Page 96 - Canine Lameness

68 5 The Rehabilitation Examination

Box 5.1 Components of the Rehabilitation Exam
1) Passive Range of Motion (PROM)
a) End-feel
b) Osteokinematics (goniometry)
2) Joint Play
a) Arthrokinematics
3) Flexibility
a) Passive flexibility (muscle stretching)
b) Myofascial exam (Chapter 6)
4) Strength
a) Canine Muscle Test (C-MT)
5) Special tests (see Chapters 12–22 for specific regions)

continues to be the gold standard for determining the underlying cause of lameness. Therefore, if
diagnostics are not available, care should be taken when using clinical exam findings for the purpose of
treatment planning.

5.2 Passive Range of Motion

PROM testing comprises the foundation of the rehabilitation manual evaluation for the purpose
of determining if osteokinematic abnormalities contribute to a canine patient’s lameness.
Osteokinematics describe the movement between two bone segments (i.e. flexion and extension,
abduction and adduction, and external and internal rotation of a joint). PROM testing includes two
components that provide important pieces of clinical information: (i) the subjective description of
the end‐feel and (ii) the objective goniometric measurement. End‐feel is the subjective description
of the sensation that the observer experiences at the end of joint range of motion (i.e. the “end‐feel
limiting structure” of the joint). The end‐feel provides the tester with information about which
tissues should be evaluated further (Figure 5.1), while the goniometric measurements determines
if PROM is normal, restricted, or excessive.
Various classifications, terminology, and descriptions have been used to describe different end‐
feel observations (Petersen and Hayes 2000; Marcellin‐Little and Levine 2015). The purpose of
assessing end‐feel is to determine which tissue type may be allowing excessive PROM or restricting
it. Some end‐feels can be normal or pathologic, depending on the joint and the point at which dur-
ing motion they are observed (Table 5.1 and Figure 5.2). As such, the observer needs to be aware of
the normal end‐feels for each joint (Table 5.2). If PROM testing detects an abnormal amount of
motion (decreased or increased) between the two bone segments, the type of end‐feel may indicate
which tissues are causing this finding and isolate those that require further evaluation as seen in
Figure 5.1. With the end‐feel in mind, the objective goniometric measurement is taken to deter-
mine if range of motion is normal. Reference ranges are available (Figure 5.3, Tables 5.3 and 5.4)
but because they may vary between breeds (Thomas et al. 2006; Hady et al. 2015), the contralateral
limb should be used for comparison (if unaffected).