Page 388 - Canine Lameness

360 20 Hip Region

pain associated with their coxofemoral laxity and resulting inflammatory changes (e.g. synovitis).
These dogs will present with a history of exercise intolerance compared to other puppies, reluctance
to climb stairs and jump onto things/into the car, generalized muscle atrophy of the pelvic limbs,
a bunny hopping and short-strided gait (Video 20.2), narrow stance, and occasionally vocalization
with petting of the hip region or manipulation of the hip joint. Later in life, presentation is associ-
ated with OA of the hip joint and a history of decrease in activity, stiffness when rising, worsening
lameness with heavy activity, reluctance to jump, muscle atrophy of the pelvic limbs, and possible
change in behavior associated with pain being reported by owners.

Video 20.2:

Hip dysplasia gait examples.

20.5.2 Physical Exam
Diagnosis is most commonly made based on physical exam findings and orthogonal radiographs.
Dogs with HD experience pain particularly during hip extension. Differential diagnosis for pain on
extension of the coxofemoral joint include any other coxofemoral joint disease (e.g. aseptic necro-
sis of the femoral head in young patients, femoral head and neck fracture, sepsis, and neoplasia),
neurological disease affecting the lower back (e.g. lumbosacral disease), stifle pathology (most
notably cranial cruciate ligament rupture), or pathology of any muscle stretched during hip exten-
sion (e.g. sartorius, iliopsoas muscle). Therefore, further manipulation of the hip joint (flexion and
abduction) should be performed as the next diagnostic step. If pain is elicited during these latter
two maneuvers, true pathology of the hip joint is more likely. If no pain is elicited, further evalua-
HIP REGION manipulation of the coxofemoral joint, and joint laxity. Hip laxity can be assessed with specific
tion of the differential diagnoses should be pursued (Figure 20.8 and Video 3.1).
In young dogs, examination will reveal generalized pelvic limb muscle atrophy, pain with

tests such as the Ortolani maneuver (Figure 20.9 and Video 20.3), whereby the hip is subluxated
and subsequently reduced (Syrcle 2017). The Ortolani test is typically performed with the dog in
lateral recumbency, but can also be done with the dog in dorsal recumbency. The clinician places
one hand on the dorsal aspect of the pelvis and spine to stabilize it, the second hand is placed on
the stifle to maneuver the hip joint. Initially, the hip is subluxated by adducting the stifle and plac-
ing gentle pressure proximally to allow the femoral head to subluxate/luxate above the dorsal rim.
This aspect of the Ortolani test is also known as the Barlow test. Next, gentle proximal pressure is
maintained along the axis of the femur while the limb is abducted. A clunk or click may be heard,
and palpated when the hip is reduced, this is considered a positive test. The Barden’s test, which is
less frequently used, also assesses for laxity of the hip joint. This is done by placing a lateral force
on the femur with one had while the dog is in lateral recumbency without abducting the limb. The
other hand is placed on the greater trochanter to assess for motion. If there is more than ½″ of

Video 20.3:

How to perform the Ortolani maneuver.