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 signalments

Answer 3

Seven month old lab with forelimb lameness: elbow dysplasia

Seven year old Rottweiler: bone tumour e.g. osteosarcoma

Eight year old GSD with sudden onset unilateral pelvic limb lameness: cruciate rupture

Eight month old GSD with pelvic limb stiffness: hip dysplasia

Question 4

History in orthopaedic case

Answer 4

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 5

Kyphosis

Answer 5

Dorsal curvature of the spine (hunching)

Question 6

Scoliosis

Answer 6

Lateral curvature of the spine

Question 7

Palmigrade

Answer 7

All parts of manus are flat against the ground

Question 8

Plantigrade

Answer 8

All parts of the pes are flat against the ground

Question 9

Valgus

Answer 9

Lateral deviation of the distal portion

Question 10

Varus

Answer 10

Medial deviaiton of the distal portion

Question 11

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

Answer 11

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 12

Gait examination

Answer 12

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

Question 13

Ataxia

Answer 13

Pelvic limb incoordination

Question 14

Paralysis

Answer 14

Loss of voluntary movement

Question 15

Paresis

Answer 15

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

Question 16

Paraparesis

Answer 16

Both pelvic limbs

Question 17

Quadriparesis

Answer 17

All limbs

Question 18

Hemiparesis

Answer 18

Both limbs on one side of body

Question 19

Paraplegia

Answer 19

Neurological deficits with absent motor function

Question 20

Signs of thoracic limb lameness

Answer 20

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

Question 21

Indication of stifle pain

Answer 21

Limb may be circumducted to prevent stifle flexion

Question 22

Indication of hip pain

Answer 22

Lateral sway and minimising hip motion

Question 23

Indication that both hips are painful

Answer 23

Bunny hopping

Question 24

Signs of pelvic limb lameness

Answer 24

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 25

Degrees of lameness (0-5)

Answer 25

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 26

Distribution of weight between limbs

Answer 26

Thoracic limbs 60%
Pelvic limbs 40%

Question 27

Equipment for objective gait analysis

Answer 27

Force plate
Pressure-sensitive walkway
Instrumented treadmill
Motion capture systems