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Advanced Clinical Nursing Theory > Orthopedic Exam > Flashcards

Orthopedic Exam Flashcards

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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

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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)

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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

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4
Q

what is the purpose of taking history?

A

may guide to problem and severity

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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

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6
Q

what conditions are often worse after rest?

A

OA

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7
Q

what conditions are often worse after exercise?

A

tendon / muscle

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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

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9
Q

define varus

A

foot aligned medially in relation to limb

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10
Q

define valgus

A

foot aligned laterally in relation to limb

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11
Q

what is pointing?

A

foot is on the floor but little weight is being put through it

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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

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13
Q

what is being looked for during gait evaluation?

A

stride length
head nodding
scuffing of nails
ataxia, paraparesis or paraplegia

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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

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15
Q

during an ortho exam what must be considered?

A

is there potential for neuro issue rather than ortho or both!

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16
Q

when is bunny hopping often seen?

A

hip issues, weight is spread between both legs

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17
Q

what can be useful in gait evaluation?

A

videos of the animal at home

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18
Q

how may lameness be graded?

A

0-10 scale

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19
Q

what is lameness grade 0?

A

sound

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20
Q

what is lameness grade 1?

A

occasionally shifts weight

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21
Q

what is lameness grade 2?

A

mild lameness at slow trot, none while walking

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22
Q

what is lameness grade 3?

A

mild lameness while walking

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23
Q

what is lameness grade 4?

A

obvious lameness while walking, places foot when standing

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24
Q

what is lameness grade 5-8?

A

degree of severity between 4 and 9

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25
Q

what is lameness grade 9?

A

places toe when standing carries limb when trotting

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26
Q

what is lameness grade 10?

A

unable to weightbear

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27
Q

what is the issue with grading lameness?

A

very subjective, can be ambiguous

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28
Q

what must be performed on every patient regardless of presenting complaint?

A

full clinical exam to check for additional / more severe issues

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29
Q

what is involved in the orthopedic physical exam?

A

palpation of standing animal
joint palpation
limb palpation
neuro exam
cranial draw
tibial thrust
patella luxation
ortolani test

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30
Q

what should be palpated while the animal is standing during the ortho exam?

A

muscles
limbs
joints
spine

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31
Q

what are you looking for during palpation during the ortho exam?

A

asymmetry
swelling
muscle atrophy
joint enlargement
abnormal confirmation

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32
Q

what is the issue with comparing contralateral limbs/joints?

A

some disease is bilateral so may feel symmetrical but both are abnormal

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33
Q

what should be assessed when palpating joints?

A

SPIRM

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34
Q

what does SPIRM stand for?

A

swelling (effusion)
pain on movement
instability
range of motion
manipulation

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35
Q

what is being assessed about joint range of motion?

A

is it reduced

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36
Q

what is assessed about manipulation of joints?

A

any crepitus

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37
Q

what should be assessed about limbs during the ortho exam?

A

any swelling
muscle atrophy
pain

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38
Q

what is a key screening step in the ortho exam?

A

neuro exam

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39
Q

what should be involved in the screening neuro exam component of the ortho exam?

A

palpation of spine, neck and LS
conscious proprioception
spinal reflexes (withdrawal, patella and perineal)

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40
Q

what should be done if abnormalities are seen in the screening neuro exam component of the ortho exam?

A

full neuro exam needed

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41
Q

when is a cranial draw test usually performed?

A

under sedation or GA due to tension

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42
Q

what does the cranial draw test, test?

A

integrity of cranial cruciate ligament

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43
Q

what position does the patient need to be in for the cranial draw test?

A

lateral recumbancy

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44
Q

how is the cranial draw test performed?

A

hold femur and tibia
try to move tibia cranially with respect to the femur
repeat with stifle at different angles of flexion or extension

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45
Q

what is indicated by movement during cranial draw test?

A

rupture of cranial cruciate ligament
degree of draw can indicate degree of rupture

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46
Q

when can a tibial thrust test be performed?

A

standing or under sedation/GA

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47
Q

what is a tibial thrust test also known as?

A

tibial compression test

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48
Q

what is tested by tibial thrust test?

A

cranial cruciate ligament integrity

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49
Q

how is a tibial thrust test performed?

A

hand over distal femur
first finger on tibial tuberosity other hand on foot
keep stifle still whilst flexing the hock

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50
Q

what will indicate ligament rupture on a tibial thrust test?

A

tibial tuberosity will displace cranially if cranial cruciate ligament ruptured

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51
Q

what direction does the patella most commonly luxate in dogs and cats?

A

medial

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52
Q

what position should the stifle be in to assess patella luxation?

A

extended with quadriceps relaxed

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53
Q

how is patella luxation assessed?

