Small Animal Lameness Evaluation Flashcards
alteration of normal gait due to pain or mechanical dysfunction can be from pain, mechanical, or combination
Lameness
What are the different types of lameness
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
What would be an example of lameness due to both pain and loss of mechanical apparatus
patellar luxation
When evaluating lameness in a dog, what should you consider regarding their signalment
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)
Do males or females more commonly get immune mediated diseases like IMPA
females
Are intact male or female dogs more likely to have vehicular trauma
intact male dogs
What breed commonly gets panosteitis
german shephard
What breed commonly gets osteosarcoma
rottweilers
What breed commonly gets elbow dysplasia
labradors
Dogs that do agility job commonly have broken
digits
Dogs that are hunting dogs commonly have strained
shoulders
With dog lameness, what should you get
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
What are cat specific questions to ask with lameness history taking?
1) Litter box habits
2) Jumping on previous favorite surfaces
3) Stairs
4) Grooming habits
5) temperament change
6) Hesitation and stiffness
What is the number one sign of cats with osteoarthritis
they are unable to jump on their previous favorite surfaces
What might be the cause of a chronic intermittent lameness
chronic tendinopathies
What might be the cause of a chronic slowly progressive lameness
arthritis
What might be the cause of an acute but improving lameness
1st or 2nd degree sprain/strain
What might be the cause of an acute, severe, and persistent lameness
fracture, luxation
What might be the cause of an acute lameness with a chronic history
-pathological fracture
-exacerbation of osteoarthritis
What is the goal of the neuromusculoskeletal exam?
localize the issue to a specific anatomic location on the lame limb
What is the systematic approach to orthopedic examinations?
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)
What are the 5 things you should always palpate for
CREPI
1) Crepitus
2) Range of motion
3) Effusion
4) Pain
5) Instability
bone on bone “gritty” or “grating” sensation
seen with osteoarthritic joint or unstable fracture
Crepitus
When might you feel crepitus
1) Osteoarthritic joint (most common)
2) unstable fracture (if on a long bone)
Passive range of motion testing consists of
1) Goniometry: flexion/ extension/ abduction/ rotation, etc
2) End-feel (What is the limiting range of motion)
How should you do passive range of motion
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
increased amount of fluid in a joint that indicates articular disease
effusion
How do you subjectively quantify joint effusion
mild, moderate or severe
mild: may feel like a reduced ability to palpate crisp margins of normal landmarks
moderate: marked effusion is squishy
What joints should you evaluate for the presence of effusion in
Stifle
Tarsus
Carpus
Elbow
Stifle effusion
landmarks: medial and lateral borders of patellar ligament
tips: when performing standing, comparative exam, ensure both legs are equally weight bearing if possible
tarsal effusion landmarks
caudal and cranial to lateral and medial malleoli
What are the landmarks of stifle effusion
medial and lateral borders of patellar ligament
What are the landmarks of carpal effusion
dorsally just distal to the radius with the carpus partially flexed
What are the landmarks of elbow effusion
just caudal to the humeral epicondyles
physiologic indicators of pain
tachypnea
tachycardia
pupil dilation
hypertension
hyperthermia
How do you reduce non-noxious stressors
-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
What should you do for a really noxious patient when trying to do your orthopedic exam
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
assesses for abnormal sagittal plan instability from CCLD
Cranial drawer
Landmarks for cranial drawer test? How do you perform this?
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
another test for CCLD that more closely mimics cranio-caudal instability that occurs during weight bearing
Tibial thrust (Cranial tibial compression test)
What are the landmarks for the tibial thrust test? How do you perform this?
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
How do you assess for patellar luxation?
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
Patellar luxation is graded on what scale?
1-4 scale
1: In-In
2: IN-out
3: Out-in
4: Out-Out
grade where the patella is typically located outside the trochlear groove but can be manually reduced back into the trochlear groove
Grade 3: out-in
grade where the patella is typically located in the trochlear groove but remains outside the groove at times even without manipulation
Grade 2: in-out
grade where the patellea is always located outside the trochlear groove and cannot be manually reduced
patella is always luxated
Grade 4: Out-out
grade where the patella is always located in the trochlear groove inless manually forced and held outside the groove
Grade 1: In-in
a test used to assessing the presence of pain in dogs with medial compartment disease
Campbell’s test
How do you perform the campbell’s test
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
The ortolani assess for
hip laxity
How do you perform an ortolani test
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)
How do you test a dogs collateral ligaments
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
In an orthopedic exam, what neuro components need to be assessed
-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)
What does flexibility testing evaluate
1) Muscle extensibility (stretching, passive elongation with manual force)
2) Determines which muscle to investigate
*NOT PROM
What might you find upon soft tissue palpation
increased: eg rupture
decreased: eg contracture
painful: e.g inflammation
How do you perform soft tissue palpation
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.)
