Equine All-Sports Medicine Center

07/31/2026

A good physical exam pays off:

This case report shows how important it is to do a full and detailed physical exam.

In this case report we saw a horse that was observed at home for the last 3 to 4 weeks to do “weird” things with his tongue. He would stick it out a bit, lick around, and put his head a bit tilted and tried to “roll up his tongue”.
Several veterinarians and an equine dentist have seen the horse, but nobody had a good idea about a diagnosis or a solution.
Dr van Wessum started his exam of this horse as with any other (sports medicine) case, and performed a full locomotion exam and then a full neuro exam. Part of the neuro exam is to palpate all lymph nodes in the head region as well as examine the sinuses by doing a percussion on the sinuses with 1 finger (“tapping on the skull”). Dr van Wessum noted some clear nasal discharge form the right nostril without a clear smell, and when he inspected the horse’s mouth a more clear smell of inflammation/necrosis.
The right maxillary sinus sounded a bit muter than left, and the right frontal sinus was completely muted and it even felt different while tapping, like a “piece of carpet” instead skin over bone.
Based on these findings we have stipulated that the horse has sinusitis (we do not know the cause yet, could be infection, tooth abscess or many other things). The normal passage (through the nose) is merely blocked, so material from the sinus drips in the pharynx and on the tongue. The horse clearly didn’t like the taste of it!

We do not have the expertise and equipment to completely diagnose and treat this problem, so the horse is referred to MSU VTH for further work-up and likely surgery. We think every veterinarian should do this, when you feel not equipped for a certain challenge, make the best choice for the animal and refer to someone with a higher level of expertise (even when we have a co-owner of the clinic, Dr Johnston, an board certified equine surgeon, but without the hospital setting to properly manage such a case).

Morale of this case: do a good physical on every case! This (tentative) diagnosis was made after just doing some clear hand-on examination with the eye, nose, and fingers of the clinician being the most valuable tools, no need for fancy equipment!

07/19/2026

To show or not to show?

we received many questions about when it is safe to go to show again. First thing to mention: " we don't know". There is NO GOOD prediction of air quality in the near future due to massive wild fires in the US and Canada.
Our advise is to not show when air quality is affected (above 100 ppm of PM2.5) and not show if the air quality was affected in the last 2 to 3 days before the show.

Every entry is a gamble with your money and potentially the health of your horse and you.

07/17/2026

When now the smoke seems to be a problem for more days, Dr van Wessum put together some scientifically based information to explain what to do and what NOT to do. Dr van Wessum is a ACVSMR board certified specialist in Equine Sports Medicine and Rehabilitation, which gives him great insight in how to deal with sport related problems, and he is board credentialed by the Dutch AVMA in Equine Medicine.

The first remark is to realize how your barn is. Most barns will not have an air filtration system, so the air in the barn is the same as the air outside. With required good ventilation (especially with higher temperatures - and ammonia vapour from the stalls can really damage the lining of the lung, much more damage than inhaling particles will do) there needs to be a high air turnover, so outside air is inside air. That means there is no advantage to keeping horses in 24-hours. Being outside in early morning, when temperatures are relatively low and do not trigger a higher respiration frequency, being outside has one GREAT advantage: the horse’s head is down while grazing, and mucus and debris can easily be moved from deeper airways to the trachea and out. This will not happen that way when locked in the barn. The mucociliary clearing (little whip hairs that move mucus from deeper airways to the trachea) is the best defense mechanism the horse has against small, inhaled particles, and we take that partly away by keeping them inside. When they are inside, feed hay from the ground for that reason!
Second point is that when horses are in the barn only, some small parts of the lung will no longer be used in breathing, and smoke particles can get lodged in into those lung parts, giving a breeding ground for infection later (it can cause pneumonia!). When the horse is walking for 10-15 minutes at east, those lung parts stay open, ventilated and with adequate blood flow, which again is a big part in the defense mechanism for the horse’s airways. Take them out for a walk in the morning or do some walking exercises in the arena to keep your horse’s lungs healthier!

Research has shown that ANY particles in the lungs of the horse in the healthy horse are removed within 24 to maximum 48 hours. There is NO need to wait 3 to 4 weeks after the smoke has cleared before starting to work again. It is even detrimental, because normal function of the lungs is limited when at stall rest (while most barns are not “clean”, often many dust and even fungus particles load the airways more than when they are outside or at work).

The mistake that is made here is that the longer period of 3 to 4 weeks is when the horse has been exposed to fire with smoke. Hot air from a fire will damage lungs much more than inhaling just some particles, and that is where the confusion stems from.

Only when your horse has a pre-existing long problem (allergies, COPD) then it may take much longer to clear the airways.

