Canine 1 Part 1: Why Physical Rehabilitation? Unit 2/4

Question 1

Which conditions in the elbow could benefit from PT? Hint: there are 6

Answer 1

In young dogs:

• Fragmented coronoid process
• Ununited anconeal process
• Osteochondrosis dissecans
• Osteoarthritis in mature dogs
• Lateral condylar fracture
• Y or bicondylar fractures

Question 2

What is a process (anatomy)?

Answer 2

A projection or outgrowth of tissue from a larger body

Question 3

What are the coronoid processes? What are the two types of coronoid processes?

Answer 3

Two small bony protrusions on the end of the ulna within the elbow joint.
The lateral coronoid process (smaller one) and the medial coronoid process (larger one)

Question 4

Define the word lateral

Answer 4

Lying away from the median and sagittal plane of a body

Question 5

Breakdown the word medial

Answer 5

Toward the midline of the body

Question 6

What is the anconeal process?

Answer 6

A small projection of bone on the ulna

Question 7

What is the difference between the coronoid processes and the anconeal process?

Answer 7

The coronoid processes are found at the ‘bottom’ of the joint, closer to the ulna and radius. The anconeal process is found at the ‘top’ of the joint, closer to the humerus.

Question 8

What is the purpose of the coronoid processes and the anconeal process

Answer 8

The coronoid process stabilises the elbow joint and prevents hyperflexion.

The anconeal process helps to stabilize the elbow joint by interdigitating with the humerus

Question 9

What is elbow dysplasia?

Answer 9

Elbow dysplasia is a developmental abnormality that occurs in the elbow joint of dogs, mostly of the medium to large breeds. There are 3 developmental problems that may be called elbow dysplasia, namely a fragmented coronoid process (FCP), an ununited anconeal process (UAP), and osteochondritis dissecans (OCD).

Question 10

What is a Fragmented Coronoid Process?

Answer 10

• FCP is a developmental defect of one of the coronoid processes, commonly occurs on the medial process.
• In this condition, one of the coronoid processes develops a fissure or crack and separates from the rest of the bone.
• This separation causes pain and joint instability.

Question 11

What are the sings of FCP? Hint: there are 6

Answer 11

• With this condition, lameness usually develops in the foreleg of young dogs that are between 5 and 11 months of age.
• The dog will have a mild to moderate weight-bearing lameness.
• Dogs with this disease may cry when the elbow is palpated.
• In many cases, the affected joint will be swollen and warm to the touch.
• The elbow joint will have a decreased range of motion.
• It is relatively common for the condition to develop in both elbows, although it is usually worse on one side than the other.

Question 12

How is FCP diagnosed?

Answer 12

Radiographs if any lameness lasts more than 2 weeks in a young, large breed dog. Several radiographs of each affected leg, with the leg in different positions, are necessary in order to get an accurate assessment of various bones and joints. In many cases, this will require a short-acting anesthetic or sedative in order to achieve the optimal positioning for diagnostic purposes.

In dogs under 6-7 months of age, X-rays can be challenging to interpret due to the presence of growth plates. To reach the diagnosis, it may be necessary to have the X-rays examined by a veterinary radiologist.

In some cases, the FCP may not be seen on standard radiographs. Rather, secondary signs associated with degenerative joint disease are seen. With FCP, a diagnosis may be made relatively early in the course of the condition using computerized tomography, or CT, scan.

Question 13

What is the recommended treatment for FCP?

Answer 13

Surgery is the treatment of choice for this condition, and its aim is to remove any abnormal cartilage or bone in an attempt to return the joint to a more normal anatomy and function. The procedure may involve a surgical exploration of the joint or an arthroscopic repair. Arthroscopic repair may be the preferable technique because the smaller incision means that there is less damage done to the supporting structures (the joint capsule and ligaments). Your veterinarian may recommend referral to an orthopedic surgeon for this procedure.

Question 14

What is the prognosis for FCP with and without surgery?

Answer 14

If the joint is not treated surgically, degenerative changes will rapidly develop and the dog will suffer from chronic pain. Surgical treatment of FCP should be performed as soon as possible after diagnosis to minimize the development of degenerative joint disease.

In all cases, some degree of arthritis will develop in the elbow joint, but with surgical treatment, the arthritis will usually be less severe and there will be less pain involved. Medical treatment such as joint protective supplements and/or anti- inflammatory medications will usually be recommended to delay progression of degenerative joint disease. Proper weight management, as well as diets containing high levels of omega-3 fatty acids are also beneficial.

