Lecture 1: Orthopedic Exam & Diagnostic Tools (Exam 1) Flashcards
What are the 4 dx test that are specific for dx lameness
- Gait analysis
- Visual inspection of body & conformation
- Palpate
- Lacalization
What should be asked/found out during Hx
- General& presenting complaint
- Anorexia, fever, depression?
- What leg & how severe
- When 1st noticed? Acute v. chronic
- Progression & response to meds?
What kind of questions should be asked when taking Hx
Open ended questions
T/F: You should switch up how you do a complete PE everytime
False; keep it the same everytime
What is proprioception
- Knowing where a part of the body is in space
- Putting my arm behind my back (know that it is behind my back)
What is normal proprioception
When you flip the paw onto the metacarpus/tarsal region and they flip it back
What is abnorm proprioception
- Px doesn’t know where limb is placed
- Px knows where limb is placed but can’t correct
- PX knows where limb is placed but is unwilling to correct
Where should you perform a gait analysis
- On the floor w/ traction
- Examine w/ owners NOT present
What gaits should be analyzed
- Walk
- Trot
- Pace
Describe a norm walk
2,3, or 4 legs support @ any one time
Describe a norm trot
- Body is supported by 2 legs on opp sides (contralateral)
- Most impt gait to eval lameness
Describe a norm pace
limbs of the same side (ipsilateral) sym support the animal
T/F: Evaluate the gait towards & away from you
True
What should you see if there is forelimb lameness
- “head bob”
- Head lifts when lame leg bears weight
- Head drops when weight bearing on norm limb
What should you see if there is hindlimb lameness
- Stride length shortened on lame leg
- Norm limb reaches forward faster than lame leg
- Oscillating motion during locomotion (towards the norm side)
- Hip hike on lame leg
0 degrees of lameness =
No lameness
1 degree of lameness =
Mild weight-breaing lameness
2 degrees of lameness =
Moderate weight-bearing lameness
3 degrees of lameness =
Severe weight-bearing lameness
4 degrees of lameness =
Non-weight bearing lameness
What is favoring
Using that limb less
What should be looked for if lameness is bilateral
- May not be obvious
- Weight shifting while standing (sometimes forward)
- Shortened stride
- Bilateral muscle atrophy
- Bilateral compensatory hypertrophy of unaffected limbs
What should be known about breeds for ortho
- Breed conformation
- Abnorm body condition
- Breed differences (like how they stand)
What should be observed during visual inspection
- Examine posture (body symmetry & areas of muscle atrophy)
- Hyperflexion or hypextension of joints
- Muscle atrophy
- Angular limb deformities (varus or valgus)
What all should be palpated
- General body palpation w/ animal standing
- Neck (Deep palpation, ventral & lateral flexion, extending the neck)
- The back
- Lumbosacral region (Dorsally do lumbosacral jt w/o loading or extending the hips)
- Medial aspect of knee
How should the back be palpated
Apply pressure to spinous processes down the entire length of the spine
Why is the medial aspect of the knee joint impt
- Swelling
- “medial buttress” found on the medial aspect of the stifle
- Indicator of cranial cruciate ligament rupture
Describe how to do localization
- W/out sedation to allow pail localization
- Neuro exam done along w/ then ortho exam
- lateral recumbency
- Start @ most distal part of leg
- Move ea. joint through full range of motion
- Apply stress to joint medially & laterally (check for excess laxity)
- Palpate bones & joints
- Isolate the joint
What are the rules of localization
- Always perform @ end of eval
- Palpate lame leg last b/c it is the most painful
Do we check joint angles w/ goniometry often
Not really
What should be done by palpating bones of joints
- Long bone pain
- Palpate each joint for pain, heat, swelling, & instability
- Joint effusion
What are the four main things you should be looking for when palpating
- Pain
- Heat
- Swelling
- Instability
What should be noted when palpating
- Asymmetry btw/ limbs
- Abnorm ROM
- Crepitation
how is ortolani sign performed
- Grasp flexed stifle & apply pressure dorsally
- Apply counter pressure w/ other hand dorsal to pelvis
- Abduct the limb slowly
What does ortolani sign mean if it is positive
Movement is felt as the femoral head reduces back into the acetabulum
What is the ortolani used to dx
Hip dysplasia
Describe the ortolani maneuver (dorsal)
- Positioned in dorsal recumbency
- Place hands over stifles
- Hold femurs parallel
- Subluxate femoral head (pushing the stifle toward the pelvis, maintain pressure, abduct the limb)
- There is a click when the femoral head returns to the acetabulum
Describe the cranial drawer test
- Both hands (one on tibia & one on fibula)
- Move tibia cranially w/ respect to femur
Where should each finger be placed on the femur when doing a cranial drawer test
- Thumb - lateral fabella
- Index finger - patella
- Thumb - fibular head
- Index finger - tibial tuberosity
What does a positive cranial drawer test mean
- > ~1 to 2 mm of movement
- Dx for CCLR
Describe the tibial compression test
- Tarsus flexed w/ force
- Tibia translates cranially w/ CCLR (tibial thrust)
Describe the luxate patella manually
- Stifle extended (medial MPL)
- Stifle slightly flexed (Lateral LPL)
What is the objective of an ortho exam
- Lameness localization
- R/O other condition/neuro disease
- Help determine other dx needs
What should be done for in a therapeutic plan
- Discussion w/ the owner regarding orthopedic exam & all dx results
- Include surgical & medical tx as pertains to the case
- Discuss possible complications & prognosis
