Orthopaedic Examination Flashcards
what might we consider in terms of signalment?
breed
age
sex
what might we ascertain about the history of the presenting complaint?
medications given
onset and duration of lameness
progression
whether continuous/intermittent
effect of exercise/rest/different ground surfaces
occupation
concurrent problems
what type of orthopaedic injury tends to become worse with exercise?
soft tissue/tendon injury
what are we assessing in terms of stance?
symmetry
weightbearing - equal on all 4 limbs?
angular deformities
what is varus?
where the distal part of the limb is medial
what is valgus?
where the distal part of the limb is lateral
what should we be assessing in terms of gait?
stride length
head nodding
scuffing of nails
ataxia, paraparesis, paraplegia
how can we assess gait?
evaluate during walk/trot/stairs/circles
how is lameness graded?
on a scale of 1-10
what is grade 0 lameness?
sound
what is grade 1 lameness?
occasionally shifts weight
what is grade 2 lameness?
mild lameness at slow trot, none whist walking
what is grade 3 lameness?
mild lameness while walking
what is grade 4 lameness?
obvious lameness whilst walking, places foot when standing
what is grade 5-8 lameness?
increasing degrees of severity
what is grade 9 lameness?
places toe when standing, carries limb when trotting
what is grade 10 lameness?
unable to weight bear
what are we looking for when palpating during an orthopaedic physical examination?
asymmetry
swelling
muscle atrophy
joint enlargement
abnormal conformation
what does SPIRM stand for?
Swelling, joint effusion
Pain
Instability
Range of motion
Manipulation
when we palpate the limbs, what are we looking for?
swelling
muscle atrophy
pain
what other type of injury must we consider during an orthopaedic examination?
neurological
how can we check for neurological abnormalities during an ortho exam?
palpate spine - neck and lumbosacral joint
screening neurological examination - conscious proprioception, spinal reflexes (patella, withdrawal and perineal)
what does the cranial draw test do?
tests the integrity of the cranial crucial ligament
how do you perform the cranial draw test?
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
what does the tibial compression (thrust) test do?
tests cranial cruciate ligament integrity
how is the tibial compression (thrust) test performed?
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
what is the advantage of the tibial compression test?
can be done on a conscious animal
how do we test for patella luxation?
stifle extended - quad muscle relaxed
try and shift patella medially and laterally
what is the ortolani test?
a test for hip laxity
how is the ortolani test perfomed?
animal in dorsal recumbency
subluxate hips by pressing towards back
abduct femurs and adduct hips
how can we tell the angle of reduction in the ortolani test?
angle where the click is seen as the hip reduces when abducted
how can we see the angle of subluxation in the ortolani test?
angle where the click is seen as hip is reluxated when adducted
what should we be able to do by the end of the examination?
localise the lameness to a leg(s) and joint
form differential diagnosis list
what are some of the ancillary aids to diagnosis?
diagnostic imaging - U/S, radiology, CT, MRI
arthrocentesis
EMG for neuro/muscular issues
where can we obtain joint fluid from?
most diarthrodial joints
what is the infection risk of arthrocentesis?
relatively low
what are the indications for joint tap?
persistent or cyclical fever
lameness localised to a joint
which joint should we tap if there are systemic problems?
3-6 joints
what joints should we tap if there is seemingly only one joint affected?
aspirate affected joint and possibly contralateral joint
what position should the patient be in for arthrocentesis?
lateral recumbency, anaesthetised/sedated
how should we prep the area for arthrocentesis?
strict asepsis
clip and clean with chlorhex/povidone iodine
finish with surgical spirit
which equipment might be used for arthrocentesis but is not essential?
gloves if inexperienced
aperture drape
what equipment should be prepared for the arthrocentesis itself?
appropriately sized hypodermic/spinal needles
2.5-5ml syringes
why is it important not to move the needle while aspirating synovial fluid?
will aspirate blood from soft tissues which contaminates the sample
what does iatrogenic contamination of blood in an arthrocentesis sample look like?
small streaks of blood
what does an arthrocentesis sample look like when there is real change to the fluid?
an even pink colour - xanthochromia
what might we want to do with an arthrocentesis sample/which equipment is needed?
EDTA for cytology
plain tube for protein
blood culture media if infection if differential
make a smear
why might we make a smear of the synovial fluid?
provides information on volume, viscosity, any iatrogenic blood contamination
what is important to remember when making a smear of joint fluid?
only requires <0.2ml (or a needle hub full)
make thin smear and do not squash it
what does normal synovial fluid look like?
viscous, clear, small volume
what does arthrocentesis actually mean?
surgical puncture and aspiration of a joint
what equipment should be used for a sample of the scapulohumeral joint?
5ml syringe
1.5-2.5” 20-21G spinal needle
(use radiograph to assess needle length)
how is a sample of the scapulohumeral joint taken?
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
what equipment should be prepared for cubital (elbow) joint arthrocentesis?
5ml syringe
1-1.5” 23G needle
how is cubital joint arthrocentesis carried out?
flex elbow to 45 degrees
needle started from point level and perpendicular to epicondylar crest alongside anconeal process
what equipment should be prepared for carpal joint arthrocentesis?
2-5ml syringe
5/8” 23-25G needle
how is carpal joint arthrocentesis carried out?
flex carpus to 90 degrees
insert needle perpendicular to skin
aspirate all joints, avoiding the neuromuscular bundle on the dorsal aspect of the carpus
what equipment should be prepared for metacarpal/metatarsal/interphalangeal joint arthrocentesis?
1-2ml syringe
5/8” 25G spinal needle
how is metacarpal/metatarsal/interphalangeal joint arthrocentesis carried out?
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
what equipment should be prepared for arthrocentesis of the coxofemoral joint?
5-10ml syringe
1.5-2.5” 20G spinal needle
use VD radiograph to assess needle length
how is arthrocentesis of the coxofemoral joint performed?
hip abducted and internally rotated to open up the joint
needle inserted craniodorsal to the greater trochanter and angled medially and caudoventrally
what equipment should be prepared for arthrocentesis of the stifle joint?
5ml syringe
1-1.5” 21-23G needle
how is arthrocentesis of the stifle joint performed?
stifle partially flexed
needle inserted lateral to patella ligament midway between the patella and tibial tuberosity, angled caudomedially until it hits bone
how is arthrocentesis of the femoropatella joint performed?
stifle extended
needle inserted at the angle between the patella and femur towards proximal
what is the risk of arthrocentesis of the femoropatella joint?
iatrogenic damage to articular cartilage
what is the benefit of arthrocentesis of the femoropatella joint compared to the stifle?
avoid passing through the fat pad, which can impede aspiration of fluid
what equipment is required for arthrocentesis of the tarsal joint?
2.5-5ml syringe
5/8-1” 23-25G needle
how is arthrocentesis of the tarsal joint performed?
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
