Clinic for Small Animal Surgery, Department of Small Animals, Vetsuisse-Faculty, University of Zurich, Zurich, Switzerland
The objectives of this lecture are to review the basic techniques associated with a proper examination of the orthopedic patient using videos and photos. The proceeding notes include only a few key points that will be discussed in more detail in the lecture. Most orthopedic conditions can be diagnosed based solely on a good history and thorough orthopedic examination. Confidence and comfort with the orthopedic examination can be gained with time and practice. A list of tips for orthopedic examination include:
1. History and signalment matters!
The breed, age and sex of the patient can guide you in the diagnosis, and help you focusing to specific areas during the orthopedic examination. Pay attention to details that you can learn from the owner. Ask specific questions that can help you ruling out trauma, infection or other specific pathologic process with certain disease pattern.
2. Develop a methodical approach
It is crucial to develop a system. You may start from the front or the back of the dog. You may start palpating the distal aspect of the limbs and progress proximally, or you may prefer to start from joints, then bones, muscles etc. However, always use the same approach.
3. Palpate normal and pathologic to build a tactile database
It is important to acquire confidence for your orthopedic examination and diagnosis. Practice is the key to gain confidence. However, practice not only on the patients with suspected orthopedic disease, but also normal animals coming for a vaccination.
4. Examine the dog without stress (both for you and your patient)
This “rule” seems obvious, but examining a stressed and scared dog can be unsuccessful, as stress may hide natural responses to painful manipulation. Although the response to stress highly depends on dog personality, it is important to minimize the stress by either letting the dog standing or laying it down, depending on the dog.
5. Review anatomy
Thorough knowledge of regional anatomy is important for orthopedic diagnosis. The typical example is palpation of the tarsus. Palpation of the tarsus is performed in both flexion and extension. A ruptured long ligament or tibiocentral ligament can be detected in extension of the tarsus showing medial instability. When evaluating lateral tarsal stability, during extension of the tarsal joint, the long lateral and the calcaneofibular short ligament are taut, while the talofibular short component is tensioned when the tarsus is in a flexed position. Similarly, palpation of the stifle can only be successful if the anatomy of the cruciate ligaments is well understood.
6. Consider sedating the animal for specific palpation techniques
It may be useful to perform palpation of the joints under sedation in addition to the evaluation in the awake animal. When awake, the dog may show pain response, but palpation to evaluate instabilities is better accomplished when sedated.
7. Take notes
This tip may help especially in the most complex cases, when multiple problems are present.
8. Do not rush!
This is probably the most important rule, which is often forgotten when gaining experience.