A

shifting of patella medially and laterally

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54
Q

how can the patella be located?

A

work proximally from tibial tuberosity

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55
Q

what animals can the patella be difficult to locate in?

A

small dogs

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56
Q

what does the ortolani test assess?

A

hip laxity and so hip dysplasia

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57
Q

what is mimicked by the ortolani test?

A

weight bearing

58
Q

what position should the patient be in for the ortolani test?

A

dorsal

59
Q

how is the ortolani test performed?

A

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
Q

what is demonstrated by the hip clicking on abduction during the ortolani test?

A

angle of reduction

61
Q

what is demonstrated by the hip clicking on adduction during the ortolani test?

A

angle of subluxation

62
Q

during the ortolani test what happens when the hips are abducted?

A

hip reduces

63
Q

during the ortolani test what happens when the hips are adducted?

A

hip subluxates

64
Q

what should be established at the end of the ortho exam?

A

localisation of lameness to a leg/legs and joint
differential diagnosis list

65
Q

what can be used to diagnose orthopedic disease following ortho exam?

A

diagnostic imaging (US, xray, CT, MRI)
arthrocentesis
EMG

66
Q

what is EMG useful for?

A

muscles
neuro issues

67
Q

where can joint fluid be obtained from?

A

most diarthrodial joints

68
Q

why is arthrocentesis so important?

A

is the only diagnostic tool for some diseases

69
Q

what are the indications for joint tap?

A

persistent or cyclical pyrexia
lameness localised to a joint
joint swelling

70
Q

what joint should be tapped if a systemic issue is suspected?

A

3-6 joints

71
Q

what joints should be tapped if only one joint affected?

A

affected joint
contralateral joint

72
Q

how should the patient be restrained for arthrocentesis?

A

anaesthetised or sedated
unless unwell or large effusion where it may be possible conscious or under local

73
Q

what position does the patient need to be in for arthrocentesis?

A

lateral

74
Q

how should the area be prepared for arthrocentesis?

A

strict asepsis
clip large area
clean with chlorhexidine or iodine
finish with surgical spirit

75
Q

what should be worn when preparing for and performing arthrocentesis

A

gloves

76
Q

what equipment is needed for arthrocentesis?

A

gloves
fenestrated drape
sterile hypodermic needles
sterile spinal needles
2-5ml syringe

77
Q

what needle sizes may be needed for arthrocentesis?

A

20-25G

78
Q

what needle lengths may be needed for arthrocentesis?

A

5/8” to 2.5” depending on site

79
Q

what does needle length for arthrocentesis depend on?

A

distance of joint from surface

80
Q

what can be used to guide the needle during arthrocentesis?

A

bony landmarks
use articulated skeleton as guide if available

81
Q

what is crucial when obtaining arthrocentesis samples?

A

do not move needle while aspirating

82
Q

what is the consequence of moving the needle while aspirating during arthrocentesis?

A

aspiration of blood from soft tissues contaminating sample

83
Q

what will streaks of blood in arthrocentesis sample indicate?

A

iatrogenic contamination

84
Q

what will joint fluid with even pink colour indicate?

A

real change and indicates haemorrhage not contamination

85
Q

what should be done with joint fluid after aspiration?

A

EDTA for cytology
make a smear
plain pot for protein
blood culture if infection is differential

86
Q

what should be done if there is very little joint fluid collected?

A

make a smear

87
Q

what should joint fluid samples not be stored in?

A

formalin

88
Q

why should joint fluid samples not be stored in formalin?

A

does not preserve cell architecture

89
Q

what is abnormal joint fluid like?

A

increased volume
reduced viscosity

90
Q

why is there increased volume and reduced viscosity in abnormal joint fluid?

A

dilution of joint fluid with serum

91
Q

what amount of joint fluid should be obtained from a healthy joint?

A

<0.2ml (needle hub full)

92
Q

what should you provide information about on the lab form for arthrocentesis samples?

A

volume
viscosity
iatrogenic blood contamination

93
Q

what should synovial fluid be like normally?

A

viscous
clear
small volume

94
Q

define arthrocentesis

A

surgical puncture and aspiration of a joint

95
Q

what size syringe is advisable for arthrocentesis of scapulohumeral joint?

A

5ml

96
Q

what length needle is advisable for arthrocentesis of scapulohumeral joint?

A

1.5-2.5”

97
Q

what guage needle is advisable for arthrocentesis of scapulohumeral joint?

A

20-21G spinal needle

98
Q

what can be used to assess needle length for aspiration of scapulohumeral joint?

A

radiograph

99
Q

where is the needle placed for arthrocentesis of scapulohumeral joint?

A

distal to acromion
slightly perpendicular and dorsomedial

100
Q

what should be done if bone is felt during arthrocentesis of scapulohumeral joint?

