Page 62 - Canine Lameness

34 3 The Orthopedic Examination

Following a consistent approach to the orthopedic examination is recommended because doing
so can avoid omitting important steps during the evaluation and subsequently missing a diagnosis.
A full neurologic examination (Chapter 4) should be performed in any dog suspected to have neu-
rologic disease. However, a few components of the neurologic examination should be included in
every orthopedic examination (i.e. paw replacement, paraspinal palpation, tail lift, and neck range
of motion). The text below, Table 3.2, and Video 3.1 outline the approach to the orthopedic exami-
nation regularly performed by the authors.

Video 3.1:

Complete orthopedic examination.

Starting the orthopedic examination with palpation of the pelvic limbs maintains distance from
the front of the animal, thus permitting an assessment of the patient’s demeanor in a safe manner.
The first step is to evaluate proprioception of both pelvic limbs by performing the paw replacement
test (Video 4.2). If there is uncertainty about which pelvic limb is affected, the examiner can gently
pull back on both legs simultaneously to compare weight‐bearing to identify the impaired leg
(Video 3.1). Subsequently, palpating the pelvic limbs simultaneously (comparing left to right) will
detect any muscle asymmetry, masses, or soft tissue swelling. The tarsus and stifle are also evalu-
ated for presence of joint effusion. Next, the examiner should lift the tail (a pain response may
indicate lumbosacral disease) and then perform paraspinal palpation (in between dorsal spinous
processes and the paraspinal musculature). This is followed by examining neck range of motion
(ventroflexion, dorsoflexion, and lateral movements). The thoracic limbs are palpated in a similar
fashion and compared for any asymmetry (e.g. muscle mass, soft tissue masses, etc.) and evaluated
for joint effusion of the elbow and carpus, ending at the distal limb whereupon proprioceptive test-
ing is performed (e.g. paw replacement test). To identify the lame thoracic limb, legs are lifted
alternatingly while standing over the animal.
Following this general palpation, a more detailed evaluation of the musculoskeletal structures of
the limbs is performed. While the above outlined steps 1–13 (Table 3.2) should be performed in a
standing position (to allow a comparative assessment), the following steps 14–44 may also be per-
formed in lateral recumbency. In general, the detailed palpation consists of long bone palpation
(e.g. evaluation for swelling, heat, pain, and crepitus), muscle palpation (e.g. evaluation for swell-
ing, hypertrophy, atrophy, and pain), collateral ligament assessment (e.g. applying varus/valgus
stress), joint assessment (e.g. performing flexion, extension for all joints, and abduction for shoul-
der and hip joint in addition to evaluation for periarticular swelling, crepitus, joint effusion, and
pain), and specific tests (e.g. drawer motion for cruciate disease). Of important note is that while
the detection of pain is an important feature of determining the source of lameness, it is not neces-
sary to elicit frequently referenced symptoms of pain (e.g. biting and vocalizing) to make this deter-
mination. The authors prefer to use more subtle signs, such as resistance to range of motion, head
turning, licking, widening of the pupillae, swallowing, muscle twitching, or moving away from the
evaluator (during standing exam). This approach maintains a positive relationship with the patient,
facilitating further diagnostics and treatment. Furthermore, it allows to follow a systematic, con-
sistent approach to the orthopedic exam (rather than evaluating the affected limb last as frequently
recommended).