🐾🦴Orthopedic Examination🦴🐾
These are the components of an orthopedic examination
general observation
ambulatory evaluation (walk and trot)
screening neurologic evaluation (do standing)
palpation (standing)
recumbent examination follow price: palpation, range of motion, instability, crepitus, effusion, do for each limb while pt on side
Joint dx: diagnostic tests are?
Physical Exam, radiology, gait analysis, infectious dx testing, arthrocentesis, synovial fluid analysis (cytology, culture), arthroscopy.
PE and then rads first
typical signalment of hip dysplasia
and what is hip dysplasia
signalment: large and giant breed dogs (GSD, labrador, rottweiler, golden retriever, bull dog, cats) bimodal age distrbuation (5-12 months, >3yrs) painful in early dx then middle age less lame then older effected again
varying degrees of hip laxity, abnormal developmental and changes to joint. hips normal at birth, and then in development get disparity. where soft tissue can't keep up. laxity/instability -> poor joint congruence (subluxation) -> abnormal hip development
Birth -> laxity -> secondary changes -> end stage
what is osteochondrosis?
etiology?
failure of endochondral ossification, occurs in skeletal development
multifactorial, breeds predispositoin, rapid growth, microtrauma, overnutrition
clinical signs
weakness (stiff gait, bunny hopping) excersise intolerance, muscle atrophy, larngeal, pharyngeal dsyfunctional. etc
It the forelimb and hindlimb the paw are checked for.
While in these limbs effusions are checked for
foreign body, interdigital cyst, pododermatisis
2) carpus, elbow, hock
This is the classification scheme for joint dxs and in which categories common joint dxs are classified
Non inflammatory vs inflammatory. subcategories of inflammatory are non-erosive and erosive.
non-inflammatory: trauma, neoplasia, DJD, malformation.
non-erosive: infectious, SLE, reactive, breed-associated, idiopathic.
erosive: infectious-L form arthritis, non infectious: erosive polyarthritis of greyhound, rheumatoid arthritis, feline chronic progressive polyarthritis
these are factors that contribute to hip dysplasia
genetic factors, Nutrional influences, environmental factors.
polygenic-genetic and environmental influences, heritability index 20% to 60%. genetic influences: bony and soft tissue anatomy, joint biomechanics, growth rate, joint fluid production, connective tissue quality, hormone production. High plane of nutrition affects growth rate (rapid bone growth, and wt gain. overload soft tissue support, increased frequency and severity of hip dysplasia). excessive vitamin D and calcium supplementation. pelvic muscle mass-disparity between muscle mass and skeletal growth.
classifications of osteochondrosis
growth plate osteochondrosis, articular osteochondrosis
growth plate-retained ulnar cartilaginous core
articular-more common. where there is secondary loss of blood supply from cartlaige canal blood vessels, then risk for microtrauma. and get get lesions. if large enough can get focal thickening of articular calirtage.
osteochrondritis dissecans-most commonly recognized manifestation of osteochondrosis. development of a cartliage flap elevated from the subchondral bone. release of necrotic debris - inflammation. get pain lamness and oa intitation.
type 1-most common. develop in center of joint. no vascular attachments.
