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60 Cards in this Set

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Where should you perform gait analysis?
Outside the exam room but away from distractions for the patient
What different gaits do you want to observe when performing small animal gait analysis?
-observe gait at walk & trot, sometimes run
-Straight line, sometimes circle, up or down stairs
-no tension on leash
-may need handler to switch sides
-observe coming towards & away from you
-Exam animal dorsally while walking and from side
What are 11 gait abnormalities to look for in small animals?
1) Shortened stride
2) Dragging of the toenails
3) Toeing in or toeing out
4) Limb circumduction
5) hypermetria
6) Strumbling
7) generalized weakness
8) Ataxia
9) crossing of legs
10) abnormal sounds
11) head bob
How do you determine if an animal has a shorted stride?
Look at where they place each paw, focus on one and compare in relationship to other paw, look at other side and see if symmetrical and even, if not= shortened stride
What, in general, can cause dragging of toenails?
Lack of flexion in limb, loss of conscious proprioception
How do you evaluate limb circumduction?
Want to see the joint move parallel, if goes medially then abnormal and if goes lateral to body then abnormal, should be a straight line
What is hypermetria and dysmetria?
Hypermetria: exaggerated movements
Dysmetria: similar, but place foot and leg in abnormal position e.g. to contralateral side, out to side
What's an example of an abnormal sound that could be heard when assessing the gait?
clicking of joints
Why do dogs do toeing out when they have orthopedic injury?
Changes weight bearing on joint
What are the 6 things to check to determine if an abnormal gait is due to orthopedic damage?
1) Shortened stride
2) Toeing in or out
3) Limb circumduction
4) Abnormal sounds
5) Head bob
6) Weakness?
What are 6 ways to evaluate if an abnormal gait is due to neurologic issues?
1) Ataxia
2) Crossing of limbs
-loss of CP
3) Hypermetria
4) Stumbling
-loss of CP
5) Shortened stride?
-loss of CP
6) Weakness?
Why do animals with orthopedic issues circumduct the limb?
To limit movement
What does it mean if the head goes down when the right leg is forward?
Means left leg is hurt
-down is sound
What are 5 signs that the front limb is lame (and not the hind limb)?
1) Head up when good leg strikes the ground
2) Shortened stride
3) Leaning back
4) Rounded haunches
5) Weight off the front
What are 5 signs that the hind limb is lame (and not the front limb)?
1) Head down when bad leg strikes the ground
2) Shortened stride
3) Weight off the backend
4) Arched back
5) Bunny hop gait
what are 5 ways to try to determine if its the right or left limb or both that's lame?
1) Leaning to one side when standing or walking
-compare shoulder heights
2) Decreased flexion of the affected joint when standing or walking
3) Bunny hop gait
4) Sitting or lying down rather than standing
5) Extended legs when sitting or lying down
-cruciate ruptures sit with one leg out to side
How do you assess if lameness is functional or painful? (3)
1) Trying to get away from the pain
2) Decreased motion of affected limb
3) Use other limbs in reference to affected limb
What's an example of a functional lameness?
Neurological damage, doesn't hurt just can't use it
What can you do if you can't determine where the animal is lame from the physical exam?
-pressure mat sensor
-nuclear scintigraphy (tissue phase, bone phase)
-computed tomography/MRI
-tell em to come back when gets worse
What are 4 things to do when performing standing palpation on a small animal?
1) Look for asymmetry
2) muscle atrophy
3) Joint effusion
4) Check range of motion in all joints if patient allows
Why is adequate restraint really important during a lameness physical exam?
Need to make sure to assess full range of motion in joints
What are you palpating for on physical exam?
-pain (leave the painful limb until last)
-Crepitus
-swelling
-laxity, instability (joint moves farther than it should)
-abnormal range of motion in joints (check collateral ligaments)
-anything DIFFERENT
Where should you always start palpation of the limbs?
At the toes
-b/w toes
-b/w pads
-nail beds
-joints: flexion/ extension
-sesmoid bones
Why is it really important to save the painful limb for last?
