Orthopedic Examination Flashcards
1
Q
What exams should you do for canine lameness and mobility assessment
A
-Subjective gait analysis
-Objective gait analysis
-Ortho exam
-Neuro exam
-Rehab exam
-Myofascial exam
2
Q
What diagnostics can you do for for canine lameness and mobility assessment
A
-Rads
-Ultrasound
-CT
-Joint blocks
others: MRI, PETCT, Arthroscopy
3
Q
What differential do you think of with a dog <1.5 years with a forelimb lameness
A
OCD/ ED
4
Q
What differential do you think of with a dog >7year with a forelimb lameness
A
OSA
5
Q
What body part is typically the cause of forelimb lameness in agility dogs
A
digits
6
Q
What body part is typically a cause of forelimb lameness in hunting dogs
A
shoulders
7
Q
What is your #1 differential for GSD with forelimb lameness
A
panosteitis
8
Q
What is your #1 differential for a Rottweiler with forelimb lameness
A
OSA
9
Q
What is your #1 differential for a lab with forelimb lameness
A
ED
10
Q
T/F: chronic tendinopathies is chronic and progressive
A
False - chronic, intermittent
11
Q
T/F: arthritis is chronic and slowly progressive
A
True
12
Q
What do you think of with acute improving forelimb lameness
A
1st or 2nd degree sprain/ strain
13
Q
What do you think of with acute, severe persistent forelimb lameness
A
fracture, luxation
14
Q
What do you think of with acute forelimb lamnesness with chronic history
A
pathologic fracture
exacerbation of OA
15
Q
T/F: never ask owner if they are favoring a leg
A
True
16
Q
When circiling dogs, what leg get exacerbated
A
the inside leg
17
Q
what is the scale of lameness
A
0-5
18
Q
Name the lameness degree:
no identifiable lameness
weight bearing at all times
A
0 (None)
19
Q
Name the lameness degree:
always non-weight bearing/toe touching
A
5 (non-weight bearing)
20
Q
Name the lameness degree:
inconistent lameness that is difficult to observe and/or is difficult to determine the affected limb (ie no consistent head movement/pelvic tilt is observed)
weight bearing at all times
A
1 (Slight)
21
Q
Name the lameness degree:
clearly detactable lameness associated with obvious head movement / pelvic tilt
ocassionally non-wright bearing / toe touching
A
4 (severe)
22
Q
Name the lameness degree:
clearly detectable lameness associated with obvious head movement / pelvic tilt
weight bearing at all ties
A
3 (moderate)
23
Q
Name the lameness degree:
clearly detectable lameness associated with minor head movement / pelvic tilt
weight bearing at all times
A
2 (mild)
24
Q
Once the animal occassionally becomes non-weight bearing / toe touching the lameness score is
A
4 or greater
25
What is the difference between score 2 (mild) and score 3 (moderate) lameness
both are weight bearing at all times
mild: minor head movement / pelvic tilt
moderateL obvious head movement / pelvic tilt
26
How should you walk a dog for a gait analysis
walk/ trot dog on loose lead to avoid pulling on lead
avoid distractions (ie grass / doggie mailboxes)
watch from:
1) front/back
2) side
3) All gaits?
