Orthopeadic exam

Question 1

What should you order of assessment be in an lameness assessment?

Answer 1

Signalment and presenting complaint 
History 
Gait examination 
Physical exam 
Differential diagnosis and diagnostic plan 
Ancillary aids to diagnose

Question 2

What should you look at when observing the signalment and presentation complaint during an orthopaedic exam?

Answer 2

Breed
sex
age

Question 3

What should you ask in the history during a lameness exam?

Answer 3

how long has it being going on for 
which limb 
worse when rest 
worse when exercised 
gradually worsening 
static complaint 
gradually getting better 
any trauma
medication
onset acute or gradual 
Continuous or intermittent
Altered by ground surface 
working dog 
any concurrent issues

Question 4

What should you assess when observing an animals gait?

Answer 4

Look for a shortening stride
Head bobbing 
Good leg will move faster
Abnormal joint movement 
scuffing nails 
ataxia 
neurological disease

Question 5

What is ataxia?

Answer 5

pelvic limb inco-ordination

Question 6

What is paraperesis?

Answer 6

Neurological deficits but motor function present

Question 7

What is paraplegia?

Answer 7

Neurological deficits no motor function

Question 8

How may stifle pain present during gait evaluation?

Answer 8

Limb may be circumducted (swung out from the body)

Question 9

How may hip pain present of gait evaluation?

Answer 9

lateral sway of the spine

bunny hopping

Question 10

How may thoracic limb lameness present?

Answer 10

Bobbing motion of the head is observed sink on the sound side when the dog throws weight onto good leg

Question 11

Name the 10 stages of lameness grading

Answer 11

0 sound
1 occasionally shifts weight
2. Mild lameness at a slow trot, non whilst walking
3. lameness at a trot and walking
4 obvious lameness whilst walking, places foot whilst standing
5-8 degrees of severity
9- Places toe when standing, carrier limb when trotting
10-unable to weight bear

Question 12

What should you observe when looking at a patients stance in an ortho exam?

Answer 12

Symmetry 
paw taking the most weight will be flatter
outward/inward pointing of the paw
Frequent sitting pelvic limb 
Frequent lying down forelimb

Question 13

What is a kyphotic stance?

Answer 13

Back curved upwards

shifting weight from pelvic limbs to thoracic limbs

Question 14

What is scoliosis stance?

Answer 14

Lateral curvature of the spine

shifting weight onto the one side

Question 15

What should you always do when assessing an orthopeadic case?

Answer 15

Full physical exam

Question 16

List the order you would complete a physical exam in a orthopeadic patient?

Answer 16

Palpate the standing animal
(asymmetry, swelling, muscle atrophy, joint enlargement, abnormal conformation)
Examine the animal in lateral recumbency
(Start at the toes work proximaly, examine all four limbs)
Examine the unaffected limb first

Question 17

When assessing joints what should you assess for?

Answer 17

Swelling 
Pain (at extreme range of motion)
Instability (apply varus and valgus)
Range of motion (extension and flexion) 
Manipulation (assess for crepitus or clunking)

Question 18

Which diseased joint is more painful in flexion than extension?

Answer 18

Carpus

All others mostly painful on extension

Question 19

When examining limbs what should you assess?

Answer 19

Swelling
Muscle atrophy
Pain

Question 20

How should you complete a neuro exam during an orthopaedic examination?

Answer 20

palpate the whole spine and neck
palpate the lumbosacral junction and manipulate the base of the tail
exam conscious proprioception
spinal reflexes (patella withdrawal, perineal reflexes)

Question 21

What is the cranial draw test and how is it preformed?

Answer 21

Test of stifle stability and CCL rupture

secure the distal femur and proximal tibia try to advance tibia cranially whilst keeping the femur still

Question 22

What is the tibial thrust test and how is it preformed?

Answer 22

Alternative test for cranial cruciate ligament rupture
easier to do in larger dogs than the cranial draw.
place on hand on the cranial aspect of the distal femur
place your first finger on the tibial tuberosity
place another hand on the foot
Keep the stifle still and attempt to flex the hock
Tibial tuberosity will move cranially if ruptured

Question 23

What test would you do to assess for patella luxation?

Answer 23

Have the stifle extended
Quadriceps relaxed
try and move the patella in either a medial or lateral direction

Question 24

What would you use to test hip laxity?

Answer 24

ortolani test
Dogs should be anaesthetised
Positon femur perpendicular to the spine
grasp the stifle and place ventral pressure down the femur to sub-luxate the hip
slowly abduct the limb until palpable click is felt (angle of reduction)
adduct the limbs until the hip reluxates (anlge of luxation)
Angles are useful in determining dogs suitability for surgery

Question 25

What should be done at the end of an orthopaedic examination?

Answer 25

Localise the lameness to a leg or joint

form differential diagnosis

Question 26

What could be the differential diagnosis to lameness?

Answer 26

Vascular 
idiopathic 
infection 
trauma 
autoimmune
metabolic
nutrtional/neoplasia 
degenerative 
congenital

Question 27

what ancillary aids can you use to diagnose lameness?

Answer 27

Radiography 
CT 
ultrasound 
MRI 
arthrocentesis 
EMG

Question 28

Which joints should you tap?

Answer 28

if systemic 3-6 joints

if only one affected aspirate that joint and the contralateral joint

Question 29

Which joints can you palpate and effusion?

Answer 29

Carpal (cranial)
Elbow (Convex buldge between olcecranon and lateral epicondyle)
Stifle (either side patella ligament)
Hock (slight buldge cranially or caudally)
Shoulder/hip no swelling palpable

Question 30

How should you prepare for an arthrocentesis?

Answer 30

Patient GA?sedated
Lateral recumbency
clip and prepare site, aseptic technique
Introduce needle into joint
Apply negative pressure without moving the needle
No fluid release and re-direct.
Once fluid is obtained release pressure then remove needle
make a smear
EDTA fo cell count and protein level
Blood culture bottle

Question 31

What equipment do you need for arthrocentesis?

Answer 31

Sterile hypodermic/spinal needles (20-25G)

5ml syringe

Question 32

What is a normal amount of joint fluid to collect?

Answer 32

0.05-0.3ml