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ACVN - MEDICAL NURSING > Orthopaedic Exam > Flashcards

Orthopaedic Exam Flashcards

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1
Q

How would you plan a lameness examination?

A
  • signalment and presenting complaint
  • history
  • gait examination
  • physical examination
  • differential diagnosis and diagnostic exam
  • ancillary aids to diagnosis
  • arthrocentesis
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2
Q

What is part of the signalment and presenting complaing section of the lameness examination?

A

breed, age and sex

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3
Q

What would knowing the breed, age and sex of the patient help you with?

A

can provide important cues with regard to the nature of the disease

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4
Q

What are you looking for when taking a history?

A
  • patient medication
  • duration of lameness
  • onset
  • progression
  • continuous or intermittent
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5
Q

If the patient is on medication for lameness what are you asking?

A
  • the duration of the treatment
  • how they responded to the treatment
  • when the treatment course finished
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6
Q

What else do you want to find out when taking a history from a lame patient?

A
  • 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
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7
Q

What might intermittent lameness be associated with?

A

could be a flare up or overuse of an arthritic joint or due to intermittent patella luxation

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8
Q

What might progressive worsening lameness be caused by?

A

neoplastic condition, osetoarthritis can cause continuous lameness

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9
Q

What are you looking at when observing the lame patients stance?

A

symmetry, weight bearing, if there is angular deformity

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10
Q

What are you looking for specifically with symmetry of the stance?

A
  • 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
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11
Q

What are you looking for specifically if a patient is weight bearing differently?

A

if they are shifting weight from pelvic to thoracic limbs

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12
Q

What is a kyphotic stance?

A

the back is curved upwards

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13
Q

What is scoliosis?

A

lateral curvature of the spine

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14
Q

What might frequent sitting be a sign of?

A

pelvic limb lameness

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15
Q

What might frequenct lying down be a sign of?

A

thoracic limb lameness

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16
Q

What are you looking for when doing a gait analysis?

A
  • stride length
  • head nodding
  • scuffing of nails
  • ataxia, paraperesis, paraplegia
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17
Q

What is ataxia?

A

pelvic limb incoordination

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18
Q

What is paraperesis?

A

hind limb neurological deficits but motor function is present

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19
Q

What is paraplegia?

A

hind limb neurological deficits with absent motor function

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20
Q

What does circumducted mean?

A

swung out from the body

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21
Q

Why might a limb be circumducted?

A

prevents stifle flexion, preventing pain

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22
Q

What is a lateral sway?

A

when hip pain causes the spine to be introduced in walking which minimises hip motion

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23
Q

How does bunny hopping occur?

A

when both hindlimbs are moved forward together and is also associated with hip pain

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24
Q

Why might head bobbing occur?

A

if there is thoracic limb lameness, and there is a sink on the sound side when the dog throws weight on the good leg

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25
Q

What is the lameness grading 0-10?

A

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

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26
Q

What might exercise intolerance be a cause of?

A

cardiac or metabolic problem

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27
Q

What are you palpating the standing animal for?

A
  • asymmetry
  • swelling
  • msucle atrophy
  • joint enlargement
  • abnormal conformation
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28
Q

When examining joints, what is SPIRM?

A

Swelling, joint effusion
Pain
Instability
Range of motion
Manipulation

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29
Q

Why might you examine a patient in lateral recumbency?

A

so that you can work from the toes upwards and easier to examine all 4 limbs

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30
Q

Which limb would you examine first for a lameness check?

A

the unaffected limb so that it is easier to compare normal to abnormal and range of motion

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31
Q

What is important to remember when checking for swellings or joint effusion?

A

differentiate between fibrous swelling and an acumulation of joint fluid

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32
Q

What is important to rememeber when checking for pain during the orthopaedic exam

A

joints are often painful on manipulation especially at extremes of range of motion

33
Q

What types of joints are often most painful on extension?

A

diseased joints

34
Q

What is important to remember when checking for instability?

A

aplly varus and valgus stresses to assess collateral ligaments or assess draw movement with ccruciate disease

35
Q

What is varus stressors?

A

distal limb moved medial

36
Q

What is valgus stressors?

A

distal limb moved lateral

37
Q

What is important to remember when checking the range of motion?

A

they often decrease in painful swollen or chronically affected joints
- an increase in range of motion may indicate ligamentous or tendinous injury

38
Q

What is important to remmeber when mainpulating a limb?

A
  • place your hand over the joint whilst moving it to assess for crepitus or clunking
39
Q

What is crepitus?

