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Applied Clinical Veterinary Nursing > Orthopaedic Examination > Flashcards

Orthopaedic Examination Flashcards

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1
Q

what might we consider in terms of signalment?

A

breed
age
sex

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2
Q

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

A

medications given

onset and duration of lameness

progression

whether continuous/intermittent

effect of exercise/rest/different ground surfaces

occupation

concurrent problems

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3
Q

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

A

soft tissue/tendon injury

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4
Q

what are we assessing in terms of stance?

A

symmetry
weightbearing - equal on all 4 limbs?
angular deformities

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5
Q

what is varus?

A

where the distal part of the limb is medial

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6
Q

what is valgus?

A

where the distal part of the limb is lateral

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7
Q

what should we be assessing in terms of gait?

A

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

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8
Q

how can we assess gait?

A

evaluate during walk/trot/stairs/circles

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9
Q

how is lameness graded?

A

on a scale of 1-10

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10
Q

what is grade 0 lameness?

A

sound

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11
Q

what is grade 1 lameness?

A

occasionally shifts weight

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12
Q

what is grade 2 lameness?

A

mild lameness at slow trot, none whist walking

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13
Q

what is grade 3 lameness?

A

mild lameness while walking

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14
Q

what is grade 4 lameness?

A

obvious lameness whilst walking, places foot when standing

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15
Q

what is grade 5-8 lameness?

A

increasing degrees of severity

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16
Q

what is grade 9 lameness?

A

places toe when standing, carries limb when trotting

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17
Q

what is grade 10 lameness?

A

unable to weight bear

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18
Q

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

A

asymmetry
swelling
muscle atrophy
joint enlargement
abnormal conformation

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19
Q

what does SPIRM stand for?

A

Swelling, joint effusion
Pain
Instability
Range of motion
Manipulation

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20
Q

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

A

swelling
muscle atrophy
pain

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21
Q

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

A

neurological

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22
Q

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

A

palpate spine - neck and lumbosacral joint

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

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23
Q

what does the cranial draw test do?

A

tests the integrity of the cranial crucial ligament

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24
Q

how do you perform the cranial draw test?

A

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

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25
Q

what does the tibial compression (thrust) test do?

A

tests cranial cruciate ligament integrity

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26
Q

how is the tibial compression (thrust) test performed?

A

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

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27
Q

what is the advantage of the tibial compression test?

A

can be done on a conscious animal

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28
Q

how do we test for patella luxation?

A

stifle extended - quad muscle relaxed

try and shift patella medially and laterally

29
Q

what is the ortolani test?

A

a test for hip laxity

30
Q

how is the ortolani test perfomed?

A

animal in dorsal recumbency

subluxate hips by pressing towards back

abduct femurs and adduct hips

31
Q

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

A

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

32
Q

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

A

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

33
Q

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

A

localise the lameness to a leg(s) and joint

form differential diagnosis list

34
Q

what are some of the ancillary aids to diagnosis?

A

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

35
Q

where can we obtain joint fluid from?

A

most diarthrodial joints

36
Q

what is the infection risk of arthrocentesis?

A

relatively low

37
Q

what are the indications for joint tap?

A

persistent or cyclical fever
lameness localised to a joint

38
Q

which joint should we tap if there are systemic problems?

A

3-6 joints

39
Q

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

A

aspirate affected joint and possibly contralateral joint

40
Q

what position should the patient be in for arthrocentesis?

A

lateral recumbency, anaesthetised/sedated

41
Q

how should we prep the area for arthrocentesis?

A

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

42
Q

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

A

gloves if inexperienced

aperture drape

43
Q

what equipment should be prepared for the arthrocentesis itself?

A

appropriately sized hypodermic/spinal needles

2.5-5ml syringes

44
Q

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

A

will aspirate blood from soft tissues which contaminates the sample

45
Q

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

A

small streaks of blood

46
Q

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

A

an even pink colour - xanthochromia

47
Q

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

A

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

48
Q

why might we make a smear of the synovial fluid?

A

provides information on volume, viscosity, any iatrogenic blood contamination

49
Q

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

A

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

50
Q

what does normal synovial fluid look like?

A

viscous, clear, small volume

51
Q

what does arthrocentesis actually mean?

A

surgical puncture and aspiration of a joint

52
Q

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

A

5ml syringe

1.5-2.5” 20-21G spinal needle

(use radiograph to assess needle length)

53
Q

how is a sample of the scapulohumeral joint taken?

A

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

54
Q

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

A

5ml syringe

1-1.5” 23G needle

55
Q

how is cubital joint arthrocentesis carried out?

A

flex elbow to 45 degrees

needle started from point level and perpendicular to epicondylar crest alongside anconeal process

56
Q

what equipment should be prepared for carpal joint arthrocentesis?

A

2-5ml syringe

5/8” 23-25G needle

57
Q

how is carpal joint arthrocentesis carried out?

A

flex carpus to 90 degrees

insert needle perpendicular to skin

aspirate all joints, avoiding the neuromuscular bundle on the dorsal aspect of the carpus

58
Q

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

A

1-2ml syringe

5/8” 25G spinal needle

59
Q

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

A

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

60
Q

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

A

5-10ml syringe

1.5-2.5” 20G spinal needle

use VD radiograph to assess needle length

61
Q

how is arthrocentesis of the coxofemoral joint performed?

A

hip abducted and internally rotated to open up the joint

needle inserted craniodorsal to the greater trochanter and angled medially and caudoventrally

62
Q

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

A

5ml syringe

1-1.5” 21-23G needle

63
Q

how is arthrocentesis of the stifle joint performed?

A

stifle partially flexed

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

64
Q

how is arthrocentesis of the femoropatella joint performed?

A

stifle extended

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

65
Q

what is the risk of arthrocentesis of the femoropatella joint?

A

iatrogenic damage to articular cartilage

66
Q

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

A

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

67
Q

what equipment is required for arthrocentesis of the tarsal joint?

A

2.5-5ml syringe

5/8-1” 23-25G needle

68
Q

how is arthrocentesis of the tarsal joint performed?

A

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

69
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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