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Orthopedic Medicine > Small Animal Lameness Evaluation > Flashcards

Small Animal Lameness Evaluation Flashcards

1
Q

alteration of normal gait due to pain or mechanical dysfunction can be from pain, mechanical, or combination

A

Lameness

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2
Q

What are the different types of lameness

A

1) Pain: abnormal gait - as response to or compensation for pain (ie osteoarthritis)

2) Mechanical: abnormal gait due to loss of a mechanical apparatus (ie fibrotic contracture)

3) Combination- patellar luxation

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3
Q

What would be an example of lameness due to both pain and loss of mechanical apparatus

A

patellar luxation

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4
Q

When evaluating lameness in a dog, what should you consider regarding their signalment

A

1) Age
2) Sex and neuter status (females overrepresented for immune-mediated disease, intact male dogs over-represented for vehicular trauma)
3) Species/breed- german shephards, rottweilers, labradors
4) Job- agility (digits), hunting dogs (shoulders)

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5
Q

Do males or females more commonly get immune mediated diseases like IMPA

A

females

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6
Q

Are intact male or female dogs more likely to have vehicular trauma

A

intact male dogs

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7
Q

What breed commonly gets panosteitis

A

german shephard

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8
Q

What breed commonly gets osteosarcoma

A

rottweilers

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9
Q

What breed commonly gets elbow dysplasia

A

labradors

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10
Q

Dogs that do agility job commonly have broken

A

digits

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11
Q

Dogs that are hunting dogs commonly have strained

A

shoulders

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12
Q

With dog lameness, what should you get

A

Dog: family history, previous lameness or mobility issue, previous health problems

Owner specific: previous or current medications, nutraceuticals/herbals, ability to perform daily tasks, diagnostics, goals

Lameness specific: suspected cause, duration, progression, pattern of lameness, exacerbating and alleviating factors

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13
Q

What are cat specific questions to ask with lameness history taking?

A

1) Litter box habits
2) Jumping on previous favorite surfaces
3) Stairs
4) Grooming habits
5) temperament change
6) Hesitation and stiffness

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14
Q

What is the number one sign of cats with osteoarthritis

A

they are unable to jump on their previous favorite surfaces

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15
Q

What might be the cause of a chronic intermittent lameness

A

chronic tendinopathies

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16
Q

What might be the cause of a chronic slowly progressive lameness

A

arthritis

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17
Q

What might be the cause of an acute but improving lameness

A

1st or 2nd degree sprain/strain

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18
Q

What might be the cause of an acute, severe, and persistent lameness

A

fracture, luxation

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19
Q

What might be the cause of an acute lameness with a chronic history

A

-pathological fracture
-exacerbation of osteoarthritis

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20
Q

What is the goal of the neuromusculoskeletal exam?

A

localize the issue to a specific anatomic location on the lame limb

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21
Q

What is the systematic approach to orthopedic examinations?

A

1) Consistent: move distal to proximal

2) Thorough:
long lones (neoplasia, panosteitis, fractures/fissures)
joints (hyperflexion/extension/ medial/ lateral stability
Muscles/tendons (tears, pain, atrophy, swelling)

3) CREPI (Crepitus, range of motion. effusion, pain, instability)

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22
Q

What are the 5 things you should always palpate for

A

CREPI

1) Crepitus
2) Range of motion
3) Effusion
4) Pain
5) Instability

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23
Q

bone on bone “gritty” or “grating” sensation
seen with osteoarthritic joint or unstable fracture

A

Crepitus

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24
Q

When might you feel crepitus

A

1) Osteoarthritic joint (most common)
2) unstable fracture (if on a long bone)

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25
Q

Passive range of motion testing consists of

A

1) Goniometry: flexion/ extension/ abduction/ rotation, etc

2) End-feel (What is the limiting range of motion)

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26
Q

How should you do passive range of motion

A

1) Isolate joint with one hand above and one hand below the joint of interest

2) Get your fingers out of the way

3) Gentle, even pressure

4) Repeatability

5) If passive range doesnt work, try active range

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27
Q

increased amount of fluid in a joint that indicates articular disease

A

effusion

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28
Q

How do you subjectively quantify joint effusion

A

mild, moderate or severe

mild: may feel like a reduced ability to palpate crisp margins of normal landmarks

moderate: marked effusion is squishy

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29
Q

What joints should you evaluate for the presence of effusion in

A

Stifle
Tarsus
Carpus
Elbow

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30
Q

Stifle effusion

A

landmarks: medial and lateral borders of patellar ligament

tips: when performing standing, comparative exam, ensure both legs are equally weight bearing if possible

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31
Q

tarsal effusion landmarks

A

caudal and cranial to lateral and medial malleoli

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32
Q

What are the landmarks of stifle effusion

A

medial and lateral borders of patellar ligament

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33
Q

What are the landmarks of carpal effusion

A

dorsally just distal to the radius with the carpus partially flexed

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34
Q

What are the landmarks of elbow effusion

A

just caudal to the humeral epicondyles

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35
Q

physiologic indicators of pain

A

tachypnea
tachycardia
pupil dilation
hypertension
hyperthermia

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36
Q

How do you reduce non-noxious stressors

A

-Position yourself behind or to the side of the patient
-avoid excessive restraint and consider the patient’s preffered position
-contact gradient
-avoid intense eye contact
-basket myzzles are your friend
-Bribery
-leave painful limbs and more irritating things (withdrawls, panniculus, toes for last)
-Keep contact