Sympathetic overdrive can mess up the exam
What all do you do to examine the carpus?
-range of motion
-flexion/extension
-pronation/ supination
-joint swelling?
-medial/ lateral collateral ligaments
How do you check the medial and lateral collateral ligaments of the carpus?
When engage collateral ligament it should just click and stop, if it doesn't then you know there's strain in the ligament
-palpate medial and lateral collateral ligaments all the way up the limb
What are the 6 components of evaluating the elbow and antebrachium on orthopedic exam?
1) Radius & ulna
2) Flexion/ extension
-should be able to flex up till parallel
-should be able to extend all the way straight
3) Rotation
-hinge joint, shouldn't move medial or lateral
4) Medial/lateral collateral ligaments
5) Joint swelling
6) Supinate/ pronate (last thing) upon flexion & extension
Why is it so important to supinate/ pronate the elbow?
Coronoid disease is only painful upon supination/ pronation
-same w/ most elbow dysplasias
What's the main way to evaluate the shoulder?
Flexion/extension
-should be able to bring forearm at least half way up the chest wall
-if head is in neutral position should go all the way up to nose and eyes
How do you evaluate the biceps and supraspinatous tendons?
Jam fingers medially into the joint and push around the joint, if tendon is injured it will hurt when you push on it
What should you check the shoulder for (other than pain upon palpation)?
-joint swelling
-subluxation
-abduct the shoulder: medial laxity if > 30 degrees
What are the components of an orthopedic exam of the hind limbs?
-check digits, metatarsals, hock just as you would the forelimb & carpus
-stifle (patellar luxation, cruciate rupture)
-hip (dysplasia, luxation)
How do you examine the stifle?
-Flex/extend, feel for joint effusion on either side of patellar tendon
-Try to dislocate patella: put leg in full extension, grab patella & try to pop over edge medially & laterally, shouldn't be able to and shouldn't be painful
What are 3 conditions you need to check for in the stifle?
1) Patellar luxation
2) Ruptured CCL
3) OCD of femoral condyle
How do you check for medial patellar luxation? Lateral?
Medial: rotate foot inwardly while putting pressure on patella
Lateral: rotate foot outwardly while putting pressure on the patella
What are 2 ways to check for a cranial cruciate rupture?
Cranial drawer test
Tibial compression test
How do you perform a cranial drawer test?
Grab femur and grab the tibia firmly, she jabs her thumbs b/w muscle and bone to grab the bone and try to move them independently of each other both forward and backward- shouldn't be able to do that if have cruciate ligaments
-if ruptured an move tibia cranial to femur
-do in flexion and extension
What are 6 common mistakes that result in the inability to correctly identify the "drawer" motion during a cranial drawer test?
1) Wrists bent or just finger tips placed
2) fingers placed laterally/medially
3) Drawer movement performed too slowly
4) Mistaking rotation for drawer
5) Grasping the muscles rather than bone
6) Failure to examine in flexion & extension
You perform a cranial drawer test and are still not sure if a dog has a ruptured cranial cruciate so you go to perform a tibial compression test, how do you do this?
Hold femur in standing angle w/ dog lying down then try to flex the hawk w/o flexing the stifle, keep knee motionless, shouldn't be motion if cruciate is in tact, it not intact then when flex the hawk put motion through the tibia and tibia will pop out forward
How do you assess the hip?
-test for pain, move joint in range of motion, palpate long bones, then palpate joint to feel for effusion- difficult bc deep joint
-put thumb b/w greater trochanter and ischium this is where you'll feel joint effusion
-then do an ortoloni test
What is the ortolani test?
A test for hip dysplasia
How do you check for craniodorsal hip luxation?
Want to look to see if hip is permanently dislocated
-feel wing of ilium, greater trochanter and ischial tuberosity- these 3 things should form an isosceles triangle w/ greater trochanter distal to the other 2 landmarks
What are 4 common mistakes make when performing a hip exam and trying to diagnose joint laxity?
