Orthopaedics: Practical Approach to the Orthopaedic Case

Question 1

What can be examined on a physical examination of an orthopaedic case?

Answer 1

Assess soft tissue
* Muscle mass and symmetry
* Joint effusions
* Tendinous insertions

Palpate long bones

Assess joints
* ROM
* Periarticular thickening
* Crepitus

Question 2

What is the therapeutic strategy for non-surgical orthopaedic cases?

Answer 2

• Excercise modification
• Physiotherapy
• Analgesia
• Weight managment

Question 3

What is the standard analgesia plan?

Answer 3

NSAID
+
Paracetamol

± Amantadine/Gabapentin

Question 4

What is the aim of excercise modification?
What is the general choice?

Answer 4

To establish a baseline level of excercise that the patient can tolerate without exacerbation of their clinical signs

Lead restricted excercise
* reduce to 25% of typical walk two-three times a day
* Increase length of walk by 5 mins every 7-14 days- 40 mins
* Introduce off lead work when lead restricted target achieved- end of each walk 5 mins, 10, 15, 20

Question 5

After the initial therapeutic assessment when should reassesment occur?

Answer 5

After 6-8 weeks

Question 6

Once the patient is stable when should reassessment be

Answer 6

Every 6 months
* Weight loss/reduction in BCS
* Gait analysis
* Improved muscle mass
* Increased ROM
* CMI’s

Question 7

What can you ask clients to fill out before consult?

Answer 7

• Liverpool osteoarthritis in dogs questionaire
• Canine brief pain inventory
• Feline musculoskeletal pain index

Gives good baseline information

Question 8

What can be assessed on a dynamic assessment?

Answer 8

Subjective gait analysis
* VIsual analogue scale
* Numerical rating system
* Descriptive scores

Objective gait analysis
* Force plate
* Pressure sensitive walkway

Use smartphone to record lameness

Question 9

What is observed about the thoracic limb on dynamic assessment?

Answer 9

• Assess when patient is walking towards you
• Head position- attempts to shift weight caudally, head will rise when leg in stance phase, drops in swing phase
• Short stance phase on lame leg
• Fast swing phase on non-lame leg

Question 10

What is observed about the pelvic limb on dynamic assessment?

Answer 10

• Assess position when walking away
• Head position- hip hike (vertically when lame leg in stance phase), head will drop when lame leg in stance phase
• Short stance on lame
• Fast swing on non-lame leg