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37
Q

What should you do for a really noxious patient when trying to do your orthopedic exam

A

use light anxiolytic sedation to dampen anxiety but still allow for pain locaization
-Gabapentin
-Trazodone
-Benzodiazepines

use heavier sedation with analgesia in more painful animals however this will hinder pain localization

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38
Q

assesses for abnormal sagittal plan instability from CCLD

A

Cranial drawer

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39
Q

Landmarks for cranial drawer test? How do you perform this?

A

1) Patella
2) Lateral fabella
3) Tibial tuberosity
4) Fibular head

top hand: stabilize femur
bottom hand: push tibia cranially while keeping tibia in sagittal plane with the femur

test in flexion and extension

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40
Q

another test for CCLD that more closely mimics cranio-caudal instability that occurs during weight bearing

A

Tibial thrust (Cranial tibial compression test)

41
Q

What are the landmarks for the tibial thrust test? How do you perform this?

A

1) Cranial distal thigh
2) Tibial tuberosity
3) Hock

top hand: feel for cranial tibial translation while maintaing the stifle extended in a standing angle

Bottom hand: flex the hock

42
Q

How do you assess for patellar luxation?

A

1) Find patella and locate tibial tubersoity
follow patellar ligament proximally until feels more like bone vs pencil
2) Holding fingers superficically, gentle wiggle patella medial and lateral in the trochlear groove

2) Push at the base of patella medially and laterally

3) Observe for both presence of luxation and spontaneous replacement

43
Q

Patellar luxation is graded on what scale?

A

1-4 scale

1: In-In
2: IN-out
3: Out-in
4: Out-Out

44
Q

grade where the patella is typically located outside the trochlear groove but can be manually reduced back into the trochlear groove

A

Grade 3: out-in

45
Q

grade where the patella is typically located in the trochlear groove but remains outside the groove at times even without manipulation

A

Grade 2: in-out

46
Q

grade where the patellea is always located outside the trochlear groove and cannot be manually reduced
patella is always luxated

A

Grade 4: Out-out

47
Q

grade where the patella is always located in the trochlear groove inless manually forced and held outside the groove

A

Grade 1: In-in

48
Q

a test used to assessing the presence of pain in dogs with medial compartment disease

A

Campbell’s test

49
Q

How do you perform the campbell’s test

A

Hold elbow and carpus at 90 degrees each while pronating and supinating the limb and applying gentle pressure over the medial coronoid

look for the presence of pain

50
Q

The ortolani assess for

A

hip laxity

51
Q

How do you perform an ortolani test

A

dog in lateral recumbency
Landmarks: dorsal pelvis, and cupping of stifle

1) Place your hands over the appropritate landmarks while ensuring to maintain the femur perpendicular to top line of the body

2) Gently adduct the limb and push up (proximally) along the axis of the femur (Subluxation step- barlow test)

3) Maintain this gentle proximal pressure while abducting the limb and watching/listening for a clunk (Reduction step)

52
Q

How do you test a dogs collateral ligaments

A

apply varus/valgus stress to joint

assess most joint in full extension- tarsus tested in extension and moderate flexion to assess both long and short collaterals, respectively

53
Q

In an orthopedic exam, what neuro components need to be assessed

A

-Gait analysis (paresis/ataxia)
-Assessment of CP
-Targeted spinal reflex assessment (withdrawals/patellars)
-Tail-lift, rectal exam
-Neck ROM/pain/axillar pain
-Cranial nerves/ anisocoria/ panniculus (forelimb lameness)

54
Q

What does flexibility testing evaluate

A

1) Muscle extensibility (stretching, passive elongation with manual force)
2) Determines which muscle to investigate

*NOT PROM

55
Q

What might you find upon soft tissue palpation

A

increased: eg rupture

decreased: eg contracture

painful: e.g inflammation

56
Q

How do you perform soft tissue palpation

A

1) Patient in lateral recumbency
2) Perform opposite of concentric action of muscle
3) Observe for amount of flexibility and the patients response (pain, muscle spasm, etc.)

57
Q

What is the difference between passive range of motion and flexibility of the stifle

A

Hip in extension= stifle extension PROM

Hip in flexion- hamstring flexibility

58
Q

What are diagnostic options for MSK diseases

A

1) Radiographs
2) Musculoskeletal ultrasound
3) CT
4) MRI
5) Arthroscopy
6) Arthrocentesis

59
Q

you observe an increased range of motion on gait, what might this indicate

A

ligament problem (such as carpa hyperextension injury with increased carpal extension or Achilles tendon rupture with increased tarsal flexion)

60
Q

In dogs, what gait should they be in to observe lameness

A

walk and ideally at the frot if the severity of maleness allows

61
Q

you should view the gait from what positions?

