Exam III: Small Animal Lameness Evaluation, OA Diagnosis and Treatment, and SA and LA Rehabilitation

Question 1

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Rehab
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There are four tools used in SA orthopedic medicine to assess functionality in the patient:
Gulick
Goniometer
Kinematic gait analysis
Kinetic gait anaylsis

What does each technique assess?

Answer 1

the Gulick is a tape measure that measures limb circumference and muscle mass

The Goniometer uses measurement tools and bony landmarks to asses the angles of limbs passively.

The Kinematic gait analysis asseses joint ROM by using reflective pieces on tape on bony landmarks and takes numerous photos of the dog while gaiting (dynaimc joint angles while gaiting).

The kinetic gait analysis uses scales to assess how much the patient is weight bearing on each limb (normal is 30-30-20-20)

Question 2

Rehab

What increases resistance in hydrotherapy for dogs?

Answer 2

turbulence and water hieght (at the elbow and stifle)

Question 3

rehab

What color results in the least amount of laser penetration?

Answer 3

Black hair coat

also remember, the darker, the easier to burn

Question 4

equine

What are some approaches to modulating pain?

Answer 4

cryotherapy, heat therapy, laser, transcutaneous electrical nerve stimulation (TENS, acute pain >100Hz, chronic pain <20Hz), therapeutic ultrasound, medications, soft tissue and jiont mobilization, therapeutic exercises, acupuncture.

Question 5

equine

What are the common rehabilitation issues during each phase (acute, proliferation and remodeling)?

Answer 5

During the acute phase, there is pain, inflammation and tissue damage.

During the proliferative phase, there is reduced ROM, muscle impairment and functional losses. *fibrosis often affects this.

During the remodeling phase, there is poor musculoskeltal function and chronic restriction/adhesion

Question 6

equine

What are the typical benchmarks for rehabiliatation phase advancement?

Answer 6

to progress from the acute phase, you relaly want to make sure you have pain management under control, initiate tissue healing, improve ROM, and ensure the patienthas a tolerance for strengthening.

The criteria for advancement from the proliferative phase is having no pain, significant tissue healing, pain free ROM, 70-80% strength, improved flexibility, and improved core stability.

The criteria to return to play or function is again no pain, full pain free ROM, normal strength and balance, normal biomechanics, and good general fitness.

Question 7

equine

What are some tactics for improving joint ROM?

Answer 7

proprioceptive exercises (ground poles, surface changes, tactile stimulators), aquatic therapy, therapeutic ultrasound, laser terapy, passive ROM

Question 8

SA OA

True or False: Sometimes the best thing you can do for an OA patient is to crate rest them

Answer 8

False, OA patients need moderated physical activity. consider a harness, booties, slings, ramps/stairs etc…

Question 9

SA lameness exam

What are the bony landmarks for stifle, tarsus, carpus, and elbow effusion?

Answer 9

stifle: medial and lateral border of the patella ligament (ensure both legs are equally weightbearing if standing, patellar ligament about size of number 2 pencil in dog)

tarsal: caudal and cranial to lateral and medial malleoli

carpal: dorsally just distal to the radiuswith the carpus partially flexed

elbow: just caudal t te humeral epicondyles

Question 10

SA lameness exam

What are two instability tests you can do in you exam to test for CCLD and how are they conducted?

Answer 10

In the cranial drawer test you are assessing abnomral saiggital plane instability. The top hand stabilizes with the thumb on the lateral fabella and pointer on the patella while the other hand has the pointer on the tibial tuberosity and thumb on fubular head and pushes the tibia cranially while keeping the tibia in saggital plane with the femur. test in flexion and extension.

For the tibial thrust test, you are mimicking cranio-caudal instability that occurs during weight bearing, the top hand has the pointer on the tibial tuberosity and thumb on the cranial distal thigh, it maintains the stifle extended in a standing angle while the bottom hand flexes the hock - top hand is feeling for cranial tibial translation

Question 11

What does patella luxation, campbell’s test, and ortolani test for? How is it done?

Answer 11

patella luxation, it’s in the name, locate the tibial tuberosity, folloe the patella ligament proximal until it feels like bone vs a pencil, holding finger superficially, gently wiggle the patella media and lateral in the trochlear groove, observe for both luxation and spontaneous replacement.

the campbell’s test was originally developed to assess for collateral ligament integrity, it is mostly used for assessing pain in dogs with medial compartment disease. hold the elbow at 90 degrees while pronating and supinating the limb and applying gentle pressure over the medial coronoid, look for presence of pain.

ortolani assesses for hip laxity. in lateral recumbecy (or dorsal), place one hand on the dorsal pelvis and the other cupping the stifle to maintain the femur in a perpendicular top line of the body. gently adduct the limb and push proximal (subluxation step). Then, maintaining pressure, abduct the limb and watch/listen for a clunk (reduction step)

you can also check collateral ligaments by applying varus/ valgus stress to a joint (tarsus tested in extension and moderate flexion to asses long and short collaterals respectively)

Question 12

T or F flexibility testing tests PROM.
What do abnormal findings of soft titssue palpation (increased flex, decreased flex, painful response) tell you?

Answer 12

False. Flexibility testing is helpful for elasticity and muscle spasm.

increased flexibility could mean a rupture. decreased could mean a contracture. painful could mean inflammation.