Page 115 - Canine Lameness

6.4 The Myofascial Examination 87

induce flexion of the coxofemoral joint are therefore required to continuously contract, which may
result in the metabolic overload and the formation of MTPs (please refer to the MPS patterns below
for more detail).

6.4 The Myofascial Examination

Myopathies are a frequent cause of lameness, yet, examination of the muscles for pain and/or dys-
function is not generally part of the standard physical, orthopedic, or neurologic examination in the
canine. In the author’s opinion, it is imperative that the myofascial examination be included in any
lameness workup to avoid missing a source of lameness and allowing for appropriate treatment.
Anatomical understanding as to the functional muscle units (i.e. muscles that activate a joint) of
a joint is crucial and can assist in examination for additional areas of pain and dysfunction.
Identification of taut bands and hypersensitive MTPs within muscle is an acquired skill that
requires practice and an understanding of muscular anatomy, especially muscle fiber direction.
The myofascial examination begins in the examination room, usually with the patient standing.
This portion of the examination is to identify areas of myalgia and patterns (Table 6.1). The myo-
fascial examination is not completely separate from the orthopedic examination but rather compli-
mentary to it. Once the areas of myalgia have been identified, examination of the muscles in a
relaxed state is preferred. This portion of the examination is usually performed with the patient in
a lateral recumbent position.

There are two basic palpation techniques (Figure 6.1) employed in a myofascial examination
(Wall 2014):
Flat palpation: Examination by finger pressure across muscle fibers in a perpendicular direction
●
to the muscle fibers while compressing them against a firm underlying structure such as bone.
This technique is employed for muscles such as the supraspinatus, infraspinatus, and psoas
major.
Pincer palpation: Examination of a part of a muscle by holding it in a pincer grasp between the
●
thumb and fingers. Groups of muscle fibers are rolled between the tips of the digits to detect taut
bands. This technique is used for muscles such as the triceps, sartorius, and tensor fasciae latae.

Table 6.1 Common myofascial pain syndrome patterns.

Clinical problem Clinical exam findings MTP locations
Chronic CCLD or slow recovery post‐ Non‐weight‐bearing or Stifle flexors, extenders, and
Tibial Plateau Leveling Osteotomy limited weight bearing in adductors as well as in thoracic
(TPLO) or Femoral Head and Neck surgical limb limb due to weight shifting
Ostectomy (FHO)
C6–T2 lesion Neurologic signs typical Triceps and any muscles
for radiculopathy innervated by the innervated
nerve
Hip dysplasia Weight‐bearing lameness Pectineus, gluteal musculature, and
hip flexors as well as in thoracic
limb due to weight shifting