Question 15

What is an ununited anconeal process?

Answer 15

The anconeal process forms part of the back surface of the elbow joint. There is a growth plate between the anconeal process and the rest of the ulna.

Growth plates are found at the ends of the bones in growing animals, and are the sites of bone growth during development. Normally, as the dog reaches puberty, the growth plates close, fusing the parts of the bone together. The growth plate between the anconeal process and the ulna normally fuses by about 5 months of age. If the anconeal process does not fuse to the rest of the ulna correctly, it causes a condition called ununited anconeal process (UAP).

Question 16

What are the signs of UAP?

Answer 16

When this part of the ulna does not fuse, the elbow joint becomes unstable, causing lameness and pain. The instability causes inflammation, and eventually the inflammation and instability will lead to the development of degenerative joint disease or arthritis. In some cases, the bone fragment floats freely in the joint, causing further discomfort.

Dogs with this disease are lame on the affected leg or legs and they may cry when the elbow is extended. Often the affected elbow joint has a decreased range of motion.

Question 17

How is the condition diagnosed?

Answer 17

UAP can be diagnosed by means of radiographs of the elbow. In some cases, this may require a short-acting anesthetic or sedative in order to achieve the optimal positioning for diagnostic purposes. In some cases, it may be necessary to have the X-rays examined by a veterinary radiologist for confirmation of the diagnosis.

Question 18

How is UAP treated?

Answer 18

Treatment requires surgery. The traditional treatment is removal of the anconeal process from the joint. A more recent approach to surgery is to use screws to reattach the anconeal process to the ulna. Your veterinarian may recommend a referral to an orthopedic surgeon for surgical correction, depending on the case. In all cases, surgery should be performed as soon as possible.

Results of surgery are much better if surgery is done before secondary arthritis affects the joint.

Question 19

What is the prognosis for UAP with and without surgery?

Answer 19

If the ununited anconeal process is not treated surgically, the lameness will progress rapidly, and your dog will be in severe pain. If surgery to reattach the UAP is delayed, or if the condition is severe, the fragment edges may not match well because of the erosion of bone and cartilage, so the piece may not be easily fixed in place. Since the condition is caused by a developmental defect, it is also possible that healing will be slow.

In all cases, some degree of arthritis will develop in the elbow joint, but with surgical treatment, the arthritis will usually be less severe and there will be less pain involved. Medical treatment such as joint protective supplements and/or anti- inflammatory medications may be recommended to delay progression of degenerative joint disease.

Question 20

What is osteochondritis dissecans?

Answer 20

The term osteochondrosis refers to an abnormal development of the cartilage on the end of a bone in the joint.
OCD or OD is an inflammatory condition that occurs when the diseased cartilage separates from the underlying bone. It most commonly affects the shoulder joint but the elbow, hip, or knee (stifle) may also be involved.

Question 21

Which breeds of dogs are likely to be affected by this condition?

Answer 21

This is a developmental disease that occurs in rapidly growing large breed dogs typically between 6 and 9 months of age and tends to occur more often in male dogs. The cause of OCD is unknown.

However, this disease is more common in dogs receiving too much energy and calcium in the diet. Other factors may also include genetics, rapid growth, trauma, lack of blood flow, and hormonal factors.

Question 22

What are the signs of OCD?

Answer 22

Dogs that are affected with OCD typically limp or are lame in the affected leg or legs. During an orthopedic examination, when pressure is applied to the affected joint or when the joint is manipulated, the dog will often cry out in pain. The affected joint may be swollen and warm to the touch. In some cases, the lameness may be mild and intermittent while in other cases, the dog may be in constant pain and avoids bearing weight on the affected leg.

Question 23

How is OCD diagnosed?

Answer 23

The results of a lameness examination may be suggestive of this condition, especially if the shoulder is the affected joint. If one of the other joints, such as the stifle (knee), hip, or elbow, other bone conditions must also be considered, including hip dysplasia, patellar luxation, and elbow dysplasia.

Because of the possibility of permanent lameness, your veterinarian will recommend diagnostic testing if the lameness persists for more than 2 weeks. Radiographs (X-rays) are usually performed to investigate lameness. Several radiographs of each affected leg are necessary in order to get an accurate assessment of various bones and joints. In many cases, this will require a short-acting anesthetic or sedative in order to achieve the optimal positioning for diagnostic purposes. In dogs under 6-7 months of age, X-rays can be challenging to interpret due to the presence of growth physes or growth plates. To reach the diagnosis, it may be necessary to have the X-rays examined by a veterinary radiologist.