When starting to work again you should pay attention to your horse, when it is breathing faster or shallower, or has some mild exudate in the nose or does cough a bit, then take it easy and reduce workload. Being outside in the morning is still encouraged!

We hope to have explained some of the misunderstandings and misinformation that is out there by a specialist in the field with large scientific credentials to keep us all doing the best for our horses and let’s hope we can return to a more normal situation soon.

07/16/2026

a post from last year, very useful this week again: for today we advise no riding at all or just walk.

With poor air quality due to Canadian wildfires in the coming days in Michigan here some advice for your horses:
Avoid deep breathing, because that will get air particles deeper into the airways and lungs. Shorter periods of work with walk in between to regulate the breathing pattern (from higher frequency and deeper breathing to normal, shallower breathing and lower frequency)on a long rein is best. No long periods of trot and especially canter. When turned out, better during the early morning hours because the lower temperature will keep the breathing pattern lower and less intense. When the horses are very active in the pasture, bring them in.

07/06/2026

We made an educational video about how to recognize signs of sacroilac pain :https://youtu.be/q-PMJ4t9u0s

07/02/2026

To be complete: Dr van Wessum wrote 4 more chapters in a major textbook; Current Concepts in Equine Medicine. How many practicioners write expert chapters in major textbooks? How many practices do have board certified specialists work cases with the newest knowledge they have provided themselves to the equine veterinary community? Equine All-Sports Medicine Center has an unique postion in entire Michigan to help equine patients with optimal and most up-to-date speciality veterinary care!

06/30/2026

Dr van Wessum got his chapter for the new textbook "A Compact Guide to the Rehabilitation for Equine Lameness (1st edition)" accepted. This is a new comprehensive text book for students, practising veterinarians and sports medicine vets, like a handbook for getting quick access to the most up-to-date scientific knowledge about equine sports medicine and rehab. Dr van Wessum was invited to write the entire chapter on back and neck as one of the leading experts on this topic. Dr van Wessum has already written the entire chapter on back and neck diagnostics and treatment options in "Adams Lameness in Horses", which is more or less the bible on lameness.
It is an honour to be an invited author for a major text book, and being recongized for his expertise in 2 major text books is a huge bonus for our practice. How many private specialty practices do have a world renowed expert handling case load?

06/26/2026

Here is a case report for another interesting case Dr van Wessum saw last week:

The horse in this case is a 20-year-old QH gelding. He was diagnosed by Dr van Wessum 12 years ago with a ligament injury to the sacral region, which has completely recovered and the horse was sound for all that time. Now he is quite lame LH. The regular vet came out and thought it was a hoof abscess, but after several weeks of soaking and trying to find the abscess the horse was still lame. Then the regular vet made x-rays of the entire LH and thought he saw problems in the stifle and injected the stifle. After 6 more weeks the horse is still lame, and the owner brought it back to us for a second opinion.
At presentation the horse was lame 3/5 LH with a clear shorter anterior stride and a pronounced hip drop left. Analysis with Sleip AI Gait Analysis showed a clear LH lameness too.
After a flexion test of the LH hock, stifle and fetlock (the standard hind limb flexion test) the horse was a bit lamer, but when the fetlock was flexed more isolated the horse showed severe pain at flexion and trotted off nearly only toe-touching LH.
Inspection and palpation could not detect any clear swelling or heat, but when pressure was applied over the back side of the fetlock over the sesamoid bones, the horse showed clear pain again.
On radiographs of the fetlock region no clear abnormalities were visible, only a slight upward pointing and sideways displacement of the lateral (outside) sesamoid bone was noted. This is a very clear indication that the ligament that keeps the sesamoid bones together, the Intersesamoidean Ligament, has been damaged at the axial top aspect of the lateral sesamoid bone.
Ultrasonography showed a clear area of increased thickness and loss of definition of the lateral aspect of the intersesamoidean ligament with at 1 spot a clear small avulsion (the ligament pulled of the bone) off the sesamoid bone.
This damage was only visible on the ultrasound, and not yet on the radiograph, a clear indication that the injury was not too old (which holds a better prognosis) and did not have clear bone changes yet (which would be irreversible).
Rehab is needed for 6 to 8 months with stall rest, hand walk and icing of the fetlock and increased mobility over the duration of the rehab, based on ultrasound findings at several recheck exams. If not responsive to this more conservative treatment (which we hope will do the job, based on the relatively early stage we diagnosed this) we can give the horse a bar shoe and potentially inject the lesion site with a biological preparation as PRP.

