Page 348 - Canine Lameness

320 19 Stifle Region

(A) (B) (C)

(D) (E) (F)

STIFLE REGION

Figure 19.6 Physical examination procedures to detect CCLD include (A) palpation of joint effusion is best
accomplished by palpating the indent just medial to the patellar ligament; (B) isolated hyperextension of
the stifle while maintaining a standing angle of the hip and tarsus can be accomplished by reaching in
between the dogs’ pelvic limbs and placing the upper hand cranial to the stifle, while extending the stifle
with the lower hand; (C) full stifle flexion can only be accomplished when simultaneously flexing the hip
and tarsus; the cranial drawer (D, E; see also Figure 19.7) and tibial compression (F; see also Figure 19.8)
tests can be performed while the patient is (D) standing or (E) in lateral recumbency.

muscle relaxation can allow for easier detection of subtle instability. Palpation of a meniscal click
may also be more accurate with sedation/anesthesia (Neal et al. 2015).
Palpable joint effusion is a consistent hallmark of CCLD at any stage and can be detected by feel-
ing for the medial and lateral borders of the patellar ligament. In the normal canine stifle, a divot
representing the joint space can be detected medial and lateral to the patellar ligament (Figure 19.6).
In the normal joint, the margins of the patellar ligament should be sharply apparent to the touch.
The pad of the index finger should fit into the space located about halfway between the insertion of
the patellar ligament at the tibial tuberosity (usually a distinct bony prominence) and the caudal
aspect of the patella. The earliest sign of CCLD will be subtle joint effusion which is consistent with
synovitis preceding ligament pathology. With joint effusion, this divot will fill in and the margins of
the patellar ligament will be less distinct. Joint effusion in combination with intermittent lameness
with exercise may be the only clinical signs detected in stable partial CCL tears. Initially this swelling