type 2-less common maintain vascular attachments
diagnostic tests
CK, alt, ast, biopsy, EMG, imagign ,infectious dx
In growing dogs these are common differential diagnoses for forelimb lameness vs adult dogs have
for pelvic limb lameness in growing dog and adult dog
forelimb
growing dogs: OCD, elbow dysplasia, limb abnormalities, fractures, luxations
adult dogs: fractures, luxations, osteoarthritis, neoplasia, inflammatory arthropathies, hypertrophic osteopathy
pelvic limb
growing dog: hip dysplasia, OCD, patellar luxation, hypertrophic osteodystrophy, fracture, luxation
adult dog: osteoarthritis, patellar luxation, cruciate ligament dx. inflammatory arthropathy, neoplasia, fracture, luxation
This joint dx is infection via blood borne, the pt will be systemically ill with pain, fever, inflamed/swollen joints, periarticular tissues. On arthrocentesis the synovial fluid will be less vicous, with lots of neutrophils, organisms on cytology. TX is resolve infection, remove debris and antibotics, joint drainage
What is this and what is the classification
Septic arthritis (inflammatory, non-erosive arthopathy)
Clinical presentation of hip dysplasia in young vs mature dogs
orthopedic exam
pelvic limb lameness. young dogs acute, coxofemoral laxity, stretching and tearing of the joint capsule. pain due to synovitis and microfractures of the acebular rim. mature dogs due to OA. Young dogs: issue up stairs, bunny hopping gait, issue rising,. older dogs swaying gait, stiff gait, pelvic limb atrophy, slow progressiion, look for ccl tears
orthopedic exam: crepitus and pain on flexion and extension of the hip, decreased range of motion, m atrophy, sway gait. ortolani sign
hips do extended view
clinical presentation?
*four widely reported locations for ocd in the dog
common in young large or giant breed dogs, males over represented. very rare in cats. specific locations, commonly bilateral
humoral head, medial aspect of the humeral condyle, lateral or medial femoral condyle, medial or lateral trochlear ridge of the talus
masticatory muscle myositis
effects 2m muscle fibers
young to middle aged dogs, more common in large breeds, german shep, retrieveres, dobermean
acute painful swelling fever depression. chronic muscle loss atrophy sunken globes issue openinging mouth
TX-steroids
To check for cruciate ligament rupture this is done
cranial drawer, cranial tibial thrust (tibial compression test); meniscal click
This is part of the systemic inflammatory response to an inciting agent. Synovitis from articular immune complex deposition. The TX is to remove underlying cause, immunosuppressive therapy often needed. EX caused by HW dx, neoplasia, IBD
and has the same clinical characteristics as?
reactive polyarthritis; IPA (idiopathic polyarthritis)
on radiograph hip dysplasia is defined by?
coverage of <50% of the femoral head by the dorsal acetabular rim.
diagnosis?
rads-see subchondral bone defect.
ultrasound, CT, mri, arthorscopy-allows concurrent diagnosis and tx
extraocular myositis
young, goldens, bilateral, ck normal, biopsy diangosis, prognosis good, tx steroids
These are diagnostic options
which is the initial screening diagnostic
radiographs, arthrocentesis, ultrasound, CT, MRI, fluroscopy, scintigraphy, gait analysis, arthrography, arthroscopy.
radiograph-sedation key, at least 2 orthogonal views
arthrocentesis-submit joint taps for both cytology and culture
ultrasound-eval ligaments and tendons. help with arthrocentesis.
scintigraphy-neoplasia, inflammation, infection
CT-eval bone
arthroscopy min invasive. diagnostic and therapeutic tool. more commonly used in elbow, shoulder and stifle.
Fluoroscopy-not commonly used as a diagnostic tool.
This is erosive polyarthritis and progressive joint destruction over time. more common in dogs, toy, small breed. and is usually in distal joints, see fever anorexia, stiffness and reluctance to move, joint pain, and swelling. Seen in adults
looks same as
rheumatoid arthritis
(looks same as IMA or impa)
TX based on stage?
conservative any age
hip preservation-immature no OA: pubic symphysiodesis-first preventive requires open physes (12-20 weeks) min aftercare and complications
triple pelvic osteotomy-young dog, improve coxofemoral joint congruity
salvage procedures: total hip replacement-mature animal, no sign of infection, clinical signs of hip dysplasia
femoral head and neck ostectomy-chronic OA from any cause, acetabular fractures, femoral head or neck fractures, chronic luxation of the hip
TX
non surgical-rest, nsaid, wt loss, pt.
sx are pallative-arthoscopy/arthrotomy, flap retrieval, debridement, of any additional unhealthy cartilage, curettage, forage, microfracture,
hypokalemic myopathy
see in cats, cervival ventroflexion. usually secondary to renal dx. stiff gait, muscle pain. resolves if correct low k