Adams and Stashak's Lameness in Horses

List of Contributors xv Preface to the Seventh Edition xix Preface to the Sixth Edition xxi Preface to the Fifth Edition xxiii Preface to the Fourth Edition xxv Acknowledgments xxvii Common Terminologies and Abbreviations xxix About the Companion Website xxxi 1 Functional Anatomy of the Equine Musculoskeletal System 1 Anna Dee Fails Anatomic Nomenclature and Usage 1 Thoracic Limb 1 Hindlimb 34 Axial Components 60 Acknowledgment 64 2 Examination for Lameness 67 History, Visual Exam, and Conformation 67 Gary M. Baxter and Ted S. Stashak Introduction 67 Adaptive Strategies of Lame Horses 67 Classification of Lameness 68 Signalment and Use 71 History (Anamnesis) 71 Visual Examination at Rest 71 Conformation 72 Conformation Components and Traits 74 Acknowledgment 91 Palpation and Manipulation 93 Gary M. Baxter and Ted S. Stashak Foot 93 Pastern 96 Fetlock 97 Metacarpus/Metatarsus (MC/MT) 97 Suspensory Ligament 99 Flexor Tendons 100 Carpus 100 Forearm (Antebrachium) and Elbow 101 Shoulder and Scapula 102 Tarsus (Hock) 105 Tibia 107 Stifle 109 Femur 112 Hip 112 Pelvis 113 Back 113 Neck 115 Flexion Tests/Manipulation 115 Distal Limb/Phalangeal/Fetlock Flexion 115 Carpal Flexion 117 Elbow Flexion 117 Shoulder/Upper Forelimb Flexion 117 Tarsal/Hock Flexion 117 Stifle Flexion 119 Full‐Limb Forelimb and Hindlimb Flexion 119 Navicular Wedge Test 119 Direct or Local Pressure plus Movement 120 Subjective Assessment of Lameness 123 Kevin G. Keegan Evaluation of the Horse for Lameness at the Walk 124 Evaluation of the Horse at the Trot 126 Evaluation of Vertical Movement of the Head for Forelimb Lameness 126 Withers Movement 129 Evaluation of Vertical Movement of the Pelvis for Hindlimb Lameness (the Vertical Pelvic Movement [VPM] Method) 129 Evaluation of Pelvic Rotation for Hindlimb Lameness (The Pelvic Rotation Method [PRM]) 131 Bilateral Lameness 132 Observing Movement of the Limbs 134 Joint Angle Measurements Associated with Lameness 134 Stride Timing and Length Variables Associated with Lameness 134 Hoof Trajectory Associated with Lameness 135 Lameness Evaluation During Ipsilateral Gaits 135 Evaluation of Lameness at the Lunge 136 Evaluation of Lameness Under Saddle 136 Subjective Scoring Methods 137 Objective Assessment of Lameness 139 Kevin G. Keegan Measurement of Ground Reaction Forces (Kinetics) 139 Measurement of Movement (Kinematics) 140 Perineural and Intrasynovial Anesthesia 157 Gary M. Baxter Types of Local Anesthetics 157 Skin Preparation and Restraint 157 Perineural Anesthesia 157 Intrasynovial Anesthesia 167 Acknowledgment 187 3 Diagnostic Imaging 189 Radiography 189 Myra Barrett and Elizabeth Acutt Equipment 189 Digital Radiography Systems 191 Radiation Safety 194 Contrast Examinations 195 Principles of Radiographic Interpretation 198 Limitations of Radiography 210 Normal Radiographic Anatomy 211 Acknowledgments 299 Ultrasound 301 W. Rich Redding Introduction 301 Ultrasound to Evaluate Tendons and Ligaments 302 Patient Preparation and Scan Protocol 303 Ultrasonographic Assessment of Tendon/Ligament Pathology 316 Limitations of Ultrasonography 321 Ultrasound to Evaluate Joint Injury 323 Indications for Ultrasonography of Joints 324 Equipment and Technique 324 Ultrasonographic Appearance of Periarticular Structures 326 Ultrasonic Appearance of the Joint 327 Conclusions 331 Other Indications for Ultrasonography of the Musculoskeletal System 332 New Directions in the Use of Ultrasound 335 Nuclear Medicine/Scintigraphy 