be evidenced by a head bob or a body drop from one side to another.

The horse’s flexibility of the neck and back, limb coordination and placement, and any signs of ataxia are additionally evaluated. The next part of the dynamic exam is the “active flexion test,” which is the flexion of the joints followed by trotting off in a straight line. It is acceptable for the horse to initially appear stiff or lame for a few steps after the flexion.

The question is whether the horse is comparable side to side and how long it takes to warm out of the flexion. Flexion tests are used as an indicator of a potential problem that may need to be radiographed or evaluated further.

Radiographs (X-rays) are routinely taken as part of the pre-purchase exam. Along with assessing any areas of concern determined during the clinical or dynamic components of the exam, a full set of X-rays can provide valuable information on which to base the purchase decision. Furthermore, the images can serve as a baseline for that particular horse to refer to in the future, as well as later arguing that X-ray findings in the horse have been unchanged over a period of time.

There are other methods of imaging that can be done as part of the pre-purchase exam if needed or warranted, such as a respiratory endoscopy, nuclear scintigraphy (bone scan), magnetic resonance imaging (MRI), ultrasound, etc.

Nuclear scintigraphy is one advanced imaging modality that can be utilized to further evaluate the horse during a pre-purchase examination. It can be particularly useful when searching for potential abnormalities or concerns within the axial skeleton, such as the dorsal articular processes of the spine or the sacroiliac region.

Who is involved in a PRE-PURCHASE EXAMINATION?

There may be multiple participants and groups involved in a single pre-purchase exam. The constant players include the buyer, seller, and the examining veterinarian. Other participants in a pre-purchase exam may also include an agent of the buyer and/or seller, the veterinarian of the seller who has examined the horse previously, and/or specialist veterinary professionals at the request of the examining veterinarian or the seller’s veterinarian.

Consequently, communication must be maintained between all groups involved. It is the responsibility of the examining veterinarian to consistently discuss all aspects of the pre-purchase exam with each distinct party. In the case of a foreign horse being vetted, it is not uncommon for the exam to be performed by an international veterinarian and for the findings of the exam to be reported to the buyer’s domestic veterinarian.

For example, if an American is purchasing a European horse, a European veterinarian may perform the pre-purchase exam. The buyer may then ask their regular American veterinarian to add his/her interpretation to those results.

COMMUNICATING THE Clinical Exam

Due to the multitude of parties that may be involved, a consistent and methodical clinical examination of the horse is required as the basis for all subsequent communication. It is crucial to document any significant findings, such as gait asymmetry or lameness, appreciated in the examination. Most veterinarians choose to evaluate the movement of the horse with no video recordings or objective analysis.

However, it is important to note that video recordings, or use of quantitative lameness technology, may prove useful and serve as an effective means of documentation for future communications with the buyer, seller, and especially other colleagues involved with the pre-purchase exam.

COMMUNICATING IMAGING
Recommendations and Findings

As the pre-purchase examination moves to the imaging portion, it is of paramount importance to distinguish and communicate with the buyer as to what imaging is recommended, what imaging the overseeing veterinarian is requesting, and what the seller will allow to be done on the horse.

This includes logistical aspects required for gathering the imaging, such as whether the seller will allow the clipping of limbs for ultrasound imaging. Regardless of the type of imaging that is recommended, it is vital to ensure the client is aware of the recommended imaging and the cost involved.

If more than a radiographic exam is recommended during a pre-purchase exam, the seller must be informed so they know and approve of the additional imaging and techniques. High-quality diagnostic imaging is not only necessary for immediate interpretation but also so that the various future parties involved after the initial pre-purchase examination can offer their opinions and prognosis based on the diagnostic information provided.

Meticulous assessment of the quality, labeling, and positioning of any diagnostic imaging is essential. This attention to detail ensures that the images are of diagnostic quality and will limit the need for other veterinarians to request that the imaging be re-done.

