Orthopaedic examination Flashcards
When are diseased joints usually most painful
On extension, except the carpus which is most painful on flexion
Whe assessing joints what are you looking for?
Crepitus
Range of motion
Instability
Swelling/joint effusion
Pain
How to assess crepitus
Place your hand over the joint whilst moving it to assess for crepitus (grating associated with loss of cartilage) or clunking (e.g. if hip luxating)
How to assess range of motion
Extension and flexion
Knowledge of normal ROM is important
Often decreases in painful, swollen, or chronically affected joints.
An increase in ROM may indicate ligamentous or tendinous injury.
How to assess instability
E.g. apply varus (distal limb moved medially) and valgus (distal limb moved laterally) stresses to assess collateral ligaments or assess draw movement with cruciate disease.
Which is the only joint that is usually painful on flexion when diseased rather than extension?
The carpus
What are you assessing on an orthopaedic assessment of the limbs (excluding joints)
Swelling
Atrophy
Pain
Neurological tests that you would do as part of an orthopaedic assessment
Palpate the whole spine and neck assessing for pain
Palpate the lumbosacral joint and manipulate the base of the tail
Perfrom a screening neurological examination - conscious proprioception, spinal reflexes (patella, withdrawal, perineal reflexes)
How do you differentiate hip pain from lower back pain?
With the dog standing up apply firm direct pressure to the lower back area
With the dog in lateral, flex the hips and then extend the lower back
If the dog does not resent hip extension then stand behind the dog and extend its hips and then apply pressure to lumbosacral area
Ortolani test
Test for hip instability
Anaesthetised or sedated in dorsal recumbency
Femur perpendicular to the spine
Place ventral pressure to subluxate hip
Slowly abduct limb until a palpable or audible click
Adduct hip until hip reluxates
Bardens test
Hip lift
Test of laxity
Anaesthetised/sedated in lateral
Apply lateral displacement to the femur
Thumb displacement test
Test of traumatic hip luxation
thumb in between greater trochanter and ischial tuberosity
Externally rotate hip - if thumb displaced, hip is not luxated
Where are joint effusions felt in the carpus?
A loss of definition of the carpal bones on the cranial aspect of the joint.
Where are joint effusions felt in the elbow?
Palpable as a convex bulge between the olecranon and lateral epicondyle
Where are joint effusions felt in the shoulder and hip?
Can’t as too much muscle mass
