Orthopaedic Exam Flashcards
How would you plan a lameness examination?
- signalment and presenting complaint
- history
- gait examination
- physical examination
- differential diagnosis and diagnostic exam
- ancillary aids to diagnosis
- arthrocentesis
What is part of the signalment and presenting complaing section of the lameness examination?
breed, age and sex
What would knowing the breed, age and sex of the patient help you with?
can provide important cues with regard to the nature of the disease
What are you looking for when taking a history?
- patient medication
- duration of lameness
- onset
- progression
- continuous or intermittent
If the patient is on medication for lameness what are you asking?
- the duration of the treatment
- how they responded to the treatment
- when the treatment course finished
What else do you want to find out when taking a history from a lame patient?
- duration of lameness
- the onset, whether it was gradual or acute, if there was an initiating trauma
- whether the lameness is static or progressive, deteriorating or improving
- is it continuous or intermittent
What might intermittent lameness be associated with?
could be a flare up or overuse of an arthritic joint or due to intermittent patella luxation
What might progressive worsening lameness be caused by?
neoplastic condition, osetoarthritis can cause continuous lameness
What are you looking at when observing the lame patients stance?
symmetry, weight bearing, if there is angular deformity
What are you looking for specifically with symmetry of the stance?
- the paw of the limb taking the most weight will be flatter and more difficult to lift this limb in the standing patient
- inward and outward pointing of the paw
What are you looking for specifically if a patient is weight bearing differently?
if they are shifting weight from pelvic to thoracic limbs
What is a kyphotic stance?
the back is curved upwards
What is scoliosis?
lateral curvature of the spine
What might frequent sitting be a sign of?
pelvic limb lameness
What might frequenct lying down be a sign of?
thoracic limb lameness
What are you looking for when doing a gait analysis?
- stride length
- head nodding
- scuffing of nails
- ataxia, paraperesis, paraplegia
What is ataxia?
pelvic limb incoordination
What is paraperesis?
hind limb neurological deficits but motor function is present
What is paraplegia?
hind limb neurological deficits with absent motor function
What does circumducted mean?
swung out from the body
Why might a limb be circumducted?
prevents stifle flexion, preventing pain
What is a lateral sway?
when hip pain causes the spine to be introduced in walking which minimises hip motion
How does bunny hopping occur?
when both hindlimbs are moved forward together and is also associated with hip pain
Why might head bobbing occur?
if there is thoracic limb lameness, and there is a sink on the sound side when the dog throws weight on the good leg
What is the lameness grading 0-10?
0 - sound
1 - occasionally shifts weight
2 - mild lameness at slow trot, none whilst walking
3 -mild lameness whilst walking
4 - obvious lameness whilst walking, placing foot when standing
5-8 - degress of severity
9- places toe when standing, carries limb when trotting
10 - unable to weight bear
What might exercise intolerance be a cause of?
cardiac or metabolic problem
What are you palpating the standing animal for?
- asymmetry
- swelling
- msucle atrophy
- joint enlargement
- abnormal conformation
When examining joints, what is SPIRM?
Swelling, joint effusion
Pain
Instability
Range of motion
Manipulation
Why might you examine a patient in lateral recumbency?
so that you can work from the toes upwards and easier to examine all 4 limbs
Which limb would you examine first for a lameness check?
the unaffected limb so that it is easier to compare normal to abnormal and range of motion
What is important to remember when checking for swellings or joint effusion?
differentiate between fibrous swelling and an acumulation of joint fluid
What is important to rememeber when checking for pain during the orthopaedic exam
joints are often painful on manipulation especially at extremes of range of motion
What types of joints are often most painful on extension?
diseased joints
What is important to remember when checking for instability?
aplly varus and valgus stresses to assess collateral ligaments or assess draw movement with ccruciate disease
What is varus stressors?
distal limb moved medial
What is valgus stressors?
distal limb moved lateral
What is important to remember when checking the range of motion?
they often decrease in painful swollen or chronically affected joints
- an increase in range of motion may indicate ligamentous or tendinous injury
What is important to remmeber when mainpulating a limb?
- place your hand over the joint whilst moving it to assess for crepitus or clunking
What is crepitus?
grating associated with loss of cartilate, NOT referred from another joint
Why might a joint ‘clunk’?
if the hip is subluxating
What are you checking for when examining the limbs?
swelling, muscle atrophy and pain
What other problems might lame dogs present with?
neurological problems
What neurlogical problems might dogs with hip dysplasia also have?
lumbosacral disease
What is involved in a screening neurlogical exam?
