Orthopedic Exam Flashcards
1
Q
what are the main sections involved in the ortho consultation?
A
signalment and presenting complaint
history
gait exam
physical exam
differential diagnosis
diagnostic plan
aids to diagnosis
arthrocentesis
2
Q
what may signalment suggest about reasons for lameness?
A
breed tendencies
age (is there a genetic disorder)
sex (less crucial - roaming in cats)
3
Q
why is it important to consider signalment?
A
can help to point towards potential causes / disease
considering these alongside lifestyle is also useful
4
Q
what is the purpose of taking history?
A
may guide to problem and severity
5
Q
what questions should be asked when taking history for an orthopedic patient?
A
medication
duration of lameness
speed of onset
progression of issue
is it continuous or intermittent
is the issue worsened by exercise or rest
effect of ground surface
which limbs
occupation
any concurrent disease
6
Q
what conditions are often worse after rest?
A
OA
7
Q
what conditions are often worse after exercise?
A
tendon / muscle
8
Q
what should be assessed about a patients stance during an ortho exam?
A
symmetry of stance
even weight bearing on all limbs
angular deformity
9
Q
define varus
A
foot aligned medially in relation to limb
10
Q
define valgus
A
foot aligned laterally in relation to limb
11
Q
what is pointing?
A
foot is on the floor but little weight is being put through it
12
Q
what is involved in gait evaluation?
A
evaluation at walk (on way into consult if severe)
if possible then at trot, on circle and up stairs
use different surfaces
13
Q
what is being looked for during gait evaluation?
A
stride length
head nodding
scuffing of nails
ataxia, paraparesis or paraplegia
14
Q
how does head nodding indicate lameness?
A
nod on sound leg as weight is shifted across
head up on lame leg to reduce weight through that limb
15
Q
during an ortho exam what must be considered?
A
is there potential for neuro issue rather than ortho or both!
16
Q
when is bunny hopping often seen?
A
hip issues, weight is spread between both legs
17
Q
what can be useful in gait evaluation?
A
videos of the animal at home
18
Q
how may lameness be graded?
A
0-10 scale
19
Q
what is lameness grade 0?
A
sound
20
Q
what is lameness grade 1?
A
occasionally shifts weight
21
Q
what is lameness grade 2?
A
mild lameness at slow trot, none while walking
22
Q
what is lameness grade 3?
A
mild lameness while walking
23
Q
what is lameness grade 4?
A
obvious lameness while walking, places foot when standing
24
Q
what is lameness grade 5-8?
A
degree of severity between 4 and 9
25
what is lameness grade 9?
places toe when standing carries limb when trotting
26
what is lameness grade 10?
unable to weightbear
27
what is the issue with grading lameness?
very subjective, can be ambiguous
28
what must be performed on every patient regardless of presenting complaint?
full clinical exam to check for additional / more severe issues
29
what is involved in the orthopedic physical exam?
palpation of standing animal
joint palpation
limb palpation
neuro exam
cranial draw
tibial thrust
patella luxation
ortolani test
30
what should be palpated while the animal is standing during the ortho exam?
muscles
limbs
joints
spine
31
what are you looking for during palpation during the ortho exam?
asymmetry
swelling
muscle atrophy
joint enlargement
abnormal confirmation
32
what is the issue with comparing contralateral limbs/joints?
some disease is bilateral so may feel symmetrical but both are abnormal
33
what should be assessed when palpating joints?
SPIRM
34
what does SPIRM stand for?
swelling (effusion)
pain on movement
instability
range of motion
manipulation
35
what is being assessed about joint range of motion?
is it reduced
36
what is assessed about manipulation of joints?
any crepitus
37
what should be assessed about limbs during the ortho exam?
any swelling
muscle atrophy
pain
38
what is a key screening step in the ortho exam?
neuro exam
39
what should be involved in the screening neuro exam component of the ortho exam?
palpation of spine, neck and LS
conscious proprioception
spinal reflexes (withdrawal, patella and perineal)
40
what should be done if abnormalities are seen in the screening neuro exam component of the ortho exam?
full neuro exam needed
41
when is a cranial draw test usually performed?
under sedation or GA due to tension
42
what does the cranial draw test, test?
integrity of cranial cruciate ligament
43
what position does the patient need to be in for the cranial draw test?
lateral recumbancy
44
how is the cranial draw test performed?
hold femur and tibia
try to move tibia cranially with respect to the femur
repeat with stifle at different angles of flexion or extension
45
what is indicated by movement during cranial draw test?
rupture of cranial cruciate ligament
degree of draw can indicate degree of rupture
46
when can a tibial thrust test be performed?
