SA Musculoskeletal Exam

Question 1

What are the clinical grades of lameness?

Answer 1

Grade I- IV
Grade I- barely perceptible
Grade II- noticeable but weight bearing
Grade III- bears weight occasionally for balance
Grade IV- Completely non weight bearing

Question 2

What may be the cause for an abnormal gait?
neurological or musculoskeletal?

Answer 2

May be due to a neurological problem rather than a primary musculoskeletal abnormality.

Question 3

How do you examine the vertebrae, ribs, and sternum?

Answer 3

palpate the neck and carefully flex, extend, and turn the head to each side to check for pain response.
apply downward pressure over the vertebrae, while supporting the animal from below to detect pain.
Palpate the ribs and sternum for fractures, pain, swelling…
elevate the tail dorsally and side to side to look for lumbosacral pain

Question 4

Name all the joints and major bones of the forelimb as you palpate each limb, beginning at the digits & moving proximally.

Answer 4

-digits: distal phalange, middle phalange, proximal phalange.
-metacarpal bones
-accessory carpal
-radius and ulna
-Olecranon (on ulna) -> ELBOW
-lateral epicondyle & medial epicondyle (which lay at the distal end of the humerus, and articulates the radius and ulna)
-greater tubercle of the humerus
SHOULDER JOINT (humeral head articulating with the glenoid cavity)
-ventral border of the scapula
-acromion
-spine of scapula

Question 5

Name all the joints and major bones of the hindlimb as you palpate each limb, beginning at the digits & moving proximally.

Answer 5

-digits: distal phalange, middle phalange, proximal phalange.
-metatarsal bone
-tarsal bones— TARSAL JOINT
-Common calcanea tendon
-tibia and fibula
-tibial tuberosity
-patella and patellar ligament
STIFLE JOINT
-Femur, lateral epicondyle and medial epicondyle
-body of femur
-greater trochanter of the femur
-HIP JOINT (head of femur + acetabulum of pelvis)
-ischiatic tuberosity
-iliac crest

Question 6

How do you examine the patella joints ?

Answer 6

examine the joint as a whole.
Positioned behind the standing animal, locate the tibial tuberosity, follow the patellar ligament proximally from it and determine the position and stability of the patella.
While applying gentle pressure, note where it can be shifted medially or laterally (indicating patella luxation)
Some mediolateral motion is normal.
REPEAT while flexing the limb.

Question 7

How do you check the integrity of the cranial cruciate ligaments?

Answer 7

The crucial ligaments are evaluated by the cranial drawer technique

cranial drawer sign = cranial cruciate abnormality

-increased cranial movement of tibia relative to the femur is the cranial drawer sign

Question 8

How do you evaluate cranial drawer signs

Answer 8

1.place animal in lateral recumbency
2. place 1 hand around the distal femur, so that your index finger rests on the PATELLA while your thumb is caudal to the femoral condyle in the area of the FABELLA.
Wrap the other hand in a similar fashion on the proximal tibia, with your thumb caudally on the FIBULAR HEAD and index finger on the TIBIAL TUBEROSITY
3. flex the joint to about 35 degrees
4. while holding the femur steady, move the tibia in a cranial caudal direction.
5. repeat this at 10 degree intervals up to 90 degrees flexion.

Question 9

what is the cranial drawer sign?

Answer 9

increased cranial movement of tibia relative to the femur is the cranial drawer sign

Question 10

what is an alternative technique to evaluate for cranial drawer, besides the cranial drawer test?

Answer 10

tibial compression test.

Question 11

how do you do the tibial compression test?

Answer 11

-can better overcome muscle tone in larger or tense animals and may be easier for those with smaller hands.

-place the stifle at a 90 degree angulation, support the leg with one hand and place that index finger along the patellar ligament, with the fingertip sitting on the tibial tuberosity.
-with your other hand around the pes, firmly flex the tarsus.

As the hock flexes, feel for anterior displacement and medial rotation of the proximal tibia.
As the hock is forced into flexion, a normal cranial cruciate ligament prevents medial rotation and anterior displacement of the proximal tibia.
if increased motion is noted, then the cranial cruciate ligament is not intact

Question 12

what is the atlas?

Answer 12

C1 has atlas wings. is a palpable landmark on dogs & cats

Question 13

what is the axis?

Answer 13

C2. is palpable

Question 14

are you able to palpate the medial collateral ligament?

Answer 14

It is firmly attached to the capsule and is often difficult to palpate.

Question 15

are you able to palpate the lateral collateral ligament?

Answer 15

it is easy to palpate as a band of tissue running dorsally from the fibular head to the lateral femoral condyle.

Question 16

what do the collateral ligaments prevent?

Answer 16

collateral ligaments are derived from and located within the fibrous parts of the joint capsule.

They prevent medial-lateral hinge motion at the joint and prevent medial-lateral rotation of the tibia on flexion.

they restrict craniocaudal motion of the tibia, hyperextension of the stifle and medial rotation of the tibia on flexion.

Question 17

what may a damaged cranial cruciate ligament result in?

Answer 17

increased cranial motion of the tibia and increased medial rotation of the tibia in flexion.

Question 18

How do you palpate the coxofemoral joints?

Answer 18

first observe in standing position for symmetry of the greater trochanter.
next place them in lateral recumbency.
flex and extend the coxofemoral joint, rotate the femur medially and laterally, and abduct and adduct the femur to fully evaluate the ball and socket joint.

Question 19

what would be the finding when palpation for a luxation of the coxofemoral joint?