- conscious proprioception
- spinal reflexes (patella, withdrawal, perineal reflexes)
How do you differentiate between hip pain and lower back pain?
1 - with dog standing apply firm direct pressure to the lower back
2 - wiith the dog in lateral recumbency flex the hips and the extend the lower back
3 - if dog doesn’t resent hip extension then stand behind dog extend the hips, the apply pressure to the lumbosacral area
What does a cranial draw test for?
integrity of the cranial cruciate ligament
How do you perform a cranial draw test?
1 - patient in lateral
2 - hold femur and tibia and try to move tibia cranially with respect to the femur
3 - repeat test with stifle at different angles or flexion/extension
What is a tibia compression test (or tibial thrust test) for?
tests cranial cruciate ligament integrity
How do you perform a tibial compression test?
1 -hand over distall femur, firt finger on the tibial tuberosity, other hand on foot
2 - keep stifle still whilst flexing the hock
3 - tibial tuberosity displaces cranially if ligament ruptured
What species usually get medial patella luxation?
dogs and cats
What does luxate mean?
dislocate
How do you luxate the patella?
1 - have the stifle extended
2 - shift the patella medially and laterally
What does the ortolani test for?
hip laxity
How would you perform the ortolani test?
1 - patient in dorsal recumency
2 - subluxate the hips by pressuign towards back
3 - abduct the femurs (they would click as hip reduces, check angle of reduction)
4 - adduct hips (would click as hip reluxated, check angle of subluxation)
What is the angle of luxation?
angle from the verticle to hip luxation
What are the ancillary aids to diagnosis?
- diagnositic imaging: ultrasound, radiology, CT, MRI
- arthrocentesis
- EMG
What are the indications for arthrocentesis?
- persistent or cyclical fever
- lameness localised to a joint
How would you prepare the patient for an arthrocentesis?
- GA or sedation
- patient in lateral recumbency
- if ill and large patient may be bale to aspirate concious or with local anaesthesia
What will you need to ensure strict apseptic technique is carried out when preparing the patient?
- clip an adequat sized area
- clean with chlorhexidine or povidone iodine
- finish with surgical spirit
What equipment will you need to perform an arthrocentesis?
- sterile hypodermic and spinal needles 20-25G, 5/8ths - 2.5” in length
- 2.5-5ml syringes
What is important not to do when taking the arthrocentesis sample?
do not move the needle as can aspirate tissue and contaminate the sample
What tube would you place a large volume of arthrocentesis fluid in?
EDTA for cytology
- Plain pot for protein
- blood culture media
What is a normal amount of joint fluid to aspiration when tapping a normal joint?
less than 0.2ml
What does synovial fluid mean?
syn - similar to
ova - egg white
What does normal synovial fluid look like?
viscous, clear and small volume
What does ‘tap’ mean?
to obtain
What does arthrocentesis mean?
surgical puncture and aspiration of a joint
What equipment would you need for a scapulohumeral joint tap?
5ml syringe
1.5-2.5” length needle
20-21G spinal needle
Tips for tapping a scapulohumeral joint
- insert needledistal to acromion, direct perpendicular and slightly dorsal and medial
- withdraw if bone is felt
- gentle traction from assistant can help open the shoulder joint
What equipment would you need for a cubital (elbow) joint tap?
- 5ml syringe
- 1.1.5” length needle
- 23G needle
How to tap cubital (elbow) joint?
-flex elbow 45 degrees
- needle started from point level and perpendicular to epicondylar crest alongside aconeal process
What equipment would you need for tapping a carpal joint?
- 2-5ml syringe
- 5/8ths length neelde
- 23-25G needle
What degree should you flex thecarpus for tapping?
90
What should you avoid when tapping the carpaljoint?
neurovascular bundle
What equipment do you need for tapping the MCP/MTP/IP joints?
- 1-2ml syringe
- 5/8ths length needle
- 25G spinal needle
What equipment do you need for a coxofemoral joint tap?
- 5-10ml syringe
- 1.5”-2.5” length needle
20G spinal needle
What equipment do you need for a stifle joint tap?
- 5ml syringe
- 1-1/5” length needle
- 21-23G needle
What equipment do you need for a tarsal joint tap?
- 2.5-5ml syringe
- 5.8-1” length needle
- 23-25G needle
What should you do if there is effusion during tarsal joint tap?
push don’t aspirate