standing or under sedation/GA
47
what is a tibial thrust test also known as?
tibial compression test
48
what is tested by tibial thrust test?
cranial cruciate ligament integrity
49
how is a tibial thrust test performed?
hand over distal femur
first finger on tibial tuberosity other hand on foot
keep stifle still whilst flexing the hock
50
what will indicate ligament rupture on a tibial thrust test?
tibial tuberosity will displace cranially if cranial cruciate ligament ruptured
51
what direction does the patella most commonly luxate in dogs and cats?
medial
52
what position should the stifle be in to assess patella luxation?
extended with quadriceps relaxed
53
how is patella luxation assessed?
shifting of patella medially and laterally
54
how can the patella be located?
work proximally from tibial tuberosity
55
what animals can the patella be difficult to locate in?
small dogs
56
what does the ortolani test assess?
hip laxity and so hip dysplasia
57
what is mimicked by the ortolani test?
weight bearing
58
what position should the patient be in for the ortolani test?
dorsal
59
how is the ortolani test performed?
subluxate hips by pressing them down towards the back
abduct femurs and feel for click as hip reduces
then adduct hips and feel for second click as hip reluxates
60
what is demonstrated by the hip clicking on abduction during the ortolani test?
angle of reduction
61
what is demonstrated by the hip clicking on adduction during the ortolani test?
angle of subluxation
62
during the ortolani test what happens when the hips are abducted?
hip reduces
63
during the ortolani test what happens when the hips are adducted?
hip subluxates
64
what should be established at the end of the ortho exam?
localisation of lameness to a leg/legs and joint
differential diagnosis list
65
what can be used to diagnose orthopedic disease following ortho exam?
diagnostic imaging (US, xray, CT, MRI)
arthrocentesis
EMG
66
what is EMG useful for?
muscles
neuro issues
67
where can joint fluid be obtained from?
most diarthrodial joints
68
why is arthrocentesis so important?
is the only diagnostic tool for some diseases
69
what are the indications for joint tap?
persistent or cyclical pyrexia
lameness localised to a joint
joint swelling
70
what joint should be tapped if a systemic issue is suspected?
3-6 joints
71
what joints should be tapped if only one joint affected?
affected joint
contralateral joint
72
how should the patient be restrained for arthrocentesis?
anaesthetised or sedated
unless unwell or large effusion where it may be possible conscious or under local
73
what position does the patient need to be in for arthrocentesis?
lateral
74
how should the area be prepared for arthrocentesis?
strict asepsis
clip large area
clean with chlorhexidine or iodine
finish with surgical spirit
75
what should be worn when preparing for and performing arthrocentesis
gloves
76
what equipment is needed for arthrocentesis?
gloves
fenestrated drape
sterile hypodermic needles
sterile spinal needles
2-5ml syringe
77
what needle sizes may be needed for arthrocentesis?
20-25G
78
what needle lengths may be needed for arthrocentesis?
5/8" to 2.5" depending on site
79
what does needle length for arthrocentesis depend on?
distance of joint from surface
80
what can be used to guide the needle during arthrocentesis?
bony landmarks
use articulated skeleton as guide if available
81
what is crucial when obtaining arthrocentesis samples?
do not move needle while aspirating
82
what is the consequence of moving the needle while aspirating during arthrocentesis?
aspiration of blood from soft tissues contaminating sample
83
what will streaks of blood in arthrocentesis sample indicate?
iatrogenic contamination
84
what will joint fluid with even pink colour indicate?
real change and indicates haemorrhage not contamination
85
what should be done with joint fluid after aspiration?
EDTA for cytology
make a smear
plain pot for protein
blood culture if infection is differential
86
what should be done if there is very little joint fluid collected?
make a smear
87
what should joint fluid samples not be stored in?
formalin
88
why should joint fluid samples not be stored in formalin?
does not preserve cell architecture
89
what is abnormal joint fluid like?
increased volume
reduced viscosity
90
why is there increased volume and reduced viscosity in abnormal joint fluid?
dilution of joint fluid with serum
91
what amount of joint fluid should be obtained from a healthy joint?
<0.2ml (needle hub full)
92
what should you provide information about on the lab form for arthrocentesis samples?
volume
viscosity
iatrogenic blood contamination
93
what should synovial fluid be like normally?
viscous
clear
small volume
94
define arthrocentesis
surgical puncture and aspiration of a joint
95
what size syringe is advisable for arthrocentesis of scapulohumeral joint?
5ml
96
what length needle is advisable for arthrocentesis of scapulohumeral joint?
1.5-2.5"
97
what guage needle is advisable for arthrocentesis of scapulohumeral joint?
