Orthopaedic Examination

Question 1

what might we consider in terms of signalment?

Answer 1

breed
age
sex

Question 2

what might we ascertain about the history of the presenting complaint?

Answer 2

medications given

onset and duration of lameness

progression

whether continuous/intermittent

effect of exercise/rest/different ground surfaces

occupation

concurrent problems

Question 3

what type of orthopaedic injury tends to become worse with exercise?

Answer 3

soft tissue/tendon injury

Question 4

what are we assessing in terms of stance?

Answer 4

symmetry
weightbearing - equal on all 4 limbs?
angular deformities

Question 5

what is varus?

Answer 5

where the distal part of the limb is medial

Question 6

what is valgus?

Answer 6

where the distal part of the limb is lateral

Question 7

what should we be assessing in terms of gait?

Answer 7

stride length
head nodding
scuffing of nails
ataxia, paraparesis, paraplegia

Question 8

how can we assess gait?

Answer 8

evaluate during walk/trot/stairs/circles

Question 9

how is lameness graded?

Answer 9

on a scale of 1-10

Question 10

what is grade 0 lameness?

Answer 10

sound

Question 11

what is grade 1 lameness?

Answer 11

occasionally shifts weight

Question 12

what is grade 2 lameness?

Answer 12

mild lameness at slow trot, none whist walking

Question 13

what is grade 3 lameness?

Answer 13

mild lameness while walking

Question 14

what is grade 4 lameness?

Answer 14

obvious lameness whilst walking, places foot when standing

Question 15

what is grade 5-8 lameness?

Answer 15

increasing degrees of severity

Question 16

what is grade 9 lameness?

Answer 16

places toe when standing, carries limb when trotting

Question 17

what is grade 10 lameness?

Answer 17

unable to weight bear

Question 18

what are we looking for when palpating during an orthopaedic physical examination?

Answer 18

asymmetry
swelling
muscle atrophy
joint enlargement
abnormal conformation

Question 19

what does SPIRM stand for?

Answer 19

Swelling, joint effusion
Pain
Instability
Range of motion
Manipulation

Question 20

when we palpate the limbs, what are we looking for?

Answer 20

swelling
muscle atrophy
pain

Question 21

what other type of injury must we consider during an orthopaedic examination?

Answer 21

neurological

Question 22

how can we check for neurological abnormalities during an ortho exam?

Answer 22

palpate spine - neck and lumbosacral joint

screening neurological examination - conscious proprioception, spinal reflexes (patella, withdrawal and perineal)

Question 23

what does the cranial draw test do?

Answer 23

tests the integrity of the cranial crucial ligament

Question 24

how do you perform the cranial draw test?

Answer 24

patient in lateral recumbency

hold femur and tibia and try to move tibia cranially with respect to the femur

repeat test with stifle at different angles or flexion/extension

Question 25

what does the tibial compression (thrust) test do?

Answer 25

tests cranial cruciate ligament integrity

Question 26

how is the tibial compression (thrust) test performed?

Answer 26

hand over distal femur, first finger on tibial tuberosity, other hand on the foot keep stifle still whilst flexing hock tibial tuberosity displaces cranially if ligament ruptured

Question 27

what is the advantage of the tibial compression test?

Answer 27

can be done on a conscious animal

Question 28

how do we test for patella luxation?

Answer 28

stifle extended - quad muscle relaxed try and shift patella medially and laterally

Question 29

what is the ortolani test?

Answer 29

a test for hip laxity

Question 30

how is the ortolani test perfomed?

Answer 30

animal in dorsal recumbency subluxate hips by pressing towards back abduct femurs and adduct hips

Question 31

how can we tell the angle of reduction in the ortolani test?

Answer 31

angle where the click is seen as the hip reduces when abducted

Question 32

how can we see the angle of subluxation in the ortolani test?

Answer 32

angle where the click is seen as hip is reluxated when adducted

Question 33

what should we be able to do by the end of the examination?

Answer 33

localise the lameness to a leg(s) and joint form differential diagnosis list

Question 34

what are some of the ancillary aids to diagnosis?

Answer 34

diagnostic imaging - U/S, radiology, CT, MRI arthrocentesis EMG for neuro/muscular issues

Question 35

where can we obtain joint fluid from?

Answer 35

most diarthrodial joints

Question 36

what is the infection risk of arthrocentesis?

Answer 36

relatively low

Question 37

what are the indications for joint tap?

Answer 37

persistent or cyclical fever lameness localised to a joint

Question 38

which joint should we tap if there are systemic problems?

Answer 38

3-6 joints

Question 39

what joints should we tap if there is seemingly only one joint affected?