In some cases, an arthroscopic examination may be required to reach or confirm the diagnosis.

Question 24

How is OCD treated?

Answer 24

The OCD lesion can vary in severity, ranging from a crack in the cartilage, to a cartilage flap, to a completely detached fragment of cartilage that is floating around in the joint (called a joint mouse).

If the defect is a crack or a very small flap of cartilage, it may heal if the patient has strict rest and activity restrictions for several weeks. In these cases, the dog will be restricted to short leash walks only, and cage rest will be strongly recommended. Medications to relieve inflammation and supplements to promote joint health will usually be prescribed. Often, you will be taught how to perform passive range of motion (PROM) exercises, in which you will move the joint through its normal range of motion while your dog is lying on his side. This is done to maintain the joint’s flexibility and mobility.

If the lameness does not improve following this conservative approach, if the cartilage flap becomes folded in the joint, if the cartilage defect is large, or if a piece of cartilage breaks free, surgery will be required to remove the defective flap or the floating piece of cartilage. This may be done by surgically opening the joint or by using an arthroscope. Whatever the surgical technique, the remainder of the cartilage surface will be inspected and any other areas of defective cartilage will be debrided or removed.

Question 25

What is the prognosis of OCD following surgery?

Answer 25

The prognosis varies depending on the joint that is affected. If the shoulder joint is affected, the prognosis is good; if the elbow joint is affected the prognosis is guarded. In all cases, the prognosis improves if surgery is performed early in the course of the disease, before secondary degenerative joint disease occurs.

Weight control is important to avoid unnecessary stress on the joint.

Question 26

What is Osteoarthritis?

Answer 26

OA, also referred to as Degenerative Joint Disease (DJD), is a progressively worsening inflammation of the joint caused by the deterioration of cartilage. In a healthy joint, cartilage acts as a cushion to allow the joint to move smoothly through its full range of motion. In cases of osteoarthritis, this cartilage cushion begins to break down because of factors such as age, injury, repetitive stress, or disease. The loss of this protective cushion results in pain, inflammation, decreased range of motion, and the development of bone spurs. While any joint in the body can develop osteoarthritis, the condition most commonly affects the limbs and lower spine.

Question 27

Breakdown the word osteoarthritis

Answer 27

Osteo = bone
Arthur = joint
Itis = inflammation

Question 28

What are the humeral condyle?

Answer 28

The end of the humerus that forms the upper part of the elbow joint is composed of two halves, called the medial and lateral condyles, which are separated down the middle in young dogs by a growth plate that normally fuses upon reaching adulthood

Question 29

What is a lateral humeral condylar fracture?

Answer 29

Lateral condylar fractures occur when forces concentrated on the lateral portion of the elbow joint cause breakage along this vertical growth plate and through the lateral portion of the bone above it.

Question 30

What are the most common fractures that occur in the humerus?

Answer 30

Fractures of the humerus are common in dogs and cats with approximately half of all humeral fractures occurring in the distal portion of the bone, at or near the elbow joint. The vast majority of distal humeral fractures involve the elbow joint and are classified according to their anatomic location. Distal humeral condylar fractures are much more common in dogs than they are in cats.

Question 31

Which animals/conditions are more likely to have a lateral condylar fracture?

Answer 31

Lateral condylar fracture is most common in young dogs and may occur with minimal trauma as a result of the relative weakness of the growth plate. It is also not uncommon to see this type of fracture in mature dogs, with spaniel breeds being at increased risk due to a genetic predisposition to incomplete growth plate closure in this location. While lateral condylar fractures are most common, sometimes the medial condyle or both condyles may be fractured (called a “Y” or “T” fracture).

Question 32

How are humeral condylar fractures diagnosed?

Answer 32

Fractures of the humeral condyles are diagnosed by taking x-rays of the elbows. Because of the discomfort caused by this injury and the need for very precise positioning, sedation and pain medication are necessary to take diagnostic x-rays. Occasionally, more advanced forms of diagnostic imaging of both elbow joints, such as a CT scan, can provide additional information that will be necessary for treatment.

Question 33

What is the treatment for a lateral condylar fracture?

Answer 33

Surgery is the best treatment for almost all humeral condylar fractures. The operation involves repositioning the bone fragments back into the correct place and stabilizing them using screws, pins and bone plates. Fracture repair can be challenging due to the involvement of the joint (with the need to accurately reconstruct this component of the fracture to minimize the subsequent development of osteoarthritis), the small size of the fragments and the possibility of an underlying weakness in the bone that can affect fracture healing. However, with appropriate surgical technique, most dogs are very comfortable after their operation and can start to walk and bear weight on the limb within a day or so.

