Veterinary Orthopaedic and diagnostic assessment Flashcards
Describe a hands off assessment
History
Static evaluation
Dynamic assessment
What kind of questions might you ask (general)?
Age, breed & sex
Behaviour
General medical history
Vaccinations
Is the animal on any medications?
Allergies
Insurance status
What kind of questions might you ask (orthopaedic focused)?
Acute or chronic?
Has it happened before? Intermittent/continuous
If intermittent, how long does each ‘attack’ last? Does anything seem to trigger it?
History of injury/wounds in the area?
When was the horse last shod?
When was it noticed?
Describe a hands on assessment
Palpation and manipulation
Flexion tests
Regional anaesthesia +/- ancillary tests
What should you consider regarding the posture?
Are they evenly weightbearing?
Is one leg being carried?
Are they shifting weight?
What is their head position?
Is there hyperflexion or hyperextension of joints?
Are there any angular limb deformities?
What is their spinal posture?
How may symmetry be beneficial during an examination?
Muscle atrophy
Muscle hypertrophy
Swellings
Angular limb deformity
What environmental considerations should you make when carrying out an examination?
Enclosed
Sufficient light
Sufficient space
Distractions
Guideline
What assessments can you carry out to aid the examination?
Walk vs trot
Variety of directions - straight line & circle (both directions)
Variety of surfaces - hard & soft
Ridden assessments can be useful
Describe the UK lameness scoring system
0 - Sound
2 - Lameness hard to detect at walk or trot
4 - Lameness barely detectable at walk, easy to see at trot
6 - Lameness easily detectable at walk
8 - Hobbling at walk, unable/unwilling to trot
10 - Non-weight bearing
Describe the AAEP lameness scoring system
0 - Lameness not perceivable under any circumstances
1 - Lameness difficult to observe and not consistently present
2 - Lameness is difficult to observe at walk or trot in a straight line but can be consistently apparent under certain circumstances (ridden, circling etc)
3 - Lameness consistently observable at trot under all circumstances
4 - Lameness is obvious at walk
5 - Minimal weight bearing in motion or at rest or complete inability to move.
Describe other signs you may see if the animal has forelimb lameness
Head nod - nod on the sound leg
Ear bounce - as ears bounce up, that’s the lame leg
Head position - if lunging horse, if lame leg is on the inside, head will aim outwards
Describe other signs you may see if the animal has hindlimb lameness
Pelvic rise - lame limb may show greater amount of movement
Foot placement - hind limb should hit where forelimb was placed when walking. If falls short, may be lame
Toe dragging
Degree of joint flexion
Describe non-specific limb signs of lameness
Foot fall - can you hear the difference
Stride length and character
Tail position
What is referred lameness?
‘False lameness’
The animal tries to compensate by taking weight off of lame foot, which can make a different foot look lame instead
Describe secondary lameness
‘True’ lameness
Due to prolonged overloading
Referred -> secondary
Multiple limbs makes it difficult
Use ancillary tests!
What should you palpate?
Sequence to ensure no omissions
Relevant anatomy
- Ligaments
- Tendons
- Joints
- Bony prominence’s
Swellings
Pain
What are the two types of reduced ROM?
Mechanical
Painful
Describe a flexion test
Exacerbate lameness
Limb held in tight flexion (approx. 1 minute)
Horse is immediately trotted 12-15m
A positive result is a more pronounced lameness compared to before the test
Not very specific as cannot confirm exactly what joint as will be flexing more than one joint at a time
Describe diagnostic regional anasthesia
‘Nerve blocks’
Detect region of limb affected
Local anaesthetic used to desensitise certain areas
At least 80% improvement
Start low and work up – anaesthesia will work its way down so will numb everything below
What does the palmar/plantar digital nerve block affect?
Desensitises entire foot EXCEPT:
Dorsal aspect of coronary band
Laminae of the dorsal wall of the toe
What does the abaxiol sesamoid nerve block affect?
Desensitises:
Entire foot
Distal interphalangeal joint
Distal sesmoidean ligament
Flexor tendons distal to site
Proximal interphalangeal joint
What does the low 4 point nerve block affect (forelimb)?
Desensitises limb distal to injection sites
What does the low 6 point nerve block affect (hindlimb)?
Similar to low 4 point but in the hindlimb
Additional injection site
Tested by skin sensation distal to the sites
Desensitises limb distal to injection sites
What does the high 4 point nerve block affect (forelimb)?
Palmar nerves just distal to carpus
Tested by squeezing of the suspensory ligament
Desensitises limb distal to injection site
What does the high 6 point nerve block affect (hindlimb)?
Similar to high 4 point but in the hind limb
additional injection site
Tested by squeezing the suspensory ligament
Desensitises limb distal to injection site
Name two additional nerve blocks in the forelimb
Median nerve block
Ulnar nerve block
Name two additional nerve blocks in the hindlimb
Tibial nerve block
Peroneal nerve block
Describe joint blocks
Local anaesthetic injected into joint spaces
Positive result would be >80% improvement in lameness seen
Aseptic conditions
List methods of diagnostic imaging
X-rays
Ultrasound
Computed Tomography
Magnetic Resonance Imaging
Thermography
Scintigraphy
Arthroscopy
What are the different types of x-ray machines?
Fixed machines
Portable machines
What are some health and safety concerns regarding x-rays?
Change atom or molecule
Inappropriate chemical reactions
What safety measures can you put in place with x-rays to reduce H&S concerns?
Radiation monitors/badges
Lead lined aprons, thyroid protectors and gloves
Grids
Safety measures surrounding x-rays will differ between small animal and equine. How?
SA - min 2 metres from primary beam
Equine - Individuals in equine with portable must hold machine and plate
Describe contrast media
Highlights area of interest
Positive Liquid contrast medium
Negative Air/carbon dioxide
Describe ultrasound
Electric current applied to piezoelectric crystals
Change shape and vibrate
Produce high frequency sound waves
Amount reflected back at transducer is what produces the image
Describe computer tomography
Ring-shaped machine
X-ray tube at one side and detector on the other
Rotates back and forth as patient moves through.
Cross-sectional images
Great differentiation of tissues with greyscale
Hounsfield scale
Is computed tomography used in equine or small animal?
Heavily utilised in small animal
They can fit through the machine!
Use is limited in horses…. at the moment
Head
Neck
Distal limb
Describe thermography
Infrared radiation emitted from the skin
Detects heat patterns and changes in blood flow
Highlights area of inflammation
Describe scintigraphy
‘Nuclear’ imaging
Nucleotides attached to pharmaceuticals target body part
Accumulate in areas of increase physiological function
Healing (fractures)
Increased cell turnover (neoplasia)
Increased blood supply (inflammation)
Nucleotides emit gamma radiation
Detected using a gamma camera as ‘hot spots’
Radioactive therefore heavily governed by H&S
Describe arthroscopy
Endoscopy
Diagnostic and therapeutic
Full GA and ASEPTIC TECHNIQUE
Name two laboratory techniques utilised in orthopaedics
Arthrocentesis
Synovial membrane biopsy
Describe arthrocentesis
‘Joint taps’
Puncture joint capsule and aspirate synovial fluid
Aseptic technique
Iatrogenic joint sepsis
What can an arthrocentesis analyse?
Gross appearance
Cytology
Bacteria
Antibodies (Lyme’s disease)
Protein
Indicates inflammation, septic joints, Lyme’s disease etc
What can be put into the joint to assess joint involved with wounds?
Sterile saline
What are ultrasounds good for viewing?
Tendons
Ligaments
Muscles
(Soft tissues)