A

1) The side: to judge stride length, symmetry, and possible changes in sagittal joint range of motion
2) Towards and away ( to judge head nod, pelvic tilt, and frontal plane abnormalities)

62
Q

What might make a lameness more detectable in dogs

A

trot in circles, walk stairs, go up or down stains

63
Q

Animals with _______limb disease will display a more pronounced head nod when going downstairs

A

Thoracic limb diseases

and use the non-affected limb to step down first

64
Q

Animals with thoracic limb disease will use the ________ limb to step down first

A

non-affected limb

65
Q

describes the number of ground impacts within each stride cycle

A

beat

66
Q

The walk is a ______ beat gait

A

4 beat gait - because each limb touches the ground at different time points within the stride cycle

67
Q

describes a phase where none of the feet are touching the ground, commonly observed in high velocity gaits like trot and canter

A

suspension phase

68
Q

T/F: pacing is a diagnonal gait

A

False- ipsilateral limb pairs move simultaneously

69
Q

T/F: trotting is a diagonal gait

A

True- diagonal limb pairs move simultaneously

70
Q

A 4 beat gait without a suspension phase

A

Walk

71
Q

A 2 beat, diagonal gait with a suspension phase

A

Trot

72
Q

A 2 beat, lateral gait in which ipsilateral limb pairs move synchrony

A

Pace

73
Q

3 beat, asymmetric gait with different patterns on the right and left side

A

Canter

74
Q

What is the fastest gait

A

Gallop

75
Q

What might be occuring if a dog switches from a regular walk to pacing

A

evaluation for any change in orthopedic status is indicated

76
Q

The most steady and rhythmic gait and therefore generally the easiest gait to identify a mild-moderate lameness

A

trot

77
Q

What gait makes interpretation of lameness more complicated

A

pacing

78
Q

vertical head movement is generally associated with

A

thoracic limb lameness - the animal attempts to -ff-weight the affected elg

79
Q

With thoracic limb lameness, the head is _______ when the non-affected thoracic limb touches the ground and _______ when the affected limb touches the ground

A

lowered (non-affected)

raised (affected)

80
Q

Why is he head raised when the affected limb touches the ground in thoracic limb lameness

A

to reduce the amount of eight placed on the affected limb, rasing of the head happens just before the foot touches the ground

81
Q

Why might a head nod also be observe in severe pelvic limb lameness

A

the animal is attempting to shift its body weight forward

82
Q

Since the trot is a diagonal gait, how will pelvic limb lameness look

A

it will mimic a thoracic limb lameness of the ipsilateral side

ex: the head is lowered during the left front stance phase, this indicates a right thoracic limb lameness or right pelvic limb lameness (or both which would result in an exaggerated head nod)

83
Q

When the animal paces, a right thoracic limb lameness will

A

mimic a left pelvic limb lameness and vice versa

84
Q

You notice an upward movement of the head in the TROT during the stance phase of the left thoracic limb, what two things could be happening

A

Placing more weight on right limb to inload the left limb, could either be:

1) Left thoracic limb - head lowers during stance phase of right thoracic limb

2) Left pelvic limb - head lowers during stance phase of left pelvic limb

85
Q

How does the tail move with lameness

A

off-loading, generally observed to be swinging up when the affected limb contacts the ground

86
Q

lame animals generally have ______ cranial stride phase and a ______- caudal phase

A

decreased cranial stride phase and a lengthened caudal phase

however, the overall stride length is not changed with lameness

87
Q

Which of the following joints is not easily assessed for the presence of effusion?

Hip
Stifle
Elbow
Carpus
Tarsus

A

Hip

88
Q

What is the difference between passive range of motion and flexibility testing?

A

Flexibility testing evaluates soft tissue extensibility and necessitates that the muscle be stretched

89
Q

Bone on bone grating sensation commonly appreciated in osteoarthritic joints

A

Crepitus

90
Q

What is available as diagnostics for lameness

A

Diagnostic imaging

joint/nerve blocks/ flexion tests

palpation

91
Q

Test that is easy for superficial tendons (ie biceps, supra/infraspiantus) +/0 iliopsoas, meniscus

A

Ultrasound

92
Q

Pros and Cons of diagnostic CT

A

Pros: fast: fast, less costly, #D reconstruction, no concerns with implants and ferromagnetic concerns)

Cons: less soft tissue detail than MRI but better than X-rays

93
Q

Pros and Cons of MRI

A

Pros: evaluates entire organ (intra-and extraarticular structures), diagnostic method of choice for neurologic disease

Cons: osseous structures better visualized with CT, time consuming, limited number of organs *unlike CT)

94
Q

Best osseous detail, use this test for shelbows and tarsus

A

CT

95
Q

use for osseous disease and soft tissue calcification
effusion of stifle)

A

radiographs

96
Q

Use this test for muscle/tendon (shoulder, ilopsoas, achilles) +/- meniscus

A

ultrasound

97
Q

Use this test for soft tissue injury (shoulder, muscle disease)

A

MRI

98
Q

Use this test for lesion localization but not diagnosis

A

Bone scan

99
Q

shows the metabolic activity- lesion localization but not diagnosis

A

PET-CT

Orthopedic Medicine (8 decks)

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