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Orthopedic Medicine > Small Animal Lameness Evaluation > Flashcards

Small Animal Lameness Evaluation Flashcards

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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
Passive range of motion testing consists of
1) Goniometry: flexion/ extension/ abduction/ rotation, etc 2) End-feel (What is the limiting range of motion)
26
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
27
increased amount of fluid in a joint that indicates articular disease
effusion
28
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
29
What joints should you evaluate for the presence of effusion in
Stifle Tarsus Carpus Elbow
30
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
31
tarsal effusion landmarks
caudal and cranial to lateral and medial malleoli
32
What are the landmarks of stifle effusion
medial and lateral borders of patellar ligament
33
What are the landmarks of carpal effusion
dorsally just distal to the radius with the carpus partially flexed
34
What are the landmarks of elbow effusion
just caudal to the humeral epicondyles
35
physiologic indicators of pain
tachypnea tachycardia pupil dilation hypertension hyperthermia
36
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
37
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
38
assesses for abnormal sagittal plan instability from CCLD
Cranial drawer
39
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
40
another test for CCLD that more closely mimics cranio-caudal instability that occurs during weight bearing
Tibial thrust (Cranial tibial compression test)
41
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
42
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
43
Patellar luxation is graded on what scale?
1-4 scale 1: In-In 2: IN-out 3: Out-in 4: Out-Out
44
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
45
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
46
grade where the patellea is always located outside the trochlear groove and cannot be manually reduced patella is always luxated
Grade 4: Out-out
47
grade where the patella is always located in the trochlear groove inless manually forced and held outside the groove
Grade 1: In-in
48
a test used to assessing the presence of pain in dogs with medial compartment disease
Campbell's test
49
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
50
The ortolani assess for
hip laxity
51
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)
52
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
53
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)
54
What does flexibility testing evaluate
1) Muscle extensibility (stretching, passive elongation with manual force) 2) Determines which muscle to investigate *NOT PROM
55
What might you find upon soft tissue palpation
increased: eg rupture decreased: eg contracture painful: e.g inflammation
56
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.)
57
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
58
What are diagnostic options for MSK diseases
1) Radiographs 2) Musculoskeletal ultrasound 3) CT 4) MRI 5) Arthroscopy 6) Arthrocentesis
59
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)
60
In dogs, what gait should they be in to observe lameness
walk and ideally at the frot if the severity of maleness allows
61
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)
62
What might make a lameness more detectable in dogs
trot in circles, walk stairs, go up or down stains
63
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
64
Animals with thoracic limb disease will use the ________ limb to step down first
non-affected limb
65
describes the number of ground impacts within each stride cycle
beat
66
The walk is a ______ beat gait
4 beat gait - because each limb touches the ground at different time points within the stride cycle
67
describes a phase where none of the feet are touching the ground, commonly observed in high velocity gaits like trot and canter
suspension phase
68
T/F: pacing is a diagnonal gait
False- ipsilateral limb pairs move simultaneously
69
T/F: trotting is a diagonal gait
True- diagonal limb pairs move simultaneously
70
A 4 beat gait without a suspension phase
Walk
71
A 2 beat, diagonal gait with a suspension phase
Trot
72
A 2 beat, lateral gait in which ipsilateral limb pairs move synchrony
Pace
73
3 beat, asymmetric gait with different patterns on the right and left side
Canter
74
What is the fastest gait
Gallop
75
What might be occuring if a dog switches from a regular walk to pacing
evaluation for any change in orthopedic status is indicated
76
The most steady and rhythmic gait and therefore generally the easiest gait to identify a mild-moderate lameness
trot
77
What gait makes interpretation of lameness more complicated
pacing
78
vertical head movement is generally associated with
thoracic limb lameness - the animal attempts to -ff-weight the affected elg
79
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)
80
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
81
Why might a head nod also be observe in severe pelvic limb lameness
the animal is attempting to shift its body weight forward
82
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)
83
When the animal paces, a right thoracic limb lameness will
mimic a left pelvic limb lameness and vice versa
84
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
85
How does the tail move with lameness
off-loading, generally observed to be swinging up when the affected limb contacts the ground
86
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
87
Which of the following joints is not easily assessed for the presence of effusion? Hip Stifle Elbow Carpus Tarsus
Hip
88
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
89
Bone on bone grating sensation commonly appreciated in osteoarthritic joints
Crepitus
90
What is available as diagnostics for lameness
Diagnostic imaging joint/nerve blocks/ flexion tests palpation
91
Test that is easy for superficial tendons (ie biceps, supra/infraspiantus) +/0 iliopsoas, meniscus
Ultrasound
92
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
93
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)
94
Best osseous detail, use this test for shelbows and tarsus
CT
95
use for osseous disease and soft tissue calcification effusion of stifle)
radiographs
96
Use this test for muscle/tendon (shoulder, ilopsoas, achilles) +/- meniscus
ultrasound
97
Use this test for soft tissue injury (shoulder, muscle disease)
MRI
98
Use this test for lesion localization but not diagnosis
Bone scan
99
shows the metabolic activity- lesion localization but not diagnosis
PET-CT

Orthopedic Medicine (8 decks)

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