Page 61 - Canine Lameness

3.2 The Orthopedic Examination 33

Pertinent questions that should be included in the history are as follows:
1) Was the inciting cause of the lameness observed?
2) How long has the lameness been observed?
3) What was/is your dog’s activity level before/since the onset of lameness?
4) Has the lameness worsened, stayed the same, or improved?
5) Does the lameness improve or worsen with exercise?
6) Have any diagnostics been performed?
7) What treatment(s) has been initiated (including rest and pharmacologic management) and
what was the response?
Knowing the patient’s signalment and taking a thorough history in combination with knowledge
of predisposed breeds is very useful in establishing a diagnosis. Many patients presenting to the
veterinary health professional for lameness are suffering from inherited diseases. It is therefore
advisable to consider these diseases as highly likely differential diagnoses. Online resources are
available to provide this information for purebred dogs (Sargan 2004). For example, a frequent
diagnosis for an eight‐month‐old Labrador Retriever with a two‐month history of bilateral thoracic
limb lameness is elbow dysplasia (ED) or shoulder osteochondrosis dissecans.

3.2.2 Visual Exam
The distant, visual examination is an important part of the orthopedic exam and many conditions
can be suspected without physical palpation. As mentioned in Chapter 1, dogs will frequently
show off‐loading at a stance clearly indicating the affected limb, which is best observed from a
distance (Video 1.1). During the visual exam, conformational abnormalities such as angular limb
deformities, joint instabilities (e.g. valgus deviation with medial collateral ligament injury of the
carpus), and other osseous deformities can be identified. Periarticular swelling (which may indi-
cate joint effusion or chronic degenerative changes), soft tissue masses or swelling (such as Achilles
tendon swelling; Figure 18.8), or other obvious pathology (such as traumatic digit injuries;
Figure 12.8) can be noted. In shorthaired dogs, muscle atrophy can be visible. Standing joint angles
should be assessed and compared between contralateral limb pairs or to reported normal values
(Milgram et al. 2004) if bilateral abnormalities are present. For example, carpal hyperextension
(Video 13.1) and Achilles tendon rupture (Video 18.1) can be suspected based on the visually
increased joint angles.

3.2.3 Palpation

The examination can be performed with the patient in a standing or recumbent position, using
restraint as needed. However, because restraint affects the ability to interpret subtle responses of
the patient, its usage should be minimized. In general, a combination of standing and recumbent
positions is ideal. It is important to compare contralateral limbs to determine whether detected
abnormalities are normal or pathologic, keeping in mind that many diseases are bilateral. This is
best accomplished during a standing examination – if dogs are unable or unwilling to stand, an
assistant may support the dog’s weight by gently lifting from below the abdomen. The recumbent
position is necessary to perform certain specific tests (e.g. Ortolani) and helpful to allow more
detailed palpation of the affected limb. Recumbent versus standing position may also elicit a differ-
ent response from the animal and as such may be helpful if pain responses are difficult to interpret
in an individual patient.