Locomotor system

Question 1

Locomotory organs

Answer 1

• bones
• muscles and tendons
• joints and ligaments

Question 2

Why to examine them?

Answer 2

Disease conditions:
• Trauma
• Infection
• Metabolic
• Malformation 
• Degeneration
Administrative issues:
• Breeding
• Purchase

Question 3

Primary diseases of the locomotory organs

Answer 3

• bones: fracture, panosteitis, neoplasma, malformation
• muscles: haematoma, abscess, myositis, atrophy
• joints: arthritis; degenerative joint disease

Question 4

Metabolic/systemic/other organic disease with locomotory manifestation

Answer 4

• Cushing’s disease (muscles, bones)
• hyper-, hypothyreoidism (muscles)
• diabetes mellitus (neuropathy)
• some autoimmune diseases (joints, endplate)
• cathabolic states (heart disease, kidney disease, septic conditions (muscles)
• CNS/PNS disease (muscles!)
• tetanus
• hydrocephalus
• rachitis (Vit.D deficiency)

Question 5

Examination

Answer 5

1. Nationale (age, gender, breed)
2. History (general health - systemic disease, travel, disease progression)
3. Physical examination
   • general impression
   • organs
   • locomotory organs

Question 6

The order of examination, decisions

Answer 6

1. Locomotory or other (organic, toxic, metabolic etc.) disorder?
2. If locomotory: localisation? (region, limb; bone/muscle/joint?)
3. Are other areas of the locomotory system involved?
4. Additional examinations needed?
5. Treatment

Question 7

Bone disorders

Answer 7

• trauma
• congenital/developmental anomalies (e.g. prognathia inferior)
• neoplasia
• others e.g. panostitis, acropachia 
• metabolic disorders – CKD/rubber jaw
-skull/mandible: 
• hydrocephalus
• craniomandibular osteopathy
• high rise syndrome (palatoschisis, symphysiolisis)
• neoplasias of the nasal cavity or paranasal sinuses
• dental diseases
-vertebral column:
• scoliosis/lordosis/kyphosis
• nutritional osteopathy
• vertebral dislocation
-long bones:
• trauma
• young dog: panosteitis, osteodystrophia hypertrophica
• old dog: acropachia (paraneoplastic)
• neoplasia: painful and malignant

Question 8

Standpoints of examination

Answer 8

- inspection:
• shape
• size
- palpation:
• firmness
• shape
• surface
• skin above: intactness, temperature
• pain – at palpation/for pressure (e.g. panosteitis)
• abnormal moveability? (crepitation–sound when fracture) 
• symmetry!
- percussion: 
• sound
• pain

Question 9

Bones – additional examination

Answer 9

• diagnostic imaging:
  • radiography
  • CT (cranium, sinuses, spine)
  • (scintigraphy – malignancies)
• laboratory examination:
  • metabolic parameters: Ca++,P, D vitamin, parathormone, kidney function
  • osteolysis: ALKP (growth phase - OK)
  • septic disease: CBC (complete blood count), inflammatory markers (globuline, CRP…)
• others: septic/inflammatory/neoplastic process suspected: • histopathology (=biopsy, or surgical excision material),
  • microbiology(cultureandsensitivitytesting)
• rectal examination (pelvis)

Question 10

Joints disorders

Answer 10

• Degenerative Joint Diseases (DJD)
• traumatic injuries
• polyarthritis: often septic or immune mediated!
• Bartonella, Ehrlichia, Anaplasma, Borrelia b., bacteria
• Hip dysplasia

Question 11

Joints – standpoints of the description

Answer 11

1. inspection:
• shape (swelling, angle)
• size
• skin
• symmetry
• axis: varus (O), valgus (X)
2. palpation:
• consistency
• temperature 
• pain
3. (Passive) Range of Motion = ROM (extention, flexion, rotation)

Question 12

Joints – additional examination

Answer 12

• diagnostic imaging:
  • radiography
  • CT,MRI
  • arthroscopy – diagnostic and therapeutic
  • ultrasonography
• arthrocentesis:
  • citology
  • microbiology
  • (biochemistry - globuline?)
• laboratory examination:
  • septic process suspected: CBC, inflammatory markers (globuline, CRP…)
  • immune-mediated process suspected: CBC, thr, proteinuria,
  • others: serology (antibodies) - Ehrlichiosis, Borreliosis
  • joint fluid tapped

Question 13

joint fluid tapped - normal characteristics

Answer 13

very small amount, clear, (light) straw coloured, viscous (sticky)

Question 14

Muscles disorders

Answer 14

• spastic paresis – muscle atrophy

* myositis eosinophilica

Question 15

Muscles – standpoints of the description

Answer 15

1. inspection:
• shape, volume (swelling, hypertrophy, atrophy)
• symmetry
• fibrillar contractions, tic, clonus
2. palpation:
• temperature
• consistency (pasty-like, firm etc)
• lumps (haematoma, abscess, neoplasm) 
• tone (resistance for passive motion)
• pain
- skin: intactness, temperature, sensitivity

Question 16

Muscles – additional examination

Answer 16

- diagnostic imaging:
• ultrasound (rupture, abscess...)
• MRI
- laboratory:
• blood: enzymes: CK, LDH, AST, ALT (myocyte injury) 
• blood: Ca++, Mg++
• blood: myoglobinaemia, urine: myoglobinuria
- functional:
• EMG (elektromyographia)
- other:
• biopsy
• serology: Neosporosis, Toxoplasmosis

Question 17

Examination of the locomotory organs

Answer 17

1. static part – superficial examination in standing position
   • regions: head, vertebral column, thorax, forelimbs, rear limbs
   • always start with the healthier side!
   • check limbs starting from the distal part (toes, digits) towards the proximal part
   • inspection, palpation, percussion
2. dinamic part
   • at rising (sit to stand)
   • at stance
   • in motion
   • walk, trot, gallop
   • strainght line/round, up/downhill, stairs
3. last but not least: additional examinations!