27
In a trot, what will you see in an animal with a forelimb lameness
Head nod or bob
*Head moves up from neutral when lame leg hits the ground
... to decrease weight placed on the sore leg
body weight distrubyted away from lame leg ... may result in head bob for HL lameness
28
With forelimb lameness, why does the head move up from neutral when the lame leg hits the ground
to decrease the weight placed on the sore leg
29
What is a hip hike
on pelvic limb lameness there is excess pelvic movement to decrease weight placed on the sore leg
-Pelvis rotates away from lame pelvic limb and towards the normal limb ... greater movement rather than absolute heigh more relevate
30
How does the tail move with pelvic limb lameness
excess tail movement to change weight bearing
up when affected limb on ground
31
When the affected pelvic limb hits the ground, what does the tail do
tail is up when the affected limb on ground
32
With pelvic limb lameness, the pelvis rotates
away from the lame pelvic limb and towards the normal limb
greater movement rather than absolute height more relevant
33
T/F: combined fore and pelvic limb lameness is difficult to assess
true- need to tell prmary vs compensatory
34
If you see a dog is lame in the back leg and they have a head bob, it is more likely to be primary forelimb lameness if:
***
1) Head bob without forward shift
2) Head bob persists in walk (walk = 4 beat)
3) No hip hike or changes in stride length of pelvic limbs
4) off-loading during stance (putting weight in forelimbs)
35
Why will you not get a head bob from a hindlimb lameness in a walk
bc all of the limbs hit the grounds
therefore, it is more likely to be a primary forelimb lameness if the head bob persists in a walk (4 beat gait)
36
What does a head bob without forward shift tell you
that it is more likely to be a primary forelimb lameness
37
two beat "lateral couplet symmetrical gait in which ipsilateral limb pairs move in synchrony
Pace
38
Pacing can be _______ or _________
pacing can be normal or induced by leash-walking
39
You see upward movement of the head in the trot during stance phase of the left thoracic limb. How do you tell the left thoracic limb is affected
1) Head lowers during stance phase of RIGHT thoracic limb
2) Animal places more weight on right thoracic limb to unload left thoracic limb
40
You see upward movement of the head in the trot during stance phase of the left thoracic limb. How do you tell the left pelvic limb is affected
1) Head lowers during stance phase of left pelvic limb
2) Animal places more weight on right thoracic limb to unload left pelvic limb
41
You see upward movement of the head in the trot during stance phase of the right thoracic limb. How do you tell the right thoracic limb is affected
1) Animal palces more weight on left thoracic limb to unload right thoracic limb
2) Head lowers during stance of left thoracic limb
42
You see upward movement of the head in the trot during stance phase of the right thoracic limb. How do you tell the right pelvic limb is affected
1) Animal places more weight on left thoracic limb to unload right pelvic limb
2) Head lowers during stance phase of right pelvic limb
43
______ is diagonal gait while ______ is lateral gait
Trot: diagonal
Pacing: lateral
44
In a trot, right pelvic limb lameness might be confused with
right thoracic limb lameness
animal places more weight on left thoracic limb to unload the right pelvic limb
this causes the head to lower during stance phase of left thoracic item
45
In a pace, right pelvic limb lameness might be confused with
left thoracic limb lameness
animal places more weight on right thoracic limb to unload right pelvic limb
head lowers during stance phase of right thoracic limb
may be confused with left thoracic limb lameness
46
How do you distinguish a grade 1 from 2 lameness
grade 2 is consistent
grade 1 is intermittent
47
Your neuro exam should always include what
1) Assessment of CP
2) Paraspinal palpation
3) Tail-lift, rectal exam (pelivc limb lameness)
4) Neck ROM/ pain/ axillary pain (forelimb lameness)
5) Cranial nerves / anisocoria (forelimb lameness)
48
What orthopedic and neurologic diseases often present together
1) OA and neurological disease
2) Humeral fracture and brachial plexus avulsion
3) Shoulder OA and brachial plexus tumors
tools that help: history, gait, neuro/ortho exam
49
incoordination of the gait that implies neurological cause
ataxia
1) Vestibular
2) Cerebellar
3) Proprioceptive (spinal)
49
What are the 3 reasons for abnormal gait
1) Gait controllers (neuro): UMN and LMN systems that control gait and locomotion
neurological in orign
2) Pain (ortho or neuro)
-abnormal gait in response to (or compensation for0 pain
-pain can be from OA or prolapsed disc
3) Mechanical = neuromuscular / ortho