342 Kurt Selberg, Elizabeth Acutt, and Alejandro Valdés‐Martínez Principles of Nuclear Medicine 342 Radiation Safety and Protection 343 Imaging Equipment 343 Method for a Scintigraphic Exam of the Musculoskeletal System 344 Indications for Nuclear Scintigraphy of the Musculoskeletal System in Horses 347 Normal Bone Scan 348 Scintigraphic Signs of Disease 356 Abnormal Conditions for Specific Anatomical Regions 361 Limitations of Nuclear Medicine 373 Computed Tomography 376 Mathieu Spriet Introduction 376 Equipment and Principles of CT 376 Clinical Use of CT in Equine Orthopedic Imaging 378 Contrast‐Enhanced CT 380 Positron Emission Tomography 383 Conclusion 383 Magnetic Resonance Imaging 387 Michael Schramme and Emilie Segard‐Weisse Introduction 387 General Principles and Physics of MRI 387 Equipment, High‐ and Low‐Field Magnets, and RF Coils 387 Sequences and Protocols for Equine MRI 389 Artifacts of MRI 390 Interpretation of Musculoskeletal MR Images 393 Contrast MRI Techniques 396 How to Read an Equine MRI Study 397 Indications, Case Selection, Advantages, and Disadvantages of MRI 397 Magnetic Resonance Imaging of the Foot and Pastern 397 Magnetic Resonance Imaging of the Fetlock Region 409 Magnetic Resonance Imaging of the Metacarpal and Metatarsal Regions 416 Magnetic Resonance Imaging of the Carpal Region 420 Magnetic Resonance Imaging of the Tarsal Region 421 Magnetic Resonance Imaging of the Stifle Region 424 Thermography 431 Tracy A. Turner Thermographic Instrumentation 431 Principles of Use 431 Specific Applications for Lameness Diagnostics 433 4 Lameness of the Distal Limb 439 Navicular Region/Palmar Foot 439 Randy B. Eggleston and Gary M. Baxter Navicular Syndrome/Disease 439 Fractures of the Navicular (Distal Sesamoid) Bone 454 Soft Tissue Injuries in the Foot (DDFT and Podotrochlear Apparatus) 456 Acknowledgments 459 Coffin Joint and Distal Phalanx 463 Gary M. Baxter Osteoarthritis (OA) of the Distal Interphalangeal (DIP) Joint 463 Fractures of the Distal Phalanx (P3, Coffin Bone) 465 Subchondral Cystic Lesions of the Distal Phalanx (P3) 471 Collateral Ligament Injuries of the Distal Phalanx 472 Ossification of the Collateral Cartilages of the Distal Phalanx (Sidebone) 474 Miscellaneous Conditions of the Foot 477 Gary M. Baxter Sole Bruises, Corns, and Subsolar Abscesses 477 Septic Pedal Osteitis 479 Penetrating Injuries of the Foot 481 Keratoma 483 Avulsion Injuries of the Hoof 485 Acknowledgments 489 Laminitis 490 James Belknap, Andy Parks, and Katy Dern Overview 490 Relevant Anatomy 490 Pathogenesis: Pathophysiologic Considerations 491 Pathogenesis: Structural Considerations of the Equine Digit 492 The Clinical Presentation: The Horse at Risk of Laminitis 494 Clinical Signs: The Acute Onset of Laminitis 496 Hoof Wall Resections 509 Coronary Band Grooving and Resection 509 The Pastern 512 Ashlee E. Watts and Gary M. Baxter Osteoarthritis (OA) of the PIP Joint (High Ringbone) 512 Osteochondrosis (OC) of the PIP Joint 517 Luxation/Subluxation of the Proximal Interphalangeal (PIP) Joint 518 Fractures of the Middle (Second) Phalanx (P2) 522 Fractures of the Proximal (First) Phalanx (P1) 525 Desmitis of the Distal Sesamoidean Ligaments (DSLs) 532 Desmitis of Digital Annular Ligaments 535 SDFT and DDFT Abnormalities 536 The Fetlock 541 Matt Brokken and Alicia Bertone Osteochondral Fractures and Fragmentation of the Proximal Phalanx 541 Fractures of the Proximal Sesamoid Bones 543 Sesamoiditis 548 Axial Osteitis/Osteomyelitis of the Proximal Sesamoid