Answer 19

will result in asymmetry of the greater trochanters in the standing animal.

place in lateral recumbency.
place your thumb in the depression just caudal to the greater trochanter and cranial to the ischiatic tuberosity.
use your other hand to laterally rotate the femur.
as you rotate the femur in a normal animal, your thunk will be bumped out of the depression.
if the femoral head is luxated, then your finger will stay where it is.

Question 20

How do you check for instability of the coxofemoral joint?

Answer 20

Ortolani sign

Question 21

what is the ortolani sign? what is it detecting?

Answer 21

Instability of the coxofemoral joint can be detected by checking for a positive ortolani sign

two motions are required to perform this manuever:
1. in a lateral recumbency, attempt to dorsally subluxate the hip (One hand stabilizes pelvis, while the other pushes the femur dorsally while simultaneously adducting the stifle)
2. with pressure maintained dorsally, the stifle is abducted while using the thumb of your other hand to push on the greater trochanter. A positive ortolani sign is an audible click or a palpable thunk as the femoral head reenters the acetabulum.

Question 22

what may a positive ortolani sign mean?

Answer 22

may suggest hip dysplasia or other coxofemoral joint instability.

Question 23

What are the postural reactions?

Answer 23

paw replacement and hoppingg

Question 24

How do you perform paw replacement test and what is it?

Answer 24

it is a postural reaction test.
start with your patient standing on all four limbs. pick up one paw at a time and place it sot hat dorsal surface of the paw bears weight.
a normal animal will immediately return the paw to its normal position.
successful paw replacement test requires several peripheral and CNS components, so it is a neurological function evaluation

Question 25

how do you perform hopping and what is it?

Answer 25

a postural reaction test
pick up one fore or hindlimb, leaving the opposite side limb bearing weight. Then move the animals body laterally over the limb being tested.
As the body passes over the limbs weight bearing axis, a normal animal will pick it up and hop laterally.
a normal hopping response will be smooth, regular and fairly rapid, the paw will never drag or land on its dorsal surface.

Question 26

what does hopping depend on as a screening test?

Answer 26

depends on all components involved in normal limb movement from sensory neurons in the skin, to ascending spinal cord tracts, cns, and back to motor neurons and muscles controlling limb movement,

Question 27

how do you evaluate spinal reflexes?

Answer 27

patellar reflex in the pelvic limbs
withdrawal reflex in both pelvic and thoracic limbs

Question 28

how do you perform a patellar reflex test?

Answer 28

Hold the relaxed limb in partial flexion, allowing the limb to rest on your non dominant hand.
using a plexor or scissor handle, tap the patellar ligament.

Question 29

how do you interpret a patellar reflex test?

Answer 29

A positive response is a brisk extension of the stifle, indicating normal function of the femoral nerve (sensory and motor branches) and spinal cord segments L4, L5 and L6.

Question 30

How do you perform a flexor reflex test?

Answer 30

Also called withdrawal reflex.
The general technique is to apply stimulus to the paw and observe for withdrawal of the limb via flexion of the joints.
Pinch the interdigital skin webbing with your fingers. maintain pinch pressure to observe the degree of limb flexion elicited.

Question 31

what is a normal response to a flexor reflex test?

Answer 31

Normal response is reflex limb flexion involving all of the major joints in the limbs. If an animal fails to flex in response, apply more stimulation.

Question 32

what are the peripheral nerves stimulated by the flexor reflex?

Answer 32

pelvic limb:
sciatic-common fibular branch
sciatic- tibial branch
femoral- saphenous

thoracic limb:
radial
ulnar
musculocutaneous

Question 33

what are the autonomous zones for the pelvic limb?

Answer 33

Sciatic nerve, common fibular branch: dorsal paw
sciatic nerve, tibial branch: plantar surface of paw
femoral nerve, via saphenous branch: medial surface of crus

Question 34

how do you evaluate specific peripheral nerves via their autonomous zones on the pelvic limbs?

Answer 34

use the flexor reflexor/withdrawal reflex
-to evaluate each branch of the sciatic nerve, pinch the skin of the dorsal and plantar paw separately.
-compression of digits 3,4,&5, tests sciatic nerve by stimulating both branches at the same time (common fibular and tibial)
-avoid compressing digits 1 and 2. along with sciatic nerve, these may stimulate the femoral nerve (via saphenous branch)
-femoral nerve distal extend is variable bc sensory fibers may or may not extend all the way to the medial digits.

Question 35

what are the autonomous zone of the thoracic limb?

Answer 35

radial nerve: dorsal surface of paw
Musculocutaneous nerve: medial surface of antebrachium
ulnar nerve: caudal surface of antebrachium

Question 36

how do you evaluate specific peripheral nerves via their autonomous zones on the thoracic limbs?

Answer 36

-the ulnar nerves autonomous zone extends from the caudal antebrachium to include the lateral digits.
To avoid confusion when evaluating the radial nerve, restrict the pinch to the skin of the dorsal paw.
Compression of the palmar aspect of the digits stimulates either the median or ulnar nerve.
to avoid confusion when evaluating the ulnar nerve, restrict pinch to the caudal antebrachium.

Question 37

How do you differentiate between a positive withdrawal reflex (flexor reflex) and nociception?

Answer 37

Positive withdrawal reflex will cause flexion. in the pelvic limb, a positive response will be flexion of all the joints.
-hip, stifle, and tarsus flexors.

in the thoracic limb, a positive response is flexion of the forelimbs joints.
-shoulder, elbow, and carpal flexors