Page 105 - Canine Lameness

5.3 Joint lay 77

teres major, deep pectoralis, deltoids, infraspinatus, and the long head of the triceps. Flexibility
testing of these muscles and thorough evaluation for pain should then be performed. These
findings may then lead the tester to determine that further diagnostics (e.g. ultrasound) of the
area may be indicated (Figure 5.1).

5.3 Joint Play

While testing range of motion is commonly taught in veterinary school, testing of motion within
the joint is only taught for very specific examples (such as “cranial drawer” motion with rupture of
the cranial cruciate ligament). These small amplitude movements at the level of the joint are
defined as arthrokinematics, joint play, or accessory motions. The concept of arthrokinematic testing
has been described for assessment of the canine spine, where it is known as the chiropractic
evaluation (Taylor and Romano 1999). Although there is a lack of research supporting the use of
chiropractic evaluations and treatments in veterinary medicine (Rome and Mckibbin 2011), there
are several examples of arthrokinematic assessments being applied in veterinary orthopedics.
Such examples include the testing for hip laxity (Ortolani maneuver; Chapter 20) and evaluation
of cranial or caudal drawer motion of the stifle. While these examples are well‐known applications
of arthrokinematics in small animal orthopedics, the rehabilitation exam aims to use the same
concept to identify more subtle abnormalities for all joints. In other words, the chiropractic exami-
nation includes arthrokinematic evaluation of the spine, whereas joint play is the arthrokinematic
evaluation of appendicular joints.
When goniometric measurements are increased or decreased, further evaluation of joint arthro-
kinematics is warranted. PROM tests osteokinematic motion, whereas joint play (i.e. arthrokine-
matics) tests the subjective quality and quantity of movement between two articular surfaces
(Figure 5.6). Joint play occurs between two joint surfaces and may include a combination of three
primary types of motion: rolling, spinning and gliding (sliding) which can be associated with spe-
cific osteokinematic motions. For example, carpus extension and carpus flexion PROM are associ-
ated with the carpal bones gliding caudally and cranially respectively on the radius and ulna. If
carpus PROM measurement is abnormal, further evaluation of joint play of the carpal bones on the
radius and ulna is indicated.
Because the primary PROM limitations diagnosed during canine lameness exam are the
osteokinematic motions of flexion and extension, the remainder of this section is devoted to fur-
ther rehabilitation manual evaluation of the joint play gliding which is associated with these spe-
cific motions. However, the same concepts also apply for evaluating the motion of abduction and
adduction.

5.3.1 How to Perform Joint Play Testing

Joint play testing is the subjective evaluation of two components of arthrokinematics – the quality
and quantity of motion. This test is passive and should be completed with the dog resting in lateral
recumbency. The testing joint should be placed in a neutral position (approximately midrange
between end range flexion and extension) slacking the joint capsule and ligaments to allow the
distal joint surface to glide on the proximal surface with the least interference from these joint
stabilizing structures. To prepare to test joint play, the tester manually stabilizes the proximal bone
as close to the joint surface as possible without painfully compressing soft tissues. To initiate the