Bones 549 Osteoarthritis of the Metacarpophalangeal/ Metatarsophalangeal Joint 550 Palmar/Plantar Osteochondral Disease 552 Fetlock Subchondral Cystic Lesions (SCLs) 553 Traumatic Rupture of the Suspensory Apparatus 554 Luxation of the Metacarpophalangeal/ Metatarsophalangeal Joint (Fetlock Luxation) 556 Constriction of or by the Fetlock Palmar/Plantar Annular Ligament 558 Acknowledgments 560 The Metacarpus and Metatarsus 563 Kyla F. Ortved and Alicia L. Bertone Bucked Shin Complex and Stress Fractures of the Dorsal Third Metacarpus 563 Fractures of the Condyles of the Third Metacarpal/ Metatarsal Bones (Condylar Fractures, Longitudinal Articular Fractures) 567 Fractures of the Third Metacarpal/Metatarsal (Cannon) Bone 571 Metacarpal/Metatarsal Exostosis (Splints) 572 Fractures of the Small Metacarpal and Metatarsal (Splint) Bones 576 Enostosis‐Like Lesions 580 Suspensory Ligament Desmitis 580 Superficial Digital Flexor (SDF) Tendinitis (Bowed Tendon) 585 Deep Digital Flexor Tendinitis 590 Desmitis of the Accessory Ligament of the Deep Digital Flexor Tendon (Distal Check Ligament) 591 5 Lameness of the Proximal Limb 597 The Carpus 597 Chris Kawcak Developmental Abnormalities of the Carpus 598 Miscellaneous Carpal Swellings 604 Dorsal Carpal Swelling 605 Intra‐articular Fractures 607 Accessory Carpal Bone Fracture 612 Carpal Luxations 613 Soft Tissue Damage to the Carpus 614 Osteoarthritis 615 Carpometacarpal Osteoarthritis 616 Osteochondrosis of the Carpus 617 Osteochondroma of the Distal Radius 617 Desmitis of the Accessory Ligament (Radial or Superior Check Ligament) of the Superficial Digital Flexor Tendon 619 The Antebrachium, Elbow, and Humerus 623 Jeremy Hubert Fractures of the Radius 623 The Elbow 627 Fractures of the Humerus 633 Neoplastic Lesions of the Humerus 637 Paralysis of the Radial Nerve 637 Acknowledgment 638 The Shoulder and Scapula 641 Jeremy Hubert Inflammation of the Intertubercular Bursa (Bicipital Bursitis) 641 Inflammation of the Infraspinatus Bursa 643 Osteochondrosis (OC) of the Scapulohumeral (SH) Joint or Shoulder 644 Osteoarthritis (OA) of the Scapulohumeral Joint 646 Luxation of the Scapulohumeral (Shoulder) Joint 648 Suprascapular Nerve Injury (Sweeny) 650 Fractures of the Scapula 652 Fractures of the Supraglenoid Tubercle (Tuberosity) 653 Acknowledgment 655 The Tarsus 657 W. Rich Redding Introduction 657 Diagnosis of Tarsal Lameness 657 Articular Diseases of the Tarsus 662 Cunean Tenectomy 672 Fractures and Luxations of the Tarsus 680 Soft Tissue Injuries of the Tarsus 687 Periarticular Tarsal Cellulitis 697 Tibia and Crus 701 W. Rich Redding Introduction 701 Diagnostic Analgesia of the Crus 701 Imaging the Tibia/Crus 701 Clinical Conditions 701 Enostosis‐Like Lesions 702 Fractures of the Tibia 703 Incomplete Fractures 704 Proximal Physeal Fractures 705 Diaphyseal Fractures 706 Tibial Tuberosity Fractures 706 Gastrocnemius Disruption in Foals and Adults 707 The Stifle: Femoropatellar Region 709 Gary M. Baxter and Ken E. Sullins Introduction 709 Femoropatellar Joint 711 Upward Fixation of the Patella (UFP) 717 Desmitis of the Patellar Ligaments 719 Patellar Luxation/Subluxation 721 Synovial Osteochondroma in the Hindlimb 722 The Stifle: Femorotibial Joint Region 725 Chris Kawcak Subchondral Cystic Lesions (SCLs) of the Stifle 726 Fractures 729 Femoral Condyle Lesions 731 Collateral Ligament Injury 734 Cruciate Ligament Disease 734 Meniscal Injuries 735 Synovitis/Capsulitis/OA 737 Femur and Coxofemoral Region 740 Nicolas S. Ernst