This case shows again that a complete diagnosis is needed before starting any therapy, and the owner did a great job realizing she needed more specialistic help for this case.
Damage to the intersesamoidean ligament is relatively rare and not many veterinarians know of its existence and without high-end ultrasound equipment and a very experienced ultrasonographer there is no way to detect and diagnose this injury.
When this horse would have progressed with no clear diagnosis bone proliferation and arthritis of the fetlock joint would have made this horse permanently lame in the near future…
A second opinion with a board-certified lameness or sports medicine specialist is a good next step if an initial complaint does not disappear with the proposed treatment of the regular vet. In this case, when it had been a hoof abscess, the initial vet did a good job, but when the proposed treatment doesn’t work a second opinion is a good plan.
It would have been “overkill” to go to a specialist at first sight, an hoof abscess is not a reason to visit a specialist, but this owner saved her horse by seeking more advanced help!

06/25/2026

Here is a case report for another interesting case Dr van Wessum saw this week:

The horse, a 11-year-old Paint horse, as seen last year in the pasture slightly off. Later that season he was ok, but this year in spring he was off again, and the last weeks he is getting increasingly lame.
The owner consulted a local veterinarian, who made several X-rays of the limb (for a total of $1250) and then said it was not clear why the horse was lame based on the X-rays. However, the vet suggested injecting the coffin joint. The owner, a medical educated person, thought that was “odd” to treat a thing you cannot find, and decided to look for a specialist (what you would do in human medicine).
Dr van Wessum evaluated the horse and saw a severe RF lameness (even visible in walk). When he asked the horse to walk on a serpentine, every stride to the right was even more lame. The flexion test of the fetlock LF was not painful, but the RF fetlock flexion was clearly more painful, and the horse trotted off more lame than the initial lameness after the flexion test. Rotational tests (rotating the hood inward and outward respectively) showed a stronger pain reaction than the flexion test and there was mild swelling above the coronary band visible at the attachment area of the medial collateral ligament of the coffin joint.
After ultrasound examination with a high-powered ultrasound unit with a 16Mhz probe (with has a very high resolution and is only present on high-end large ultrasound machines) it was visible that the medial collateral ligament of the RF was twice the size of the identical ligament of the LF with signs of loss of definition of fiber pattern. The final diagnosis was chronic desmopathy of the medial collateral ligament of the coffin joint RF. Likely the initial mild lameness last year was the first incident, and then, because the horse was still out in pasture and used for riding, more and more mild damage was done to the ligament until it recently got more severely damaged.
With a good rehab plan for at least 6-9 months and adequate medication we feel good about full recovery for this horse. Ligaments heel slowly but if you give them time and appropriate increasing mobility over time (the rehab program) it will heal nearly completely with full restoration of function.
Morale of this case report: small soft tissue injuries (like this ligament) can be very painful but difficult to detect, especially without a good initial clinical exam (the first vet that saw this horse did only 1 flexion test and then started doing X-rays of the entire lower limb). A good ultrasound exam by an experienced and well trained ultrasonographer with top-of-the-line ultrasound equipment like an ACVSMR-boarded sports medicine specialist as Dr van Wessum is a good follow up when your local veterinarian cannot properly identify the problem. The owner of this horse did a good job in trusting the gut feeling that an injection if the coffin joint (which would have delayed or stopped healing of the ligament completely) was not the right answer!
To give you an idea about the total costs for the exam, sedation for the ultrasound, ultrasound exam and meds for this case with Dr van Wessum for the first visit (some recheck visits are needed to guide proper healing in the coming months) was $1650.

06/23/2026

A good story about knowing your horse…

Last week Dr van Wessum saw a horse he has seen several times over the years. This time the horse was presented because the last 2 weeks he has not jumped as before, feels a bit sluggish and too quiet for what he normally is. After a full lameness and neuro exam, Dr van Wessum concluded he was sound and not any musculoskeletal or neurological abnormality was found.
In the interview with the owner before starting the exam Dr van Wessum asked if lately possibly a tick was found on the horse, and the answer was several in the last 2-3 weeks.
Based on the fact that Dr van Wessum had seen the horse several times before, he could agree with the owner that the horse seemed too quiet and “not himself”, reason to send some blood work to MSU for CBC, chemistry, Vitamin E and testing for Anaplasma and Lyme.
Blood work came back with a titer for Lyme, indicative for a recent infection, which was supported by the rest of the blood work and the negative findings on physical exam on musculoskeletal and neurological exams. Based on these findings, the horse is medicated with Doxycycline for 2 to 3 weeks, because the infection is likely very recent and easy to treat.

This case shows again how important it is for a horse owner to know your horse and know when something is off and then seek veterinary help (not go for treating by yourself with bute or firocoxib or ask for chiropractor, massage of whatever other alternative treatments) from a specialist that can pinpoint the problem. It is also very helpful Dr van Wessum knows this horse quite well, and agreed with the owner about the “not being normal” instead of telling the owner “he is fine…”