Question 34

What aftercare is needed for lateral condylar fracture surgery?

Answer 34

Certain passive and active exercises can and should be performed at home with the patient after surgery. Short walks on a short leash can be started immediately, but all unrestricted or unsupervised exercise, such as running or jumping needs to be avoided. As with most fractures, pain medications are usually given for a week or two. Dogs that have undergone surgery will need to be taken to their vet for a check-up one week and then two weeks after surgery to have their stitches removed.

Regular physical rehabilitation therapy appointments are a very beneficial addition to the at-home exercises in patients healing after surgical repair of an elbow fracture. At these appointments, modalities such as laser therapy and underwater treadmill are used to facilitate healing, and improve joint function and limb use.

Reevaluation for the dogs at about six weeks after surgery are typical, with a physical exam and x-rays to assess limb function and bone healing. At this point, if healing is progressing well, a gradual increase in physical activity may be initiated. Typically if all goes well, a dog can be expected to return to full physical activity by 4-6 months post-injury.

Question 35

WHAT IS THE PROGNOSIS FOR HUMERAL CONDYLES FRACTURE SURGERY IN DOGS?

Answer 35

The prognosis following surgery for fractures of the outside (lateral aspect) of the humeral condyle is generally good, although because of joint surface involvement, some degree of osteoarthritis will eventually develop in the elbow joint.

Question 36

What is the Y or bicondylar fractures?

Answer 36

Fractures that occur on both the lateral and medial condylar. Y fractures are called this as the fractures are shaped similar to the letter y. They are much more demanding than lateral condylar fractures, where only the lateral side is fractured.

Question 37

What is effusion in the body?

Answer 37

Effusion isswelling that happens when fluid leaks out of a vein, artery, lymph vessel, or synovial membrane into the surrounding tissue. This causes the tissue to expand, or swell. When effusion happens in a joint — commonly the knee — excess fluid can pool in a part of the joint called the synovial cavity.

Question 38

Why does Dr Daryl Millis require 10 days in hospital rehab after Y or bicondylar fracture surgeries?

Answer 38

And the reason for that is you spend a lot of time putting these things back together, they’re difficult and challenging fractures. The owner invests a lot of money, and the dog is obviously pretty well invested in the whole process. And so I’ve just made the decision that if we don’t do rehab, and that elbow stiffens up, we have terrible loss of muscle mass, and we can almost completely prevent those problems within house rehab.

Now, the owners are always going to say, ‘Well, I think I can do that at home’. But we have proven time and time again, that when a lot of these patients go home for their home therapy, at least in the early post operative period, that we can measure an actual deterioration. They don’t know how hard to push, or how much to go with range of motion. That’s something that’s a feeling, it’s something that’s developed over time, and they don’t want to hurt their pets. And that’s one of the basic premises of rehab. We don’t want to hurt the pet either. But we have to manage the pain appropriately, which can be done in house and stretch the tissues to hopefully get them to remodel and strengthen earlier and quicker.

Question 39

What is hip dysplasia?

Answer 39

Hip dysplasiais a deformity of the hip that occurs during growth. The hip joint is a ball and socket joint. During growth, both the ball (thehead of the femur, or thighbone) and the socket in the pelvis (acetabulum) must grow at equal rates.
In hip dysplasia, this uniform growth during puppyhood does not occur. The result is laxity (looseness) of the joint, followed bydegenerative joint disease(DJD) orosteoarthritis(OA), which is the body’s attempt to stabilize the loose hip joint.

Question 40

What causes hip dysplasia?

Answer 40

Hip dysplasia is a genetic disease that is affected by factors such as diet, environment, exercise, growth rate, muscle mass, and hormones.

Question 41

What treatments are available for hip dysplasia?

Answer 41

In a younger patient, surgery is used to preserve the hip joint.

For older patients, a conservative management approach would be used, such as changing exercise, strengthening gluteal muscles, dietary changes, anti-inflammatory drugs and pain medication.

Other options include total hip replacement as well as femoral head & neck excision

Question 42

Describe a total hip replacement

Answer 42

THR involves removing the femoral head from the top of the femur and replacing it with a bob alt chrome ball prosthetic. The acetabulum of the pelvis is resurfaced using a ‘cup’ implant to provide a seat for the new femoral head to sit in. The implants can be attached to the bone using bone cement, or may have a porous coating into which the bone can grow.

