Flexion tests can be beneficial, provided the person knows exactly what he is doing and why. Nancy Kerns Photo.

The basic premise of the American Association of Equine Practitioners (AAEP) is that the purpose of a veterinary prepurchase horse exam is to determine if the horse you’re interested in buying appears to be healthy and sound. The findings of a prepurchase horse exam apply only to the specific day and time the veterinarian is looking at the horse. The prepurchase horse examination isn’t supposed to—and in fact it can’t—tell you things like future soundness, suitability of the horse for the work intended, or value of the horse compared to the sale price. In theory, this sounds straightforward. In practice, however, it’s anything but. 

Reality Check
Too many buyers want the prepurchase exam findings to tell them precisely what we listed above as out of the scope of the exam. Even some veterinarians try to stretch beyond what the limits should be.

The reason many veterinarians dislike doing prepurchase exams is that they’re put on the spot, asked to give predictions about future soundness, or interpret isolated findings in a way that’s impossible.  No one can guarantee future soundness or whether an abnormal finding on exam or X-ray will cause the horse problems.

They also often feel pressured to find something, anything, “wrong” with the horse, just to validate that they looked closely. The veterinarian is between a rock and hard place. If the horse is declared free of any obvious problems, but develops one after purchase, the owner may sue.

Lawsuits regarding prepurchase exams are one of the reasons equine malpractice insurance rates are so high. This tends to make vets more likely to point out every  questionable finding on a horse.

The flip side, of course, is the seller’s point of view. If the veterinarian’s comments cause a loss of the sale, and the horse goes on to do well in someone else’s hands, you can bet that story will be retold countless times.

Put It To Use • Always get a prepurchase exam—even on a “free” horse. • Base tests on the horse’s intended use. • Keep a blood sample on hand for eight weeks after the sale. • Insist on complete    veterinary records before the exam. • Make the buy/don’t buy decision yourself.

The No-Frills Exam
A basic prepurchase examination should include a thorough physical examination. The veterinarian should do a hands-on exam of every square inch of the horse.  The eyes should be examined with an ophthalmoscope. The mouth should be opened and examined. The lungs, heart and abdomen should be listened to with a stethoscope. Visual inspection and hands-on palpation of the legs and feet is the first step toward uncovering any problems there.

The next step is to watch the horse move at a walk and trot, in a straight line and when circling in both directions.

A blood sample should be drawn that can be used to check for drugs in the event the horse shows a lameness shortly after purchase, or there is an obvious change in the temperament/behavior of the horse. Remember there are tranquilizers that can last as long as six to eight weeks.

This careful exam, together with the history, will give your vet a good idea of the horse’s current physical condition. The cost of the exam will include the farm call and the veterinarian’s time.  Depending on where you live and who you use, it will range anywhere from $100 to $350.

Add-Ons
Some vets will insist on one or more of the following tests, others will offer them but not insist, and some may only be used if there are any questionable findings on the basic exam.

• Flexion tests are often employed. The horse’s joints are held in a flexed position for 30 seconds to 3 minutes, depending on the joint and the vet’s preference, then the horse is  jogged off to see if they show a lameness. Flexion tests are fairly controversial at the moment, since studies have shown that perfectly sound horses with clean X-rays may jog off lame after a flexion test and some vets flex harder than others.

They’re most useful if the horse seems to be showing a low-grade lameness on the basic exam. In that case, if the flexion test correlates with other findings (visual exam, palpation, etc.), the result from the test is more likely to be a significant finding.

Pay For Only Tests You Need
A prepurchase exam should always include:
• Thorough physical examination.
• Watching the horse move in both directions (possibly under saddle as well).
• Blood draw to check for drugs.
• Rectal examination of mares to be used for breeding.
• Testicular examination of stallions to be used for breeding.

Optional tests, based on horses intended use:
• Flexion tests.
• X-rays.
• Ultrasound.
• Watching the horse perform at its intended use.
• Ultrasound examination for mares.
• Endoscopy of the throat.
• Uterine culture and/or biopsy for broodmares.
• Vaginal examination for broodmares.
• Semen evaluation for breeding stallions.
• Additional blood tests, e.g. chemistry, CBC.
• Second opinion from a board-certified radiologist or another veterinarian (or both) if there is any question about X-ray findings.