and Troy N. Trumble The Femur 740 Diaphyseal and Metaphyseal Femoral Fractures 740 Fractures of the Third Trochanter 744 Fibrotic and Ossifying Myopathy 744 Femoral Nerve Paralysis (Crural Paralysis) 748 Calcinosis Circumscripta 749 Trochanteric Bursitis (Trochanteric Lameness, Whirlbone Lameness) 750 Ruptured Quadriceps Muscle 750 The Coxofemoral Joint 750 Osteochondrosis or Osteochondritis Dissecans (OCD)/ HIP Dysplasia of the Coxofemoral Joint 752 Infectious Arthritis/Physitis of the Coxofemoral Joint 752 Partial Tear/Rupture of the Ligament of the Head of the Femur (Round Ligament) 753 Coxofemoral Subluxation and Luxation (Dislocation of the Hip Joint) 754 Osteoarthritis (OA) of the Coxofemoral Joint 757 Capital Physeal Fractures of the Femoral Head 758 Intra‐articular Acetabular Fractures 758 Acknowledgment 759 6 Lameness Associated with the Axial Skeleton 763 The Axial Skeleton 763 Rob Van Wessum Anatomy and Biomechanics of the Vertebral Column 763 Primary vs. Secondary Back Pain 767 The Pelvis 770 Rob Van Wessum Fractures of the Pelvis 770 Specific Types of Pelvic Fractures 771 Thrombosis of the Caudal Aorta or the Iliac Arteries 775 Sacroiliac Region 777 Rob Van Wessum Etiology 778 Clinical Signs 778 Diagnosis 779 Treatment 782 Prognosis 783 Thoracolumbar Spine/Back 784 Rob Van Wessum Overriding/Impingement of Dorsal Spinous Processes 784 Supraspinous Ligament Injuries 785 Fractures of the Spinous Processes 786 Vertebral Fractures 787 Facet Joint Arthritis and Vertebral Facet Joint Syndrome 788 Discospondylitis 792 Spondylosis 793 Scoliosis, Kyphosis, and Lordosis 794 The Neck and Poll 796 Rob Van Wessum Nuchal Ligament 796 Cervical Facet Joints 797 Radiculopathy 798 Discospondylitis 798 Cervical Fractures 798 7 Principles of Musculoskeletal Disease 801 Joint Injuries and Disease and Osteoarthritis 801 C. Wayne McIlwraith Anatomy and Physiology of Joints 801 Pathobiology of Joints and Their Reaction to Insult and Injury 808 Primary Disease of Subchondral Bone 816 Bone Injuries and Disease 820 Chris Kawcak and Gary M. Baxter The Immature Skeleton 820 Local Diseases of Bone 825 Systemic Diseases of Bone 841 Tendon and Ligament Injuries and Disease 849 Laurie R. Goodrich Anatomy 849 Functions of Tendons and Ligaments 851 Biomechanical Properties 852 Types of Tendon and Ligament Injuries 852 Effect of Aging and Exercise on Tendon Injury 853 Mechanisms of Tendon Degeneration 854 Response of Tendons and Ligaments to Injury: Phases of Healing 854 Monitoring Tendon Injury 856 Biomarkers for Tendon Disease 857 Common Clinical Conditions of Tendons and Ligaments 857 Muscle Injuries and Disease 860 Stephanie J. Valberg Classification of Muscle Disorders 860 Diagnosis of Specific Muscle Disorders 860 Muscle Soreness 862 Exertional Rhabdomyolysis 865 8 Principles of Therapy for Lameness 875 Systemic/Parenteral 875 Drew W. Koch and Laurie R. Goodrich Parenteral NSAIDs 875 Polysulfated Glycosaminoglycans (PSGAGs) and Pentosan Polysulfate (PPS) 875 Hyaluronan 876 Bisphosphonates 877 Tetracyclines 877 Estrogen 878 Methocarbamol (Robaxin) 878 Gabapentin 878 Topical/Local 881 Drew W. Koch and Laurie R. Goodrich Topical NSAIDs 881 Topical First Aid (Cold Therapy and Bandaging) 881 Dimethyl Sulfoxide 882 Extracorporeal Shockwave Therapy 882 Regional Perfusion 882 Therapeutic Ultrasound, Lasers, and Electromagnetics 883 Counterirritation 883 Intrasynovial 886 Lauren E. Smanik and Laurie R. Goodrich Corticosteroids 886 Hyaluronan 888 Corticosteroid and HA Combinations 