A

withdraw slightly and aim more distal or proximal

101
Q

what can help to open up the shoulder joint during arthrocentesis of scapulohumeral joint?

A

gentle traction by assistant

102
Q

what size syringe is advisable for arthrocentesis of cubital (elbow) joint?

A

5ml

103
Q

what length needle is advisable for arthrocentesis of cubital (elbow) joint?

A

1-1.5”

104
Q

what gauge needle is advisable for arthrocentesis of cubital (elbow) joint?

A

23G

105
Q

how is arthrocentesis of cubital (elbow) joint performed?

A

flex elbow to 45-90 degrees

106
Q

where is the needle directed during arthrocentesis of cubital (elbow) joint?

A

level and perpendicular to epicondular crest alongside anconeal process

107
Q

what may abnormal joint fluid look like?

A

increased volume
lower viscosity
colour change

108
Q

what size syringe is advisable for arthrocentesis of carpal joint?

A

2-5ml

109
Q

what length needle is advisable for arthrocentesis of carpal joint?

A

5/8ths” as close to surface

110
Q

what gauge needle is advisable for arthrocentesis of carpal joint?

A

23-25G

111
Q

how is arthrocentesis of carpal joint performed?

A

flex carpus to 90 degrees to open joint space
insert needle perpendicular to skin
aspirate all joints

112
Q

what must be avoided during arthrocentesis of carpal joint?

A

neurovascular bundle on dorsal surface of carpus

113
Q

what size syringe is advisable for arthrocentesis of MCP/MTP/IP joints?

A

1-2ml

114
Q

what length needle is advisable for arthrocentesis of MCP/MTP/IP joints?

A

5/8”

115
Q

what gauge needle is advisable for arthrocentesis of MCP/MTP/IP joints?

A

25G spinal needle

116
Q

what else must be considered about arthrocentesis of MCP/MTP/IP joints?

A

short bevel needle to ensure whole needle tip is in the joint space to avoid contamination of sample

117
Q

what size syringe is advisable for arthrocentesis of coxofemoral joints?

A

5-10ml

118
Q

what length needle is advisable for arthrocentesis of coxofemoral joints?

A

1.5-2.5”

119
Q

what gauge needle is advisable for arthrocentesis of coxofemoral joints?

A

20G

120
Q

what can be used to assess needle length for arthrocentesis of coxofemoral joints?

A

VD radiograph

121
Q

where is the needle inserted for arthrocentesis of coxofemoral joints?

A

craniodorsal to greater trochanter
angled medially and caudoventrally

122
Q

how can the hip joint be opened for arthrocentesis of coxofemoral joints?

A

hip abducted and internally rotated

123
Q

what size syringe is advisable for arthrocentesis of stifle joints?

A

5ml

124
Q

what length needle is advisable for arthrocentesis of stifle joints?

A

1-1.5”

125
Q

what gauge needle is advisable for arthrocentesis of stifle joints?

A

21-23G

126
Q

what position should the stifle be in for arthrocentesis of stifle joints?

A

partially flexed

127
Q

where is the needle inserted for arthrocentesis of stifle joints?

A

lateral to patella ligament midway between the patella and tibial tuberosity angled caudomendially until hits bone

128
Q

how can the femoropatella joint be accessed for arthrocentesis?

A

stifle extended

129
Q

where is the needle placed for arthrocentesis of the femoropatella joint?

A

angle between the patella and femur porximally

130
Q

what is the negative of arthrocentesis of the femoropatella joint?

A

risk iatrogenic damage to articular cartilage

131
Q

what is a benefit of arthrocentesis of the femoropatella joint?

A

avoids passing needle through stifle fat pad which can impede aspiration of fluid

132
Q

what size syringe is advisable for arthrocentesis of tarsal joints?

A

2.5-5ml

133
Q

what length needle is advisable for arthrocentesis of tarsal joints?

A

5/8”-1”

134
Q

what gauge needle is advisable for arthrocentesis of tarsal joints?

A

23-25G

135
Q

how is the joint positioned for arthrocentesis of tarsal joints?

A

partially flexed

136
Q

how is the needle inserted for arthrocentesis of tarsal joints?

A

needle angled perpendicular to the skin into the joint
palpation and manipulation of joint to assess articulation

137
Q

where can fluid be obtained from during arthrocentesis of tarsal joints?

A

craniolateral
caudolateral
depends on swelling location

138
Q

what can be done with effusion in the tarsal joint to make aspiration easier?

A

push it across to needle site

139
Q

what must you do before removing the needle from the joint?

A

release negative pressure

140
Q

describe the process of arthrocentesis for an average dog

A

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
Q
A

Advanced Clinical Nursing Theory (36 decks)

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