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1144 Otoscopy, Video

○ Know normal range of motion for all plateau relative to the rest of the stifle), rim [DAR] view of pelvis, hyperflexed or
joints. appreciated by placement of an index • Arthrocentesis (p. 1059)
hyperextended view of joint).
VetBooks.ir normal for comparison, best achieved in ○ Animal cooperation will determine ○ Where joint swelling is palpated, arthro-
finger on the tibial crest.
○ When appropriate, use opposite limb as
whether the exam requires sedation or
centesis may be indicated for cytologic
a standing position.
evaluation of synovial fluid.
general anesthesia.
• Specific orthopedic tests include an Ortolani
maneuver for hip joint laxity and a cranial • Perform a rectal exam in cases of pelvic trauma. • CT scan and MRI (p. 1132) techniques can
drawer/sign test or a tibial thrust test for be extremely useful in specific cases.
stifle joint instability. Postprocedure ○ Rule in or rule out diagnosis that is unclear
• Ortolani maneuver • Inform owner that some animals may be from exam and routine testing
○ The femur is forced dorsally and per- sore or painful after an orthopedic exam. ○ CT scan is usually preferred for bone
pendicular to the spine in an attempt to • Use nonsteroidal antiinflammatory drugs analysis, and MRI is usually preferred for
subluxate the hip joint. (NSAIDs) if the animal shows evidence soft-tissue analysis, including ligament and
○ Slow abduction of the limb allows the of discomfort or pain (e.g., lameness) after articular cartilage damage.
femoral head to return to the acetabulum. manipulation. ○ Requires general anesthesia
○ An audible or palpable clunk is a positive ○ Cost or availability may be prohibitive.
sign, suggesting hip laxity. Alternatives and Their • Bone scan and nuclear scintigraphy
• Cranial drawer/sign test (p. 218) Relative Merits ○ Helpful to localize an occult orthopedic
○ The examiner places a finger and thumb • Plain radiographs lameness
of one hand on the patella and lateral ○ May require sedation ○ Highly sensitive but nonspecific
fabella proximal to the joint; the finger ○ Minimum of two views of the localized ○ Requires sedation and hospitalization of
and thumb of the other hand are placed region “hot” animal, and cost or availability may
on the fibular head and tibial crest distal ○ Normal opposite limb can be useful as a be prohibitive.
to the joint. control for comparison. • Diagnostic ultrasound
○ Cranial translation of the tibia can be ○ In trauma patients, thoracic radiographs ○ In skilled hands, can identify biceps,
applied to the joint in stifle flexion and should precede orthopedic radiographs as supraspinatus, infraspinatus, triceps,
extension. A torn cranial cruciate ligament part of a minimum database. Achilles and iliopsoas tendon lesions
produces cranial subluxation (cranial ○ Initial radiographic assessment of spinal • Arthroscopy
movement) of the tibia relative to the injuries should ideally be performed ○ Allows minimally invasive visualization
femur. without sedation. and diagnosis ± surgical repair of a joint
• Tibial thrust test (p. 218) ○ Radiographic information and clinical/ disorder
○ Evaluates the same instability as a cranial physical exam are complementary; one ○ Requires general anesthesia, and cost or
drawer test (i.e., tests mainly for cranial cannot entirely replace the other because availability may be prohibitive.
cruciate ligament integrity) some animals with radiographically severe
○ Dorsiflexion of the hock while the stifle lesions are clinically mildly affected and AUTHOR: Nicholas J. Trout, VetMB, MA, DACVS,
is in slight flexion vice versa. DECVS
EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
○ Positive result consists of a tibial thrust ○ Specific radiographic studies may be Thompson, DVM, DABVP
motion (cranial movement of the tibial indicated (e.g., PennHIP, dorsal acetabular

Otoscopy, Video Bonus Material
Online

Difficulty level: ♦♦ ○ Deafness (p. 237) Deep ear flushing:
○ Horner’s syndrome • Requires an assistant; this can be the same
Overview and Goal ○ Vestibular disease (p. 1037) person who is monitoring anesthesia
Video otoscopy is a visually superior technique • Management and monitoring of unresponsive • Requires intubation to protect the lower
over traditional, handheld otoscopy for examin- or recurring otitis respiratory tract
ing the ear canal. It facilitates • Myringotomy for treatment of otitis • Video-otoscope
• Image capture for improving client compli- media • Intraprocedural analgesia to prevent patient
ance and therapeutic monitoring response to stimulus
• Constant visualization during deep canal Contraindications • Ceruminolytic agent such as squalene before
flushing Very painful ears without analgesia and phar- premedicating
• Examination of the middle ear macologic restraint • Warm soapy (chlorhexidine based) water
• Myringotomy and medical treatment of otitis • Sterile physiologic saline solution (warmed
media Equipment, Anesthesia to body temperature)
• Intralesional injection of corticosteroids for Otoscopy: • Three large-volume syringes (>60 mL) to
severely stenotic canals • Video-otoscope push solutions at variable pressures into
• Removal of polyps and foreign bodies • Anti-fog agent (the author uses a drop of the canal
• Biopsy of masses liquid hand soap rubbed on lens) • 5-Fr polypropylene urinary catheter or red
• Skilled restrainer rubber feeding tube with the tip cut, convert-
Indications • Sedation and analgesia if the patient’s ears ing it into an open-ended catheter (heat the
• Diagnostic workup of are painful cut end briefly over a flame to dull it)
○ Otitis (externa and media) (p. 728) • Cotton-tipped swabs to collect samples for • Videoscopic curettes, biopsy forceps, and
○ Head shaking cytology grasper

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