Page 317 - Canine Lameness
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18.3  ­FractFres  ofctrf rFesral  reg o  289

             18.3.2  Physical Exam
             When the injury is recent, the affected limb is usually carried. There may be an angular deformity
             evident at or distal to the tarsocrural joint. Because of the acute nature of the injury, physical exam
             findings usually show severe pain upon tarsal manipulation requiring sedation to perform a full
             examination and diagnostics of the limb. Examination of the limb should include placing the tar-
             sus through full range of motion, evaluation for joint effusion, and stress testing of the limb in
             varus and valgus stress as well as applying dorsal and plantar stress (Figure 18.4). If the distal tibia
             is held in position while the metatarsus is manipulated, excessive flexion, extension, or mediolat-
             eral motion may be elicited.


              (A)                       (C)                      (E)                            TARSAL REGION






















              (B)                       (D)                      (F)























             Figure 18.4  Physical examination steps to detect tarsal joint pathology: (A) to fully flex the tarsal joint,
             the hip and stifle joint also have to be flexed; (B) isolated tarsal hyperextension can be performed by
             grasping the tibia below the stifle and extending the tarsus with the lower hand – this allows the observer
             to differentiate stifle from tarsal pathology; joint effusion is palpable (C) caudal and (D) cranial to the
             lateral malleolus; (E) applying upward pressure from plantar while flexing the stifle stresses the distal
             tarsal joints and may show instability; (F) the common calcanean tendon can be stretched by holding the
             stifle in extension from cranially while flexing the tarsus.
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