889 IA Polysulfated Glycosaminoglycans 889 Polyglycan® 890 Autologous Conditioned Serum 890 Platelet‐Rich Plasma 890 Autologous Protein Solution 891 Bone Marrow‐ or Fat‐Derived Mesenchymal Stem Cell Therapy 891 Polyacrylamide Hydrogel 891 Miscellaneous 892 Intrasynovial Therapy: Practical Considerations 892 Intralesional 896 Sara K.T. Steward and Laurie R. Goodrich Introduction 896 Hyaluronan and Polysulfated Glycosaminoglycans 896 Autologous Cell Therapies: Mesenchymal Stem Cell Therapy, Autologous Bone Marrow Aspirate, Tendon‐ Derived Progenitor Cells 896 Blood‐Derived Biologics: Platelet‐Rich Plasma, Autologous Conditioned Serum, Autologous Protein Solution, and Bone Marrow Aspirate 897 Corticosteroids 898 Miscellaneous 898 Oral/Nutritional 900 Nicolas S. Ernst and Troy N. Trumble Nonsteroidal Anti‐Inflammatory Drugs 900 Nutraceuticals 903 Therapeutic Trimming and Shoeing 911 Andrew H. Parks Introduction 911 Examination of the Limb for Therapeutic Shoeing 911 The Trim 912 Shoeing 912 Protection and Support 917 Clinical Applications of Principles 918 Summary 920 Acupuncture Treatment of Limb Lameness and Back Pain 921 Kevin K. Haussler Introduction 921 Techniques of Stimulation 921 General Indications for Treatment 922 Lameness 922 Chronic Back Pain 923 Adverse Effects 924 Manual Therapy Techniques 925 Kevin K. Haussler Introduction 925 Therapeutic Touch 925 Massage Therapy 925 Passive Stretching Exercises 925 Mobilization 926 Joint Mobilization and Manipulation 926 Contraindications 927 Rehabilitation/Physical Therapy 929 Melissa King, Katherine Ellis, and Narelle C. Stubbs Introduction 929 Clinical and Client Demand for Rehabilitation/PT 929 Manual Therapy 930 Proprioceptive Facilitation/Neuromotor Control Techniques 934 Physical Modalities 936 Conclusion 943 9 Occupational‐Related Lameness Conditions 949 The Thoroughbred Racehorse 949 Ryan Carpenter Risk Factors for Injury 949 Diagnosis of Lameness 950 Common Conditions 951 The Standardbred Racehorse 964 Kimberly Johnston and Frank A. Nickels Description of the Sport 964 Lameness Exam 965 Specific Lameness Conditions 966 The Racing Quarter Horse 972 Nancy L. Goodman and Larry R. Overly Introduction 972 Conformation Relating to Lameness 972 Training the Racing Quarter Horse 973 Shoeing 973 Lameness Related to Track Surface 973 Lameness Examination 973 Specific Lameness Conditions 975 The Western Performance Horse 980 Robin M. Dabareiner Introduction 980 Team Roping Horses 980 Tie‐Down and Breakaway Roping 981 Barrel Racing 982 XII Table of Contents Reining Horses 982z Cutting Horses 983 Jumping, Eventing, and Dressage Horses 986 Omar Maher Introduction and Horses Used for the Disciplines 986 Structure of Training and Competition 987 Training Surfaces and Shoeing 989 Lameness Diagnosis 990 Common Lameness Problems 991 Acknowledgment 996 The Endurance Horse 998 Todd C. Holbrook The Sport 998 Athletes and Exercise Conditions 998 Veterinary Control 998 The Lameness Examination 1000 Common Causes of Lameness 1002 The Western Pleasure Horse 1006 Sherry A. Johnson and David D. Frisbie Understanding the Sport 1006 Western Pleasure Terminology 1007 Training and Showing 1007 Commonly Encountered Musculoskeletal Issues in the Western Pleasure Athlete 1008 Foot Pain 1008 Fetlock Osteoarthritis 1010 Proximal Suspensory Desmopathy 1010 Distal Tarsal Disease 1012 Rehabilitation and Management of the Western Pleasure Athlete 1013 Conclusion 1013 Gaited Horses 1015 David A. Wilson and Kevin G. Keegan Evaluating Gaited Horses for Lameness 1015 What Is a Gaited Horse? 