What is the difference between passive range of motion and flexibility of the stifle
Hip in extension= stifle extension PROM
Hip in flexion- hamstring flexibility
What are diagnostic options for MSK diseases
1) Radiographs
2) Musculoskeletal ultrasound
3) CT
4) MRI
5) Arthroscopy
6) Arthrocentesis
you observe an increased range of motion on gait, what might this indicate
ligament problem (such as carpa hyperextension injury with increased carpal extension or Achilles tendon rupture with increased tarsal flexion)
In dogs, what gait should they be in to observe lameness
walk and ideally at the frot if the severity of maleness allows
you should view the gait from what positions?
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)
What might make a lameness more detectable in dogs
trot in circles, walk stairs, go up or down stains
Animals with _______limb disease will display a more pronounced head nod when going downstairs
Thoracic limb diseases
and use the non-affected limb to step down first
Animals with thoracic limb disease will use the ________ limb to step down first
non-affected limb
describes the number of ground impacts within each stride cycle
beat
The walk is a ______ beat gait
4 beat gait - because each limb touches the ground at different time points within the stride cycle
describes a phase where none of the feet are touching the ground, commonly observed in high velocity gaits like trot and canter
suspension phase
T/F: pacing is a diagnonal gait
False- ipsilateral limb pairs move simultaneously
T/F: trotting is a diagonal gait
True- diagonal limb pairs move simultaneously
A 4 beat gait without a suspension phase
Walk
A 2 beat, diagonal gait with a suspension phase
Trot
A 2 beat, lateral gait in which ipsilateral limb pairs move synchrony
Pace
3 beat, asymmetric gait with different patterns on the right and left side
Canter
What is the fastest gait
Gallop
What might be occuring if a dog switches from a regular walk to pacing
evaluation for any change in orthopedic status is indicated
The most steady and rhythmic gait and therefore generally the easiest gait to identify a mild-moderate lameness
trot
What gait makes interpretation of lameness more complicated
pacing
vertical head movement is generally associated with
thoracic limb lameness - the animal attempts to -ff-weight the affected elg
With thoracic limb lameness, the head is _______ when the non-affected thoracic limb touches the ground and _______ when the affected limb touches the ground
lowered (non-affected)
raised (affected)
Why is he head raised when the affected limb touches the ground in thoracic limb lameness
to reduce the amount of eight placed on the affected limb, rasing of the head happens just before the foot touches the ground
Why might a head nod also be observe in severe pelvic limb lameness
the animal is attempting to shift its body weight forward
Since the trot is a diagonal gait, how will pelvic limb lameness look
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)
When the animal paces, a right thoracic limb lameness will
mimic a left pelvic limb lameness and vice versa
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
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
How does the tail move with lameness
off-loading, generally observed to be swinging up when the affected limb contacts the ground
lame animals generally have ______ cranial stride phase and a ______- caudal phase
decreased cranial stride phase and a lengthened caudal phase
however, the overall stride length is not changed with lameness
Which of the following joints is not easily assessed for the presence of effusion?
Hip
Stifle
Elbow
Carpus
Tarsus
Hip
What is the difference between passive range of motion and flexibility testing?
Flexibility testing evaluates soft tissue extensibility and necessitates that the muscle be stretched
Bone on bone grating sensation commonly appreciated in osteoarthritic joints
Crepitus
What is available as diagnostics for lameness
Diagnostic imaging
joint/nerve blocks/ flexion tests
palpation
Test that is easy for superficial tendons (ie biceps, supra/infraspiantus) +/0 iliopsoas, meniscus
Ultrasound
Pros and Cons of diagnostic CT
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
Pros and Cons of MRI
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)
Best osseous detail, use this test for shelbows and tarsus
CT
use for osseous disease and soft tissue calcification
effusion of stifle)
radiographs
Use this test for muscle/tendon (shoulder, ilopsoas, achilles) +/- meniscus
ultrasound
Use this test for soft tissue injury (shoulder, muscle disease)
MRI
Use this test for lesion localization but not diagnosis
Bone scan
shows the metabolic activity- lesion localization but not diagnosis
PET-CT
