Orthopeadic exam Flashcards
What should you order of assessment be in an lameness assessment?
Signalment and presenting complaint History Gait examination Physical exam Differential diagnosis and diagnostic plan Ancillary aids to diagnose
What should you look at when observing the signalment and presentation complaint during an orthopaedic exam?
Breed
sex
age
What should you ask in the history during a lameness exam?
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
What should you assess when observing an animals gait?
Look for a shortening stride Head bobbing Good leg will move faster Abnormal joint movement scuffing nails ataxia neurological disease
What is ataxia?
pelvic limb inco-ordination
What is paraperesis?
Neurological deficits but motor function present
What is paraplegia?
Neurological deficits no motor function
How may stifle pain present during gait evaluation?
Limb may be circumducted (swung out from the body)
How may hip pain present of gait evaluation?
lateral sway of the spine
bunny hopping
How may thoracic limb lameness present?
Bobbing motion of the head is observed sink on the sound side when the dog throws weight onto good leg
Name the 10 stages of lameness grading
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
What should you observe when looking at a patients stance in an ortho exam?
Symmetry paw taking the most weight will be flatter outward/inward pointing of the paw Frequent sitting pelvic limb Frequent lying down forelimb
What is a kyphotic stance?
Back curved upwards
shifting weight from pelvic limbs to thoracic limbs
What is scoliosis stance?
Lateral curvature of the spine
shifting weight onto the one side
What should you always do when assessing an orthopeadic case?
Full physical exam
List the order you would complete a physical exam in a orthopeadic patient?
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
When assessing joints what should you assess for?
Swelling Pain (at extreme range of motion) Instability (apply varus and valgus) Range of motion (extension and flexion) Manipulation (assess for crepitus or clunking)
Which diseased joint is more painful in flexion than extension?
Carpus
All others mostly painful on extension
When examining limbs what should you assess?
Swelling
Muscle atrophy
Pain
How should you complete a neuro exam during an orthopaedic examination?
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)
What is the cranial draw test and how is it preformed?
Test of stifle stability and CCL rupture
secure the distal femur and proximal tibia try to advance tibia cranially whilst keeping the femur still
What is the tibial thrust test and how is it preformed?
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
What test would you do to assess for patella luxation?
Have the stifle extended
Quadriceps relaxed
try and move the patella in either a medial or lateral direction
What would you use to test hip laxity?
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
What should be done at the end of an orthopaedic examination?
Localise the lameness to a leg or joint
form differential diagnosis
What could be the differential diagnosis to lameness?
Vascular idiopathic infection trauma autoimmune metabolic nutrtional/neoplasia degenerative congenital
what ancillary aids can you use to diagnose lameness?
Radiography CT ultrasound MRI arthrocentesis EMG
Which joints should you tap?
if systemic 3-6 joints
if only one affected aspirate that joint and the contralateral joint
Which joints can you palpate and effusion?
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
How should you prepare for an arthrocentesis?
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
What equipment do you need for arthrocentesis?
Sterile hypodermic/spinal needles (20-25G)
5ml syringe
What is a normal amount of joint fluid to collect?
0.05-0.3ml