Question 43

What is a femoral head & neck excision?

Answer 43

An FHO, orfemoral head ostectomy, is a surgical procedure that aims to restore pain-free mobility to a diseased or damaged hip, by removing the head and neck of the femur (the long leg bone or thighbone).

Question 44

What is the difference between a total hip replacement and a femoral head/neck excision?

Answer 44

While both surgeries remove the femoral head and neck, only the THR provides a replacement for the hip bone, while an FHO restores mobility to the hip by only removing the head of the femur, leaving just an empty socket. The muscles of the leg will initially hold the femur in place and, over time, scar tissue will form between the acetabulum and the femur to provide cushioning that is referred to as a’false joint’.

Question 45

What is the difference between primary and secondary osteoarthritis?

Answer 45

Primary Osteoarthritis:This form of osteoarthritis develops due to aging and the wear and tear that comes along with it. It is not caused by any existing disease and is not due to any injury. Aging increases the water content of the cartilage, in turn gradually decreasing its protein content. When this happen the cartilage begins to flake and develop tiny crevasses. This deterioration causes friction between the bones that leads to pain, inflammation and limitations on joint mobility. This type of osteoarthritis is typically seen in people above the age of 55. It is believed that if we all live long enough, at some point, everybody will be affected by primary osteoarthritis.

Secondary Osteoarthritis:Osteoarthritis in this form develops due to a specific cause such as injury or another disease. It is for this reason that there are more chances of it affecting people at an earlier age. There are a few risk factors that contribute to the onset of the disease.

Question 46

What is a cruciate ligament?

Answer 46

The cruciate ligaments are two bands of fibrous tissue, the caudal and cranial cruciate ligaments, located within each stifle (knee) joint. They join the femur and tibia (the bones above and below the knee joint) together so that the knee works as a stable, hinged joint.

Question 47

What is a luxating patella?

Answer 47

The patella, or ‘kneecap,’ is normally located in a groove on the end of the femur (thigh bone) just above the stifle (knee).

The termluxatingmeans ‘out of place’ or ‘dislocated’. Therefore, a luxating patella is a kneecap that moves out of its normal location. Pet owners may notice a skip in their dog’s step or see their dog run on three legs. Then suddenly they will be back on all four legs as if nothing happened.

Question 48

What is arthroscopy?

Answer 48

Arthroscopy is a surgical procedure that orthopaedic surgeons use to visualize and treat problems inside a joint. The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). The term literally means “to look within the joint.”

Question 49

Define metaplastic

Answer 49

relating to or characterized by abnormal change in the nature of a tissue

Question 50

What are some potential causes for cruciate ligament rupture? Hint: there are 5 listed

Answer 50

• Genetics
• Eniroment
• Exercise (or lack thereof)
• Obesity
• Sex hormone changes

Question 51

What were the results of the 1996/1997 experiment on the effect of Physical Rehabilitation on Stifle Extension?

Answer 51

Dogs with cruciate rupture and had an extracapsular technique performed as treatment where selected and divided into two groups. One group got “standard post operative care”, consisting of restriction to cage or run for a period of time after surgery, leash walks only with no particular attention to use of the limb. The other group receiving rehab had passive range of motion exercises, cryotherapy, slow leash walks, and other therapeutic exercises to help encourage use of the limb, transcutaneous electrical nerve stimulation, neuromuscular electrical nerve stimulation and then towards the end, a little bit of aquatic therapy. And so one of the things that was looked at was the effect of rehab versus no rehab on stifle extension. The study showed that by the three month period, there’s really been no change in comfortable knee extension for the no PT group. Whereas the dogs that had rehab, they started off at about the same point but very quickly, within a few days, they had significantly greater stifle extension.

Question 52

What is cryotherapy?

Answer 52

Cryotherapy is the application of extreme cold to destroy abnormal or diseased tissue.

Question 53

What is transcutaneous electrical nerve stimulation?

Answer 53

TENS (Transcutaneous Electrical Nerve Stimulation) is a form of electrotherapy that is used to treat inflammation and acute pain. The therapy uses small electrodes that are placed directly on the skin over the trigger point. These are the points where an animal instinctively rubs when there is an ache. These deliver a low-level electrical current to the client. The machine can be adjusted for comfort and usually, the gentle pulsing will be quite comfortable for the animal.

Question 54

What is neuromuscular electrical nerve stimulation?