The physical examination of the horse should include palpation of the dorsal spinous processes and surrounding soft tissues, as well as palpation of the sacroiliac. This can help to reveal any discomfort or underlying conditions that may warrant further investigation or imaging.

PRE-PURCHASE Documentation

Detailed documentation of the examination findings accompanied by the veterinarian’s opinions is critical and may be time-sensitive. The documentation may be formatted as worksheets or as a letter summarizing the findings. Furthermore, this is the stage of the pre-purchase exam where it may be prudent to seek an expert opinion on any imaging, such as contacting a board-certified radiologist.

Moreover, if there is any concern regarding the horse systemically, it would be time to recommend additional specialized veterinary opinions to include, but not limited to, ophthalmic or cardiac consultations, and/or drug screening. It is important to add additional opinions to the documentation so that each party has access to all the relevant material.

With the consent of the seller, this medical information should be shared with the purchaser and/or their veterinarian. If there has been any verbal communication with the buyer, the buyer’s agent, or a veterinarian prior to the report being written, it is vital for the written documentation to also reflect the verbal communication.

The full detailed report of the pre-purchase examination should be sent to all parties for review as quickly as possible so that there is time to ask suitable questions prior to irrevocable economic decisions being made.

COMMUNICATING Medical History

The most common communication between veterinary colleagues in the pre-purchase exam is a call or email requesting prior medical history on the horse presenting for the pre-purchase examination. The veterinarian who has previously examined this horse for the seller must then request permission from the seller to forward any medical records or imaging.

Not uncommonly, the seller is asking the veterinarian to limit or edit the prior medical history. This undoubtedly puts the seller’s veterinarian in both an ethical and legal conflict, in addition to straining the relationship with the seller should the veterinarian refuse to edit the medical record.

This dilemma must be resolved with the seller before the records can be transferred. Otherwise, the seller’s veterinarian must respond back to the buyer’s veterinarian, indicating that the records will not be forthcoming.

Often, the buyer’s veterinarian will contact the seller’s veterinarian and discuss the matter “off the record.” Remember, this does not absolve the veterinarian’s ethical and legal responsibility to the requests of the seller, and it is rare that “off the record” discussions remain that way, particularly if lawyers become involved.

Care, meticulous documentation, and impeccable communication with all parties will usually see you through this complex predicament.

Communicating PRE-PURCHASE RESULTS

The second most common communication between veterinarians regarding a pre-purchase examination usually results after the veterinarian has failed a horse and indicates the presence of a lameness or a specific radiographic finding. In this case, the seller’s veterinarian may be contacted for either prior radiographs or to give an opinion regarding potential concerns for the horse’s future athletic performance.

Not uncommonly, this can put the veterinarian of both the buyer and the seller at odds over differing opinions for their respective clients. The best way to avoid this particular problem is to have fully documented the concerns during the pre-purchase examination and, if necessary, reach out for additional expert veterinary opinions prior to getting the seller’s veterinarians involved.

For example, consider the buyer’s veterinarian notes a Grade 2/5 right front lameness while the horse was circling right on a firm surface during the pre-purchase examination. Ideally, the veterinarian would video record the lameness, adequately document the lameness in the record, and, if able, assess the horse with a quantitative lameness device.

Such thorough documentation should resolve the majority of the “he said, she said” arguing that sometimes follows a failed pre-purchase exam.

Another conflicting situation may arise from a radiographic finding for which the buyer’s veterinarian deems the horse unsuitable for purchase. If the buyer’s veterinarian is not confident in his/her ability to assess whether this radiographic finding will limit the horse’s ability to perform its future job, it is advised to consult with a colleague or a radiologist for an additional opinion.

This second opinion should also be well documented within the record as it may additionally defuse a future argument between parties.

A 15-year-old Warmblood Grand Prix Dressage horse presenting for pre-purchase. Mild to moderate effusion was noted in both front coffin joints, and flexions of both lower forelimbs showed a moderate response. Radiographs of the navicular bones raised considerable concerns.