A

grating associated with loss of cartilate, NOT referred from another joint

40
Q

Why might a joint ‘clunk’?

A

if the hip is subluxating

41
Q

What are you checking for when examining the limbs?

A

swelling, muscle atrophy and pain

42
Q

What other problems might lame dogs present with?

A

neurological problems

43
Q

What neurlogical problems might dogs with hip dysplasia also have?

A

lumbosacral disease

44
Q

What is involved in a screening neurlogical exam?

A
  • conscious proprioception
  • spinal reflexes (patella, withdrawal, perineal reflexes)
45
Q

How do you differentiate between hip pain and lower back pain?

A

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

46
Q

What does a cranial draw test for?

A

integrity of the cranial cruciate ligament

47
Q

How do you perform a cranial draw test?

A

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

48
Q

What is a tibia compression test (or tibial thrust test) for?

A

tests cranial cruciate ligament integrity

49
Q

How do you perform a tibial compression test?

A

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

50
Q

What species usually get medial patella luxation?

A

dogs and cats

51
Q

What does luxate mean?

A

dislocate

52
Q

How do you luxate the patella?

A

1 - have the stifle extended
2 - shift the patella medially and laterally

53
Q

What does the ortolani test for?

A

hip laxity

54
Q

How would you perform the ortolani test?

A

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)

55
Q

What is the angle of luxation?

A

angle from the verticle to hip luxation

56
Q

What are the ancillary aids to diagnosis?

A
  • diagnositic imaging: ultrasound, radiology, CT, MRI
  • arthrocentesis
  • EMG
57
Q

What are the indications for arthrocentesis?

A
  • persistent or cyclical fever
  • lameness localised to a joint
58
Q

How would you prepare the patient for an arthrocentesis?

A
  • GA or sedation
  • patient in lateral recumbency
  • if ill and large patient may be bale to aspirate concious or with local anaesthesia
59
Q

What will you need to ensure strict apseptic technique is carried out when preparing the patient?

A
  • clip an adequat sized area
  • clean with chlorhexidine or povidone iodine
  • finish with surgical spirit
60
Q

What equipment will you need to perform an arthrocentesis?

A
  • sterile hypodermic and spinal needles 20-25G, 5/8ths - 2.5” in length
  • 2.5-5ml syringes
61
Q

What is important not to do when taking the arthrocentesis sample?

A

do not move the needle as can aspirate tissue and contaminate the sample

62
Q

What tube would you place a large volume of arthrocentesis fluid in?

A

EDTA for cytology
- Plain pot for protein
- blood culture media

63
Q

What is a normal amount of joint fluid to aspiration when tapping a normal joint?

A

less than 0.2ml

64
Q

What does synovial fluid mean?

A

syn - similar to
ova - egg white

65
Q

What does normal synovial fluid look like?

A

viscous, clear and small volume

66
Q

What does ‘tap’ mean?

A

to obtain

67
Q

What does arthrocentesis mean?

A

surgical puncture and aspiration of a joint

68
Q

What equipment would you need for a scapulohumeral joint tap?

A

5ml syringe
1.5-2.5” length needle
20-21G spinal needle

69
Q

Tips for tapping a scapulohumeral joint

A
  • 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
70
Q

What equipment would you need for a cubital (elbow) joint tap?

A
  • 5ml syringe
  • 1.1.5” length needle
  • 23G needle
71
Q

How to tap cubital (elbow) joint?

A

-flex elbow 45 degrees
- needle started from point level and perpendicular to epicondylar crest alongside aconeal process

72
Q

What equipment would you need for tapping a carpal joint?

A
  • 2-5ml syringe
  • 5/8ths length neelde
  • 23-25G needle
73
Q

What degree should you flex thecarpus for tapping?

A

90

74
Q

What should you avoid when tapping the carpaljoint?

A

neurovascular bundle

75
Q

What equipment do you need for tapping the MCP/MTP/IP joints?

A
  • 1-2ml syringe
  • 5/8ths length needle
  • 25G spinal needle
76
Q

What equipment do you need for a coxofemoral joint tap?

A
  • 5-10ml syringe
  • 1.5”-2.5” length needle
    20G spinal needle
77
Q

What equipment do you need for a stifle joint tap?

A
  • 5ml syringe
  • 1-1/5” length needle
  • 21-23G needle
78
Q

What equipment do you need for a tarsal joint tap?

A
  • 2.5-5ml syringe
  • 5.8-1” length needle
  • 23-25G needle
79
Q

What should you do if there is effusion during tarsal joint tap?

A

push don’t aspirate

ACVN - MEDICAL NURSING (22 decks)

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