-abnormal gait due to loss of a mechanical appartus
luxating patella, fibrotic contracture, malunion
50
Weakness could be
1) Neurological
2) Systemic
3) Mechanical
51
lameness is nociceptive and may be caused by
1) Orthopedic
2) Neurological
3) Muscle
52
How do you distinguish neurogenic muscle atrophy from disuse atrophy
Neurogenic is rapid
53
What might mechanically effect reflexes
contractures / fibrosis
54
3 kinds of ataxia
1) Vestibular
2) Cerebellar
3) Proprioceptive (spinal) - looks like ortho disease (ie hip dysplasia)
55
How might you distinguish proprioceptive ataxia from ortho disease
Neuro is irregularly irregular (random, not predictable as it is a problem with the gait controllers)
56
You have a gait that is regularly irregular
(rhythmic and predictable) what might be the general cause
Neuro or ortho
compensation for nociception or mechanical
57
Toe nails wear in patients with
neurologic disease
(not mutually exclusive)
58
Do a standing exam if
Do recumbent exam if
standing: quicker and comparative
recumbent: if abnormality detected
59
What should you observe when palpating the long bones
Neoplasia
Panosteitis
Fractures
Fissures
60
What should you observe for when palpating muscles/ tendons
tears, pain, atrophy, swelling
61
What should you observe when palpating joints
Hyperflexion
Extension
Medial
Lateral stability
62
large motion of joint itself
e.g flexion/extension
one aspect of PROM
Osteokinematics
63
small motion at joint surface
e.g accessory motion (drawer)
=joint play
Arthrokinematics
64
Passive range of motion testing consists of what two things
1) End-feel: what is limiting range of motion
A. elastic (muscle or tendon)
B. bony (osteophytes/OA)
C. Capsular = thickened joint capsule
D. Muscle spasm = muscle pain
2) Goniometry: flexion, extension, abduction, rotation
65
What 4 things might limit ROM (end feel)
A. elastic (muscle or tendon)
B. bony (osteophytes/OA)
C. Capsular = thickened joint capsule
D. Muscle spasm = muscle pain
66
PROM testing determines
1) whether joint ROM is abnormal
2) which tissue type restricts ROM
can help determine appropriate subsequent diagnostic steps
PROM tests end-feel and gonio
67
With should passive range of motion, you get a shoulder PROM of 140 degrees (normal is 160 degrees) indicating decreased extension
the end-feel is elastic, indicating muscle pathology. What is the cause
pathology of muscles that restruct shoulder extension
-Deltoids
-Infraspinatus
-Latisimus dorsi
68
What muscles inhibit shouder flexion
Supraspinatus
Biceps brachii
69
What does flexibility testing evaluate
muscle extensibility = stretching; passive elongation with manual force
determines which muscle to investigate further
70
How do you distinguish PROM from flexibility
PROM: muscles on slack
Flexibility: muscle stretched
71
How do you do flexibility testing
1) lateral recumbency
2) kneed to know origin and insertion and concentric action of muscle
3) Perform opposite of concentric action of muscle
4) Observe: amount of flexibility, patients response (pain, muscle spasm, etc)
Increased = rupture
Decreased = contracture
Painful = infallmation
72
What does increased flexibility testing indicate
rupture
73
What does decreased flexibility testing indicate
contracture
74
Ortho exam should always include what
Neurologic exam
1) Assessment of CP
2) Paraspinal palpation
3) Tail-lift, rectal exam (hindlimb lameness)
4) Neck ROM/pain/axillary pain (forelimb lameness)
5) Cranial nerves/anisocoria (forelimb lameness)
75
What is the typical signalment of shoulder disease
OCD- young dog
MSI - middle aged
Biceps- any age
Neoplasia - old dog
76
How do vascular tendons differ from avascular
Vascular: short large tendons (triceps, achilles)
Have paratenon (lloose connective tissue with blood vessels)
better healing ability
vascular (sheathed): long, fine tendons (digital flexors, biceps)
vessels penetrate tendon sheath- hypovascular
healing capacity is diminished and they can retract in tendon sheath
77
strains are injury to the
muscle tendon unit
78
supports and stabilizes joints
injuries = sprains
ligaments
79
Degrees of soft tissue injury
1) Hemorrhage but intact fibers (contusion-bruise)
2) Hemorrhage + partial fiber disruption (variable elongation)
3) Complete rupture or avulsion of attachments
80
How do you diagnose soft tissue injury
1) Radiographs- osseous disease and soft tissue calcificiation
2) Ultrasound: muscle/tendon +/- meniscus
3) CT: best osseous detail to see calcification but not ideal for muscle/tendon injury
4) MRI: great for soft tissue (shoulder, muscle disease +/- cartilage
5) Bone scan: lesion localization but not diagnosis
6) PET-CT: physiologic function
7) Arthroscopy: good for cartilage eval
81
Whats a simple starting dose of omega-3 fatty acids
100mg/kg
82