Answer 39

aspirate affected joint and possibly contralateral joint

Question 40

what position should the patient be in for arthrocentesis?

Answer 40

lateral recumbency, anaesthetised/sedated

Question 41

how should we prep the area for arthrocentesis?

Answer 41

strict asepsis clip and clean with chlorhex/povidone iodine finish with surgical spirit

Question 42

which equipment might be used for arthrocentesis but is not essential?

Answer 42

gloves if inexperienced aperture drape

Question 43

what equipment should be prepared for the arthrocentesis itself?

Answer 43

appropriately sized hypodermic/spinal needles 2.5-5ml syringes

Question 44

why is it important not to move the needle while aspirating synovial fluid?

Answer 44

will aspirate blood from soft tissues which contaminates the sample

Question 45

what does iatrogenic contamination of blood in an arthrocentesis sample look like?

Answer 45

small streaks of blood

Question 46

what does an arthrocentesis sample look like when there is real change to the fluid?

Answer 46

an even pink colour - xanthochromia

Question 47

what might we want to do with an arthrocentesis sample/which equipment is needed?

Answer 47

EDTA for cytology plain tube for protein blood culture media if infection if differential make a smear

Question 48

why might we make a smear of the synovial fluid?

Answer 48

provides information on volume, viscosity, any iatrogenic blood contamination

Question 49

what is important to remember when making a smear of joint fluid?

Answer 49

only requires <0.2ml (or a needle hub full) make thin smear and do not squash it

Question 50

what does normal synovial fluid look like?

Answer 50

viscous, clear, small volume

Question 51

what does arthrocentesis actually mean?

Answer 51

surgical puncture and aspiration of a joint

Question 52

what equipment should be used for a sample of the scapulohumeral joint?

Answer 52

5ml syringe 1.5-2.5" 20-21G spinal needle (use radiograph to assess needle length)

Question 53

how is a sample of the scapulohumeral joint taken?

Answer 53

palpate acromion needle inserted distal to the acromion and directed perpendicular and slightly dorsal and medial gentle traction by an assistant can open up the joint

Question 54

what equipment should be prepared for cubital (elbow) joint arthrocentesis?

Answer 54

5ml syringe 1-1.5" 23G needle

Question 55

how is cubital joint arthrocentesis carried out?

Answer 55

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

Question 56

what equipment should be prepared for carpal joint arthrocentesis?

Answer 56

2-5ml syringe 5/8" 23-25G needle

Question 57

how is carpal joint arthrocentesis carried out?

Answer 57

flex carpus to 90 degrees insert needle perpendicular to skin aspirate all joints, avoiding the neuromuscular bundle on the dorsal aspect of the carpus

Question 58

what equipment should be prepared for metacarpal/metatarsal/interphalangeal joint arthrocentesis?

Answer 58

1-2ml syringe 5/8" 25G spinal needle

Question 59

how is metacarpal/metatarsal/interphalangeal joint arthrocentesis carried out?

Answer 59

if effusion is present aspiration is easy use spinal needle (short bevel) to allow entire tip of needle to be placed within the joint and avoid contaminating the sample

Question 60

what equipment should be prepared for arthrocentesis of the coxofemoral joint?

Answer 60

5-10ml syringe 1.5-2.5" 20G spinal needle use VD radiograph to assess needle length

Question 61

how is arthrocentesis of the coxofemoral joint performed?

Answer 61

hip abducted and internally rotated to open up the joint needle inserted craniodorsal to the greater trochanter and angled medially and caudoventrally

Question 62

what equipment should be prepared for arthrocentesis of the stifle joint?

Answer 62

5ml syringe 1-1.5" 21-23G needle

Question 63

how is arthrocentesis of the stifle joint performed?

Answer 63

stifle partially flexed needle inserted lateral to patella ligament midway between the patella and tibial tuberosity, angled caudomedially until it hits bone

Question 64

how is arthrocentesis of the femoropatella joint performed?

Answer 64

stifle extended needle inserted at the angle between the patella and femur towards proximal

Question 65

what is the risk of arthrocentesis of the femoropatella joint?

Answer 65

iatrogenic damage to articular cartilage

Question 66

what is the benefit of arthrocentesis of the femoropatella joint compared to the stifle?

Answer 66

avoid passing through the fat pad, which can impede aspiration of fluid

Question 67

what equipment is required for arthrocentesis of the tarsal joint?

Answer 67

2.5-5ml syringe 5/8-1" 23-25G needle

Question 68

how is arthrocentesis of the tarsal joint performed?

Answer 68

joint partially flexed palpate and manipulate the joint to feel the articulation and angle the needle perpendicular to the skin into the joint fluid can be obtained from either the cranio or caudolateral aspect of the joint