Orthopaedic Examination & Gait Analysis in Small Animals

Question 1

what is lameness

Answer 1

any abnormal gait or posture

Question 2

what are possible causes of lameness

Answer 2

1. pain (skeletal, muscular, primary neurogenic, connective tissue, skin)
2. mechanical problem (malformation, restricted joint movement, loss of muscle/tendon function, loss of joint stability)

Question 3

what are the typical presentations of lameness

Answer 3

1. severe acute lameness
2. chronic mild/moderate lameness
3. neoplasia and infectious causes

Question 4

what could the causes of acute lameness be

Answer 4

acute trauma –> fractures, dislocations, ligament tears, etc

Question 5

what could the causes of chronic mild/moderate lameness be

Answer 5

osteoarthritis, hip/elbow dysplasia, cranial cruciate

Question 6

what are the presentations of neoplasia and infectious causes of lameness

Answer 6

acute and chronic presentations

Question 7

what is important when examining for lameness

Answer 7

to keep neurology in mind (do a neuorlogical exam –> ex. ciatic nerve could be severed)

Question 8

what are factors in the diagnosis of lameness

Answer 8

1. signalment (age, breed, etc.)
2. history
3. physical examination (general, orthopaedic)
4. further diagnositic investigations (imaging, synovial fluid analysis, arthroscopy, general health –> blood test)

Question 9

what are important things to consider in history for a lameness exam

Answer 9

1. known trauma
2. onset –> acute, gradual/insidious
3. duration –> pattern over duration (improving, deteriorating, stable)
4. continuous or intermittent
5. which limb (same, multiple, shifting)
6. external changes noted (swelling, would, discharge)
7. other effects on degree of lameness (varies with surface, alters with exercise, more noticible after rest)
8. behavioural changes (temperament, activity levels, appetite, lifestyle)
9. response to treatment (medication, rest)
10. other indications of general health

Question 10

what is the difference between cat and dog lameness

Answer 10

chronic osteoarthritis very common in older cats –> don’t show lameness like dogs

behavioural and lifestyle changes (mobility, activity, grooming, demeanour, litter tray use)

Question 11

what is the most common reason for a kitty to limp

Answer 11

cat bite abscess or RTA

most common area for arthritis is elbows

Question 12

how do you start a physical orthopaedic exam

Answer 12

1. observe animal –> standing, sitting, at walk, at trot)
2. any lameness should be asssessed –> which leg(s) (gait, head position/nodding, etc.), subjective scoring of lameness (5-point scale), more objective assessment can be used (force plate or pressure mat analysis)

Question 13

what needs to be considered during palpation in the physical orthopaedic exam

Answer 13

compare sides

• alteration of muscle mass (muscle loss)
• anatomical deformity (luxations, fractures)
• swelling or thickening (difficult to detect in proximal, like shoulder and hip, areas)
• pain (direct pressure, more likely to find pain in manipulation phase of exam)

Question 14

what is done during the manipulation phase of the orthopaedic exam

Answer 14

1. flex and extend joints –> through full range of motion
2. palpate major tendons (tension)
3. pressure on long bones
4. palpate for joint effusions (distal joints)

Question 15

what is evaluated during manipulation

Answer 15

1. pain on manipulation (can use scoring scheme, but likely to be subjective)
2. reduced range and alignment of motion (OA, luxation, soft tissue contractures)
3. crepitation (pathological –> fractures or physiological)
4. joint instability (stifle) –> cranial drawer, tibial thrust

Question 16

what is important during manipulation and palpation

Answer 16

systematic, thorough, both sides

Question 17

what is important when taking radiographs

Answer 17

take two orthogonal views (minimum)

ex. mediolateral and craniocaudal

use other side for comparison

Question 18

what is ultrasound useful for

Answer 18

muscle, tendon, ligament

Question 19

what are CT/MRI useful for

Answer 19

CT: bony imaging (joints etc)

MRI: neurological and soft tissue causes

Question 20

what is scintigraphy useful for

Answer 20

physiological imaging –> increased bone activity

can be used to identify site of problem

Question 21

what does arthrocentesis and synovial fluid analysis assess

Answer 21

1. volume
2. colour and turbidity
3. viscosity
4. cytology (total cell counts, differential white cell count)
5. mucin and fibrogen clot tests
6. microbial culture

Question 22

what is common presentation of fractured elbow in a dog

Answer 22

non-weight bearing

soft tissue swelling

pain and crepitus on flexing and extending elbow

abnormal movement within elbow

medial epicondyle displaced distally relative to lateral epicondyle