Exam 1: Lecture 1 - Orthopedic Exam and Diagnostic Tools Flashcards
What are the 6 ways to diagnose lameness
- history
- PE
- gait analysis
- visual inspection of body and conformation
- palpate
- localization (ortho/neuro exam)
Why is the history important to us to diagnose lameness
we get the general history and complaint
what are some things we should ask when getting our history
- any anorexia, fever, or depression?
- what leg and how severe?
- when was it first noticed? (acute or chronic)
- was there trauma?
- any progression or response to medication?
When we are doing our PE, what should we do
do a general complete PE to rule out other differential diagnoses
what is normal proprioception
when you flip the paw over and the patient flips it back
what is abnormal proprioception
- patient does not know where limb is placed
- patient knows where limb is placed but cant correct
- patient knows where limb is placed but is unwilling to correct it
in what situation would you see abnormal proprioception where the patient knows where the limb is but is unwilling to correct the position
when there is fear of pain (ex. a fracture)
what is important to remember when doing a gait analysis
keep the presenting complaint in mind but it is important to do a FULL exam and not have tunnel vision
what are 2 things we should do when doing a gait analysis
- eval all limbs during observation
- perform gait analysis on floor w traction and without owners present
what are the 3 gaits we look at during a gate analysis
- walk
- trot
- pace
what is the MOST IMPORTANT gait to evaluate lameness at
a trot because only 2 limbs are in contact with the ground at once
describe the gait of a walk
2, 3, or 4 legs supporting at any one time
describe a trot
body is supported by 2 legs on opposite sides (contralateral)
describe a pace
limbs of the same side (ipsilateral) symmetrically support the animal
T/F: when doing a gait analysis, we should eval the dog only going away from us
false, we should eval going towards AND away
what is the purpose of a gait analysis
determines what leg is effected
what do we look for during a forelimb gait analysis and what does it mean
- look for a head bob
head lifts when lame leg bears weight
head drops when weight bearing on normal limb
what do we look for during a hindlimb gait analysis
- stride shortened on lame leg
- normal limb reaches forward faster than lame leg
- oscillating motion during locomotion (towards normal side)
- hip hike on lame leg
what is the scale of lameness in SA
0-4
what does lameness score of 0 mean
no lameness
what does lameness score of 1 mean
mild weight-bearing lameness
what does lameness score of 2 mean
moderate weight-bearing lameness
what does lameness score of 3 mean
severe weight-bearing lameness
what does lameness score of 4 mean
non-weight bearing lameness
what does favoring a leg mean
it uses the leg less than the others
T/F: is lameness if bilateral you may not see obvious lameness
true!!
what are the things we should look for if lameness is bilateral
- weight shifting while standing
- shortened stride
- bilateral muscle atrophy
- bilateral compensatory hypertrophy of unaffected limbs
what do we look for on visual inspection of confirmation
observe in standing position, know breed differences, and know abnormal body confirmation (which can be breed dependent)
what do we look for in posture
hyper flexion or hyper extension of joints, any muscle atrophy, angular limb deformities, body symmetry
where are the areas we should look for muscle atrophy
spine of scapula, greater trochanter, quadriceps
what do we look for when doing general body palpation
check for muscle atrophy and asymmetry
how do we palpate the neck
deep palpation, ventral and lateral flexion, and extend the neck
how do we palpate the back
apply pressure to spinous processes down the entire length of the spine
how do we check for lumbosacral pain
directly palpate lumbosacral region and apply pressure dorsally to lumbosacral joint (without loading or extending hips)
what is important to remember when we are checking for lumbosacral pain
make sure you dont put pressure on hips because you can confuse lumbosacral pain for hip pain!
why do we palpate the medial aspect of the knee joint
for swelling! Look for medial buttress, can be an indicator for cranial cruciate ligament rupture
T/F: We should localize pain with the patient under sedation
false! We should localize without sedation so we can localize pain
T/F: You should do a neurologic exam along with the orthopedic exam
true!
what are the rules for localization
always perform at end of evaluation and palpate the lame leg last
Explain the steps to localization
- place patient in lateral recumbency
- start at most distal part of leg (toes)
- move each joint through full ROM (range of motion)
- apply stress to joint medially and laterally to check for excess laxity
what is this a picture of
goniometry
what are the 4 things we always look for when palpating long bones
- pain
- heat
- swelling
- instability
what do we look for when we palpate each bone, joint, and soft tissue structure
- asymmetry between limbs
- abnormal ROM
- crepitation
- isolation of joint you are manipulating
why is it important to isolate the joint you are wanting to move
because you dont want to move more than one at once or else you can’t localize the pain
what is the purpose of the ortolani sign test
it is diagnostic for hip dysplasia
how do we do the ortolani sign test
- grasp flexed stifle and apply pressure dorsally while applying counter pressure with the other hand dorsal to pelvis
- abduct limb slowly
what does a positive ortolani sign test look like
movement felt as femoral head reduces back into acetabulum
what is the cranial drawer test
gives diagnosis of cranial cruciate rupture
what are the landmarks for the cranial drawer test
thumb - lateral fabella
index finger - patella
other thumb - fibular head
other index finger - tibial tuberosity
what is a positive sign of the cranial drawer test
greater than about 1-2mm of movement
what is the tibial compression test
the tarsus is flexed with force, if the tibia moves forward then there is most likely a cranial cruciate rupture
what test is this
tibial compression test
what test is this
cranial drawer test
what test is this
ortolani sign test
what test is this
patella luxation test
what are the objectives of doing an ortho exam
- lameness localization
- rule out other conditions (like neurological)
- orthopedic exam will help determine other diagnostics that may be needed
what is the purpose of diagnostic imaging for ortho conditions
to diagnose and localize lameness and to rule in/out other conditions
when should we use chemical restraint for diagnostic imaging
correct patient positioning, fractious patients, or arthrocetesis/biopsy
what are the components for the therapeutic plan
- discussion with owner regarding orthopedic examination and all diagnostic results
- include surgical and medical treatment as pertains to case
- discuss possible complications and prognosis with owners