1015 Classification of Gaits 1015 Specific Gaits in “Gaited Horses” 1018 Lameness in the Gaited Horse 1020 The Draft Horse 1026 Jan F. Hawkins Introduction 1026 Anamnesis 1026 Lameness Examination 1026 Common Causes of Lameness 1026 Diseases of Young Draft Horses 1030 10 Lameness in the Young Horse 1033 The Physis/Physeal Fractures/ Physitis 1033 Dane M. Tatarniuk, Troy N. Trumble, and Gary M. Baxter The Physis 1033 Classification and Treatment of Physeal Injuries/ Fractures 1037 Developmental Orthopedic Diseases 1041 Epiphysitis/Physitis/Physeal Dysplasia 1042 Etiology 1042 Clinical Signs 1043 Diagnosis 1043 Treatment 1046 Prognosis 1046 Angular Limb Deformities (ALDs) and Cuboidal Bone Malformations 1048 Nicolas S. Ernst, Troy N. Trumble, and Gary M. Baxter Angular Limb Deformities (ALDs) 1048 Etiology 1048 Clinical Signs 1048 Diagnosis 1049 Treatment 1051 Prognosis 1055 Cuboidal Bone Malformation/Incomplete Ossification 1055 Etiology 1055 Clinical Signs 1055 Diagnosis 1056 Treatment 1056 Prognosis 1058 Flexural Deformities 1059 Nicolas S. Ernst, Troy N. Trumble, and Gary M. Baxter Congenital Flexural Deformities 1059 Acquired Flexural Deformities 1062 Osteochondrosis 1071 C. Wayne McIlwraith Introduction 1071 Osteochondritis Dissecans (OCD) 1071 Subchondral Cystic Lesions 1078 Lameness in Foals 1081 Robert J. Hunt Diagnosis 1081 Noninfectious Causes of Lameness 1082 Infectious Causes of Lameness 1089 11 Foot Care and Farriery 1091 Basic Foot Care 1091 Stephen E. O’Grady Introduction 1091 Evaluation of the Foot 1091 Principles of Trimming and Shoeing 1095 Stephen E. O’Grady Guidelines for Trimming 1095 Trimming the Foot 1098 Trimming the Barefoot Horse 1100 The Horseshoe 1102 Placement and Application of the Shoe 1108 Non‐nail Alternatives in Farriery 1109 Acknowledgment 1111 Farriery for Common Hoof Problems 1112 Stephen E. O’Grady Conditions of the Foot That Respond to Farriery 1112 Clinical Conditions Affecting the Hoof 1121 Miscellaneous Conditions of the Foot 1129 Acknowledgment 1132 Natural Balance Trimming and Shoeing 1134 Gene Ovnicek Introduction 1134 Distortions of the Hoof 1134 Natural Balance Hoof Care Guidelines 1135 Natural Balance Evaluation, Exfoliation, and Mapping Protocol 1135 Natural Balance Barefoot Trimming 1139 Natural Balance Shoeing 1139 Summary 1142 12 Miscellaneous Musculoskeletal Conditions 1143 Musculoskeletal Emergencies 1143 Kathryn A. Seabaugh Introduction 1143 Fracture Management 1143 Musculoskeletal Wound Management 1148 Tendon and Ligament Lacerations 1149 Musculoskeletal Infections 1153 Specific Treatment Strategies for Musculoskeletal Infections 1158 The Poorly Performing Horse 1161 Elizabeth J. Davidson Introduction 1161 Signalment and History 1161 Clinical Examination 1163 Diagnostics 1164 Treatment 1165 Evaluation of Proper Saddle Fit 1166 Kevin K. Haussler Introduction 1166 Clinical Signs of Poor Saddle Fit 1166 Saddle Examination 1166 Static Examination of Saddle Fit 1166 Static Examination of Saddle Pads 1168 Dynamic Examination of Saddle Fit 1168 Prepurchase Examination 1170 Randy Eggleston Structure of the Prepurchase Examination 1171 Summary 1174 Stance and Gait Anomalies Caused by Neurological Disease 1177 Lutz S. Goehring Neurological Gait and (Neuroanatomical) Lesion Location 1177 Findings from a Neurological Exam That Can Help in Localizing a Lesion 1178 Pitfalls of Neurological Examination 1179 Select Neurological Syndromes Affecting the Gait 1180 Index 1183