How many horses FAIL AND WHY?

Virginia Equine Imaging has done a retrospective study on 700 pre-purchase examinations, looking at which horses passed, which failed, and what were the causes of the horses failing the pre-purchase exam.

Of the 700 pre-purchase exams that were performed, 47% (328/700) of horses passed on the initial examination and 53% of horses failed on the initial examination. A total of 77 horses were re-presented, and of those, 77, 36 or 69% passed on the re-presentation.

The overall pass rate was 364/700, or 52%. Of the 700 horses that presented on the initial presentation, 255 horses, or 36%, were considered lame at that examination. An additional 92/700, or 13%, of horses that passed on the initial lameness evaluation failed due to radiographic abnormalities. The remaining 4% of horses that failed the pre-purchase examination were due to other abnormalities, such as behavioral issues.

There were 512 horses of the 700 horses, or 73%, that proceeded with radiographic imaging. Of the horses that passed the pre-purchase examination, the top ten radiographic abnormalities included the following: hock osteoarthritis, fetlock osteoarthritis, navicular bone changes, dorsal spinous impingement (kissing spine), pastern osteoarthritis, fetlock OCD, sidebone, hock OCD, bony remodeling of the dorsal articular processes of the back, and coffin bone osteoarthritis.

Of these ten most prominent radiographic findings, osteoarthritis of the lower hock joints comprised 73% of horses, and fetlock joint osteoarthritis comprised 37.5% of horses.

The horses that failed on pre-purchase examination had the following top ten radiographic abnormalities: hock osteoarthritis, fetlock osteoarthritis, navicular bone changes, dorsal spinous impingement (kissing spine), pastern osteoarthritis, fetlock OCD, sidebone, hock OCD, sesamoiditis, and stifle OCD.

Additionally, there are a few radiographic abnormalities that were solely found in horses that failed on pre-purchase examination, including the following: rotation of the coffin bone, shoulder bone cyst, navicular bone cyst, bony sequestrum, and fracture.

Ultimately, of the horses that failed on pre-purchase examination, 80% failed due to a fetlock cyst, 75% failed due to a pastern cyst, 63% failed due to pedal osteitis, 62% failed due to stifle OCD, and 56% failed due to sesamoiditis.

Of the 700 horses that had a pre-purchase examination, 18 had an ultrasound of the distal limb. Of the 18 horses that were scanned, three passed the pre-purchase exam, including one with an SDFT injury and another with a suspensory ligament injury. The remaining 15 horses failed the pre-purchase exam. Of the 15 horses that failed, two were due to an SDFT injury, 11 were due to a suspensory ligament injury, one was due to a DDFT injury, and one was due to an inferior check ligament injury.

CONCLUSION

In summary, a methodical, well-documented clinical examination accompanied by adequate diagnostic imaging and, if necessary, a second opinion from a specialist veterinarian are crucial components of a pre-purchase examination. This attention to detail and thoroughness will drastically improve communication between the buyer, seller, and the veterinary colleagues who represent them respectively.

A. KENT ALLEN | DVM, Cert. ISELP

Dr. Kent Allen received his Doctor of Veterinary Medicine from the University of Missouri in 1979 and has been practicing equine medicine ever since. He opened Virginia Equine Imaging in 1996 after selling Arizona Equine Medical and Surgical Center. Virginia Equine Imaging became one of the first privately owned and operated equine diagnostic imaging specialty clinics in the world.

During his transition from Arizona to Virginia, Dr. Allen served as the Veterinary Services Manager at the 1996 Olympic Games in Atlanta, acquiring the title of Arizona Equine Practitioner of the Year. Dr. Allen is currently President, Executive Director, and board member of the International Society of Equine Locomotor Pathology (ISELP) and is a certified member.

Become a member to receive articles in our quarterly publication!