Answer 54

Neuromuscularelectrical stimulation (NMES) is an electrical stimulation therapy, which is the application of electrical impulses to a muscle group stimulating their contraction to aid in preventing atrophy of a muscle or muscle group. Transcutaneous electrical stimulation also aids in pain management.

Question 55

What is the difference between NMES and TENS therapy?

Answer 55

Transcutaneous electrical nerve stimulation (TENS)

• Intended for temporary pain relief in sore and aching muscles or for symptomatic relief of chronic pain
• Most pervasive type of electrical stimulation (a search for “TENS units” on Amazon.com brings up over 60,000 results)
• Typically limited in functionality, but cheap as a result

Neuromuscular electrical stimulation (NMES)

• Intended for relaxing muscle spasms, preventing muscle atrophy, increasing blood circulation, maintaining or increasing range of motion, and especially for re-educating the neuromuscular system
• Essentially the same as EMS, but typically focused on therapeutic use (rehab) instead of athletic use (training)
• Also similar to TENS, but designed to make the muscles contract strongly

Question 56

What is aquatic therapy?

Answer 56

Hydrotherapy literally means water therapy and can refer to any therapeutic use of water to aid or improve health. Exercising in waterhas the benefit of providing both buoyancy and resistance, making it possible to strengthen and condition muscles and build endurance without placing stress on joints. Bathing in hot water can also dilate blood vessels and relax joints and muscles, easing aches and pains and aiding in healing of injuries. For dogs, hydrotherapy usually consists of either swimming or walking in water, whether in shallow water along the beach or on an underwater treadmill.

Question 57

What is an analgesics?

Answer 57

Also known as a pain killer, a drug given to relieve pain

Question 58

What were the results of the study for Stifle Extension vs. Peak Vertical Force in Dogs 10 weeks after CCLR Transection and Stifle Stabilization?

Answer 58

The study was meant to be as part of a bigger study to help maintain muscle mass with a new drug. 10 weeks after cruciate stabilization, the study looked at the association of knee extension with weight bearing as measured on a force platform, with perfect symmetry being a number of one. Note that these dogs did not receive any physical rehabilitation. This study suggests that there is a strong relationship between knee extension and less lameness, so the greater the knee extension, the less lameness. If there is poor knee extension, there will be significant lameness. Therefore, it is crucial to reestablish knee extension as early as possible to help reduce the risk of subsequent lameness.

Question 59

What were the results for the study ‘Thigh Circumference With Rehab vs Home exercise following TPLO’?

Answer 59

This study looks at the relationship between professional physiotherapy and a home exercise group regarding thigh circumference. In this case, the owners were instructed how to do some rehab and a home exercise environment. After the six week period after TPLO, those getting physiotherapy have absolutely symmetrical thigh circumference, which is an indication of muscle mass. Whereas those with the home exercise group still had significant muscle atrophy. This suggests that there is a difference depending on how the rehab is applied and who’s doing it.

Question 60

What were the results for the study ‘Stifle Flexion Post TPLO’?

Answer 60

This study looks at the relationship between professional physiotherapy and a home exercise group regarding stifle flexion post TPLO. The physiotherapy group, after a period of recovery and rehabilitation, actually ended up having more stifle joint flexion. Whereas those in the home exercise group actually had a continued loss of flexion.Note: with flexion, a smaller number is better because we look at geometric angles, so as that angle starts to close down, that means greater flexion. As the angle opens up, it means greater extension.

Question 61

What were the results for the study ‘Stifle Extension Post TPLO’?

Answer 61

This study looks at the relationship between professional physiotherapy and a home exercise group regarding stifle extension post TPLO. The physiotherapy group ended up having a greater stifle joint extension. Whereas those in the home exercise group actually continued to deteriorate.Note: with extension, a larger number is better because we look at geometric angles, so as that angle starts to open up, that means greater extension. As the angle closes down, it means greater flexion.

Question 62

What were the results for the study looking at the relationship between Stifle ROM and Lameness?

Answer 62

This study demonstrates the relationship between loss of knee extension and lameness scores. It concludes that the less range of motion results in a lamer dog. This study rated dogs into three categories, dogs that had no loss of range of motion, less than a 10 degree loss and greater than a 10 degree loss of range of motion. Then when compared the degree of lameness, the dogs that have greater than 10 degrees loss of range of motion, have more lameness associated with clinical function.

Question 63

An improvement in stifle flexion post TPLO is indicated by an increase in ROM measurement. True or false?

Answer 63

False

Question 64

Following surgery for a cranial cruciate ligament rupture, how much muscle mass may a dog lose in the rear limb?

Answer 64

1/3