Assessment of the orthopaedic patient

Question 1

Plan of orthopaedic assessment

Answer 1

History
Gait examination
Physical examination
Ancillary aids to diagnose

Question 2

Basic plan for clinical examination of an orthopaedic patient

Answer 2

History
Observation
Palpation
Manipulation

Question 3

Common orthopaedic signalment: Seven month old lab with forelimb lameness

Answer 3

Elbow dysplasia

Question 4

Common orthopaedic signalment: Seven year old Rottweiler

Answer 4

Bone tumour e.g. osteosarcoma

Question 5

Common orthopaedic signalment: Eight year old GSD with sudden onset unilateral pelvic limb lameness

Answer 5

Cruciate rupture

Question 6

Common orthopaedic signalment: Eight month old GSD with pelvic limb stiffness

Answer 6

Hip dysplasia

Question 7

History in orthopaedic case

Answer 7

Medication

Duration of lameness

Onset

Static or progressive lameness, deteriorating or improving

Continuous or intermittent lameness

Does lameness alter with exercise

Is it altered by ground surface

Which limbs according to owner?

Working or pet dog

Any concurrent problems

Question 8

Kyphosis

Answer 8

Dorsal curvature of the spine (hunching)

Question 9

Scoliosis

Answer 9

Lateral curvature of the spine

Question 10

Palmigrade

Answer 10

All parts of manus are flat against the ground

Question 11

Plantigrade

Answer 11

All parts of the pes are flat against the ground

Question 12

Valgus

Answer 12

Lateral deviation of the distal portion

Question 13

Varus

Answer 13

Medial deviaiton of the distal portion

Question 14

What to look for when looking at the stance of an animal

Answer 14

Asymmetry
Weight bearing
Inward/outward pointing of paw
Shifting weight from pelvic limbs to thoracic limbs - kyphotic stance
Scoliosis - sign of shifting weight
Frequent sitting - pelvic limb lameness
Frequent lying down - thoracic limb lameness

Question 15

Gait examination

Answer 15

Shortened stride length
Abnormal joint movement
Head bobbing
Scuffing of nails
Ataxia
Excessive truncal motion
Look for neurological disease

Question 16

Ataxia

Answer 16

Pelvic limb incoordination

Question 17

Paralysis

Answer 17

Loss of voluntary movement

Question 18

Paresis

Answer 18

Partial paralysis, loss of motor function, stand with a narrower stance

Question 19

Paraparesis

Answer 19

Both pelvic limbs

Question 20

Quadriparesis

Answer 20

All limbs

Question 21

Hemiparesis

Answer 21

Both limbs on one side of body

Question 22

Paraplegia

Answer 22

Neurological deficits with absent motor function

Question 23

Signs of thoracic limb lameness

Answer 23

Weight shifted caudally
Head nod
Shortened stride
Faster swing on the sound leg
Circumduction of the limb
Abnormal tracking

Question 24

Indication of stifle pain

Answer 24

Limb may be circumducted to prevent stifle flexion

Question 25

Indication of hip pain

Answer 25

Lateral sway and minimising hip motion. Bunny hopping.

Question 26

Signs of pelvic limb lameness

Answer 26

Weight shifted cranially
‘hip hike’ - increased vertical motion of the lame limb so appears higher
Shortened stance phase on lame limb
Bunny hopping - often hip pain
Limb circumduction - often to avoid bending stifle
Skipping
Truncal motion - movnig pelvis side to side instead of hips

Question 27

Degrees of lameness (0-5)

Answer 27

0 - normal gait pattern
1 - mild lameness, need a trained eye to spot
2 - moderate lameness with normal stride length and partial weight bearing
3 - moderate lameness with shorter stride length and partial weight bearing
4 - severe lameness with toe touch weight bearing and minimal use of the limb
5 - non-weight bearing

Question 28

Distribution of weight between limbs

Answer 28

Thoracic limbs 60%
Pelvic limbs 40%

Question 29

Equipment for objective gait analysis

Answer 29

Force plate
Pressure-sensitive walkway
Instrumented treadmill
Motion capture systems