Discussion

General points:
Wide variety of clinical signs which may be overlap in individual cases and makes differential diagnosis difficult

- Neurological signs
- Neck pain
- Forelimb lameness
- Neck related problems appear to be more common. Why?
- Presentation from the owner may be different
- Poor performance
- Gait abnormalities or possible lameness in hindlimbs
- Lack of impulsion 'weakness' toe dragging
- Forelimb lameness or shortened stride
- Abnormal head carriage or lack of bend in neck or axial skeleton
- Neck stuck in fixed low position
- Confused by other concurrent orthopaedic problems
- Rider issues
- Age of horse

Examination at rest
- Assess head/neck posture and conformation
- Assess musculature of neck
- Palpate neck for areas of heat, pain and swelling
- Neck movement tests

Examination at exercise

Orthopaedic work-up
- Forelimb lameness
- Bilateral low grade hindlimb lameness
- Back or pelvic problems, primary or secondary to other lameness
- All these compounded in young, not fully muscled large horses
- Neuro-muscular diseases

Neurological work-up
- Full neurological examination

Imaging
- Radiography - ultrasonography - nuclear scintigraphy - thermography
- Myelography - computed tomography - nuclear scintigraphy
- Diagnostic ultrasonography

Functional testing
- Electromyelogram (EMG)
- Trans-cranial magnetic stimulation

Conditions of neck leading to forelimb lameness
- Localised muscle soreness
- Osteoarthritis of cervical SIAs
- Discospondylitis
- Fractures of cervical vertebrae
- Myeloma
- Other cyst-like lesions in cervical vertebrae
- Borrelia burgdorferi
- Nerve root injury associated first rib trauma
- Nerve root contributions to brachial plexus

Conditions of neck leading to pain
- Trauma soft and/or bony tissue of the neck or poll
- Inflammatory processes
- Degenerative conditions
- Neoplasia

Neck conditions leading to neurological signs
- Cervical vertebral stenotic or compressive myelopathy
- Vertebral trauma