Small Animal: Orthopedic Exam and Diagnostics

Question 1

what are the 5 key areas for assessing an orthopedic patient?

Answer 1

1. signalment: age, breed, sex (predispositions)
2. clinical history: what is complaint? how and when did problem start? duration? severity vary? previous treatments and responses or injuries? pet environment and diet?
3. visual exam
4. standing palpation
5. recumbent palpation

Question 2

what are the 3 aspects of the visual exam of an orthopedic patient?

Answer 2

1. gait: look for short stride or obvious lameness
2. atrophy
3. symmetry

Question 3

what are the 7 basic gait patterns for dogs?

Answer 3

symmetrical:
1. walk
2. amble
3. trot
4. pace

asymmetrical:
1. canter
2. transverse gallop
3. rotary gallop

Question 4

what are the 3 ways to describe a gait?

Answer 4

1. beat: the number of ground impacts within each stride cycle
2. suspension phase: a phase where none of the feet are touching the ground; observed only in high velocity gaits like trot and canter
3. diagonal versus lateral: describes which limb pair is supporting the animal’s weight
   -diagonal: diagonal limb pairs move simultaneously as when trotting
   -lateral: the ipsilateral limb pairs move simultaneously as when pacing

Question 5

describe the walk

Answer 5

a symmetrical 4 beat gait where each foot strikes the ground separately with no suspension phase

Question 6

describe the trot (2)

Answer 6

1. a symmetrical 2 beat gait where the two diagonal feet are in contact with the ground at the same time and has a suspension phase
2. IS THE EASIEST GAIT TO ASSESS A LAMENESS

Question 7

describe the pace

Answer 7

1. a symmetrical 2 beat gait where the two ipsilateral limbs strike the ground at the same time, with a suspension phase
2. this is a lateral gait that is unusual and inefficient for a dog, producing awkward truncal sway as the lateral limbs move in unison
3. there are 3 reasons for pacing:
4. fatigue: allows animal to alternate or rest certain core muscles
5. orthopedic pain: less spine motion to relieve back pain
6. may actually be a normal gait for some dogs!; so you MUST rule out pathology when you see this gait, but t doesn’t always have to indicate pathology

Question 8

describe thoracic limb lameness visual assessment (2)

Answer 8

1. assess at a trot
2. vertical head movement:
   -head lowers when NON affected thoracic limb touches the ground (to shift weight to non-affected limb)
   -head raises when AFFECTED thoracic limb touches the ground to reduce weight to the affected limb
   (DOWN ON THE SOUND)

Question 9

describe pelvic limb lameness visual assessment

Answer 9

1. assess at a trot (a diagonal gait)
2. head lowers when AFFECTED pelvic limb touches the ground to reduce weight on affected pelvic limb as opposite thoracic limb is on the ground
3. head raises when the NON affected pelvic limb touches the ground
4. will mimic a thoracic limb lameness of the ipsilateral side
5. hip hike or pelvic hike: pelvis can be elevated on the affected side, but can be subtle and challenging to see in some dogs; this is due to the dog shifting their weight to the non-affected side

Question 10

describe the lameness grading scale?

Question 11

describe the standing orthopedic exam (4)

Answer 11

1. try to get the dog’s legs squarely under them
2. assess for symmetry: enlargements or atrophy
   -palpation often requires enough pressure to blanch your fingernails
3. assess angulation and rotation
4. assess alignment

Question 12

what is the goal of the recumbent orthopedic exam?

Answer 12

assess each joint for CREPI

Crepitus: grinding, bone on bone, signifies more chronic diseases

Range of Motion

Effusion: puffy, inflammation, increase in synovial fluid, more difficult to palpate if more tissue around the joint (hips and shoulders)

Pain

Instability

Question 13

describe the recumbent paw exam (4)

Answer 13

1. check nails and paw pads
2. palpate every bone
3. manipulate each joint
4. assess each of the above for pain, is unsure at all, return later! assess and compare to other paws

Question 14

describe the recumbent carpus exam (3)

Answer 14

1. palpate for effusion on the dorsal aspect of the limb, there should be space between the radius and the radiocarpal bone
2. assess for pain during ROM
3. assess for instability

Question 15

describe the recumbent elbow exam (4)

Answer 15

1. palpate for effusion between the epicondyles and the olecranon
2. feel for crepitus during ROM
3. assess for pain upon full extension
4. apply pressure across the epicondyles to check for pain

Question 16

describe the recumbent shoulder exam (5)

Answer 16

1. palpate the greater tubercle and olecranon
2. palpate bicipital tendon
3. extend should
4. check axillary region
5. recumbent should exam is more common to reveal tendonopathies or soft tissue pathology

Question 17

describe the recumbent tarsus exam (3)

Answer 17

1. check for effusion on the dorsal aspect (like the carpus) and also caudally (between the calcaneous and the tibia)
2. check for pain during ROM
3. check for instability

Question 18

describe the recumbent stifle exam (5)

Answer 18

1. check for effusion by palpating the medial aspect of the patellar tendon
2. check for periarticular enlargement (how thick is the joint?)
3. palpate for patellar luxation
4. 2 tests for instability:
   -cranial drawer test: passive test
   -tibial compression test (cranial tibial thrust): dynamic test
5. tibial tuberosity is your home base for palpation!

Question 19

describe the recumbent hip exam (4)

Answer 19

1. keep finger lightly on greater trochanter during range of motion (home base for palpation)
2. be sure to extend AND abduct/adduct the limb
3. can check for ortilani sign (if sedated to check for instability/joint laxity)
4. palpate pelvic triangle: wing of ilium, ischial tuberosity, and greater trochanter should form a triangle; if all aligned, indicates something is out of place

Question 20

describe the use of radiographs in orthopedic diagnostics

Answer 20

1. used to confirm your tentative diagnosis
2. sedation should be used! improves positioning and decreases personnel exposure
3. should also radiograph the opposite limb; is helpful to have a “normal” side to compare to or can rule out the presence of or detect bilateral disease
4. repeat palpation when animal under sedation for radiographs
5. secondary osteoarthritis is a clue for an orthopedic pathology! will see SOE

S: sclerosis: thickening of bone as it tried to remodel = whiter on x-ray, indicates a chronic issue

O: osteophytes: bony outgrowths associated with cartilage degeneration around a joint, indicate a chronic issue

E: effusion: displacement of fat pads; can indicate acute OR chronic issues

Question 21

describe the use of ultrasound in orthopedic diagnostics

Answer 21

great for tendons and ligaments, but must know what specific areas to examine beforehand (already localized)

Question 22

describe the use of CT in orthopedic diagnostics

Answer 22

great for bone pathology

Question 23

describe the use of MRI in orthopedic diagnostics

Answer 23

great for global picture of soft tissues

Question 24

describe the use of bone scans (nuclear scintigraphy) and PET scans (positive emission tomography) in orthopedic diagnostics

Answer 24

helps locate a problem but doesn’t say WHAT the problem is

Question 25

describe the use of arthrotomy and arthroscopy in orthopedic diagnostics

Answer 25

provides a visual assessment of a joint

Question 26

desribe the use of arthrocentesis (joint tap) in orthopedic diagnostics

Answer 26

tells what cells are present in a joint