Prepurchase Exam Preparations
• Get an estimate from the veterinarian regarding how much time will be required (usually an hour or more) and the cost.
• Arrange a time where the owner and/or trainer can be present at the time of the exam to answer all questions.
• Request the written history and release of veterinary records be completed in advance of the exam.
• Inform the seller your vet will be drawing blood to check for drugs and that sample will be stored for at least eight weeks.
• Choose your own veterinarian, not the one the seller also uses. This is a conflict of interest and puts the veterinarian in an awkward position.
• Forget asking the vet to “pass or fail” the horse. The veterinarian can only advise you on what he or she sees at the time of the exam.

• X-rays are also commonly done but frequently raise more questions than they answer. Frankly, X-rays are limited in what they can tell you. “Clean” X-rays only mean no abnormal findings. They don’t tell you anything about the soft-tissue structures or cartilage. On the other hand, bone changes often don’t correlate well at all with soundness, nor can they be used to predict future problems in most cases.

A common scenario involves the horse that has navicular-bone changes.  Despite the fact that studies have shown poor correlation between lameness and X-rays, or pathological changes on postmortem and X-rays, not to mention that even the experts often can’t agree on what findings, if any, conclusively mean navicular disease, “navicular changes” is a common reason for sales not going through.

Get It In Writing Your vet will have a much easier time interpreting examination findings if you have as complete a history on the horse as possible. These are also health records that you should have anyway. This should include: • Vaccination history. • Deworming schedule, including drugs used. • Any medications the horse is receiving. • Past illnesses, injuries, lamenesses and medical problems (e.g. breathing problems, tying up, allergies, etc.) and treatment received. • Names and contact information for all veterinarians and farriers who have seen or treated the horse. • Get it in writing, and have it signed by the owner and the trainer. If the seller does not have these records, request that he/she authorize all veterinarians who have ever seen and treated the horse to release those records to the examining veterinarian. In fact, even if you get a written and signed history you should always request that the horse’s records be released to the new veterinarian.

• Ultrasound is the preferred examination method for tendons and ligaments but isn’t commonly done. An exception would be if a suspicious area was found on the physical examination. Ultrasound may then be recommended to confirm, or rule out, a problem.

• Riding observation: Watching the horse go under saddle, at all gaits and preferably also doing work of the same type you would like the horse to do (within the limits of the horse’s current level of training and conditioning), isn’t always part of the exam but has some advantages. Some lamenesses are more obvious under saddle, as are breathing problems like roaring or a displaced soft palate.

• Blood counts and blood chemistry are suggested by some veterinarians or requested by some buyers, but they aren’t routine.

• Endoscopy is sometimes done to look for throat problems. However, most horses with breathing problems will make an abnormal noise when worked under saddle, and this will alert the vet. In that case, endoscopy may be done to confirm a problem. Otherwise, endoscopy is more of a consideration for high-performance horses.

• Second opinions: If there’s any question about findings on X-ray, a second opinion should always be obtained. If your veterinarian doesn’t suggest this, you should do it on your own.

Bottom Line
You’re going to want at least a no-frills pre-purchase exam when you go to buy a horse. In some cases, the idea of a veterinarian examining the horse—or taking blood to test it for samples—is enough to make the seller back down. Otherwise, you’re simply ensuring that what the seller is telling you at the time of the sale, physically, is true. The number of tests you choose to perform depends largely on the purpose you have for the horse and, of course, the horse’s cost and age.

After evaluating the history, performing the exam and reviewing any X-rays or lab work, your veterinarian should present you with a list of any negative findings. He/she may also help you put the findings in perspective but can’t guarantee future soundness.

If a problem is detected, it’s outside the scope of a prepurchase examination to diagnose the problem.  If the buyer requests diagnostics, and the seller agrees, the veterinarian may or may not have time available to actually do it.

Although you may hear of a horse “passing” or “failing” a prepurchase examination, it’s really not appropriate to use these terms. It’s not the veterinarian’s job to tell you to buy the horse or not. The vet’s job is to do a thorough examination and inform you of the findings. This information, together with input from your trainer, farrier, and your own instincts about the horse, are what you consider to reach the decision about purchasing the horse.