20-21G spinal needle
98
what can be used to assess needle length for aspiration of scapulohumeral joint?
radiograph
99
where is the needle placed for arthrocentesis of scapulohumeral joint?
distal to acromion
slightly perpendicular and dorsomedial
100
what should be done if bone is felt during arthrocentesis of scapulohumeral joint?
withdraw slightly and aim more distal or proximal
101
what can help to open up the shoulder joint during arthrocentesis of scapulohumeral joint?
gentle traction by assistant
102
what size syringe is advisable for arthrocentesis of cubital (elbow) joint?
5ml
103
what length needle is advisable for arthrocentesis of cubital (elbow) joint?
1-1.5"
104
what gauge needle is advisable for arthrocentesis of cubital (elbow) joint?
23G
105
how is arthrocentesis of cubital (elbow) joint performed?
flex elbow to 45-90 degrees
106
where is the needle directed during arthrocentesis of cubital (elbow) joint?
level and perpendicular to epicondular crest alongside anconeal process
107
what may abnormal joint fluid look like?
increased volume
lower viscosity
colour change
108
what size syringe is advisable for arthrocentesis of carpal joint?
2-5ml
109
what length needle is advisable for arthrocentesis of carpal joint?
5/8ths" as close to surface
110
what gauge needle is advisable for arthrocentesis of carpal joint?
23-25G
111
how is arthrocentesis of carpal joint performed?
flex carpus to 90 degrees to open joint space
insert needle perpendicular to skin
aspirate all joints
112
what must be avoided during arthrocentesis of carpal joint?
neurovascular bundle on dorsal surface of carpus
113
what size syringe is advisable for arthrocentesis of MCP/MTP/IP joints?
1-2ml
114
what length needle is advisable for arthrocentesis of MCP/MTP/IP joints?
5/8"
115
what gauge needle is advisable for arthrocentesis of MCP/MTP/IP joints?
25G spinal needle
116
what else must be considered about arthrocentesis of MCP/MTP/IP joints?
short bevel needle to ensure whole needle tip is in the joint space to avoid contamination of sample
117
what size syringe is advisable for arthrocentesis of coxofemoral joints?
5-10ml
118
what length needle is advisable for arthrocentesis of coxofemoral joints?
1.5-2.5"
119
what gauge needle is advisable for arthrocentesis of coxofemoral joints?
20G
120
what can be used to assess needle length for arthrocentesis of coxofemoral joints?
VD radiograph
121
where is the needle inserted for arthrocentesis of coxofemoral joints?
craniodorsal to greater trochanter
angled medially and caudoventrally
122
how can the hip joint be opened for arthrocentesis of coxofemoral joints?
hip abducted and internally rotated
123
what size syringe is advisable for arthrocentesis of stifle joints?
5ml
124
what length needle is advisable for arthrocentesis of stifle joints?
1-1.5"
125
what gauge needle is advisable for arthrocentesis of stifle joints?
21-23G
126
what position should the stifle be in for arthrocentesis of stifle joints?
partially flexed
127
where is the needle inserted for arthrocentesis of stifle joints?
lateral to patella ligament midway between the patella and tibial tuberosity angled caudomendially until hits bone
128
how can the femoropatella joint be accessed for arthrocentesis?
stifle extended
129
where is the needle placed for arthrocentesis of the femoropatella joint?
angle between the patella and femur porximally
130
what is the negative of arthrocentesis of the femoropatella joint?
risk iatrogenic damage to articular cartilage
131
what is a benefit of arthrocentesis of the femoropatella joint?
avoids passing needle through stifle fat pad which can impede aspiration of fluid
132
what size syringe is advisable for arthrocentesis of tarsal joints?
2.5-5ml
133
what length needle is advisable for arthrocentesis of tarsal joints?
5/8"-1"
134
what gauge needle is advisable for arthrocentesis of tarsal joints?
23-25G
135
how is the joint positioned for arthrocentesis of tarsal joints?
partially flexed
136
how is the needle inserted for arthrocentesis of tarsal joints?
needle angled perpendicular to the skin into the joint
palpation and manipulation of joint to assess articulation
137
where can fluid be obtained from during arthrocentesis of tarsal joints?
craniolateral
caudolateral
depends on swelling location
138
what can be done with effusion in the tarsal joint to make aspiration easier?
push it across to needle site
139
what must you do before removing the needle from the joint?
release negative pressure
140
describe the process of arthrocentesis for an average dog
5ml syringe and 23/21G needle
clip and aseptic prep of site
introduce needle and apply negative pressure with needle still
release pressure before withdrawing from joint
make smear and submit EDTA
141