1) Pushing too hard on the femur
2) Placing hand directly over hip
3) Hip at wrong angle
4) Unsedated difficult patient
What is genu valgum?
Common problem with big dogs
-have an angular limb deformity in hind limb where hawks are inward compared to their feet
-lateral luxating patella very common
How do animals with genu valgum present?
Present with wide hips, narrow stifles and hocks with the toes pointing outward
What causes genu valgum?
Due to varus angulation of the femur and torsion of femoral condyles
What is a sequel to genu valgum in large dogs?
Laterally luxating patella
What are 5 things that people commonly forget to examine on an orthopedic exam?
1) Mild joint effusion
2) Muscle injuries
3) Collateral ligament instability
4) spinal pain
5) Axillary masses
what are 2 things you can do if unable to localize the pain?
Repeat exam later
Radiographs
Compare to normal animal if suspect bilateral problem
What are the 5 components of the nebulous lameness exam?
- cage rest and analgesics
-serial exams
-radiographs
-neuro exam
-minimum database (CBC, panel, UA, arthrocentesis
What are some causes of inflammatory infectious arthritis?
1) Tick-borne
-ehrlichia, RMSF, Lymes
2) Mycoplasma (cats)
3) L-form (weird bacteria)
4) Viral (calici in cats)
5) Protozoal (Leishmania)
6) Bacterial
What is a positive ortolani sign?
lace your hand on the flexed knee and push the femur straight downward (dorsal) toward the acetabulum. A hip with pathologic laxity will subluxate out of the acetabulum (a). Continue to apply downward (dorsal) pressure on the femur and abduct it towards the table (b). At some point, usually between 20 and 45 degrees of abduction, the hip will relocate into the acetabulum. When this occurs there is a palpable drop as the femoral head seats in the acetabulum, often creating an audible sound (c). The palpable relocation of the femoral head back into the acetabulumm is the Ortolani Sign, confirming pathologic laxity.
What are some possible causes of forelimb lameness in a growing dog?
OCD shoulder, congenital luxation shoulder, avulsion of supraglenoid tubercle, OCD elbow, ununited anconeal process, fragmented medial coronoid process, ununited medidal epicondyle, elbow incongruity, radius curvus, retained cartilage cores, panosteitis, hypertrophid osteodystrophy
What are some possible causes of forelimb lameness in an adult dog?
Arthritis, ununited medial epicondyle, panosteitis, bicipital tenosynovitis, calcification supraspinatous tendon, infraspinatous/supraspinatous contracture, neoplasia, inflammatory joint disease, hypertrophic osteopathy, synoval chondrometaplasia
What are some possible causes of forelimb lameness in a growing dog?
OCD shoulder, congenital luxation shoulder, avulsion of supraglenoid tubercle, OCD elbow, ununited anconeal process, fragmented medial coronoid process, ununited medidal epicondyle, elbow incongruity, radius curvus, retained cartilage cores, panosteitis, hypertrophid osteodystrophy
What are some possible causes of pelvic limb lameness in the growing dog?
Hip dysplasia, avascular necrosis, avulsion long digital extensor, OCD stifle or hock, luxating patella, genu valgum, panosteitis
A
What are some possible causes of forelimb lameness in an adult dog?
Arthritis, ununited medial epicondyle, panosteitis, bicipital tenosynovitis, calcification supraspinatous tendon, infraspinatous/supraspinatous contracture, neoplasia, inflammatory joint disease, hypertrophic osteopathy, synoval chondrometaplasia
What are some possible causes of pelvic limb lameness in an adult dog?
Arthritis, luxating patella, panosteitis, cruciate ligament rupture, meniscal tear, inflammatory joint disease, neoplasia
What are some possible causes of pelvic limb lameness in the growing dog?
Hip dysplasia, avascular necrosis, avulsion long digital extensor, OCD stifle or hock, luxating patella, genu valgum, panosteitis
A
What are some possible causes of pelvic limb lameness in an adult dog?
Arthritis, luxating patella, panosteitis, cruciate ligament rupture, meniscal tear, inflammatory joint disease, neoplasia