Taking the Lead on Orthopedic Examinations
Veterinary professionals have been trying to perfect the orthopedic examination for decades. Advanced imaging techniques (eg, infrared thermal imaging, computed tomography [CT] scans with 3D reconstruction)and diagnostic methods (eg, force plate or kinematic gait analyses) help considerably. However, despite these highly sensitive objective tools, veterinary technicians play an integral role in reaching a diagnosis.
First Impressions
Veterinary technicians begin collecting vital information before the examination, first noting patient posture and behavior while greeting the client and then as the patient is escorted into the examination room (see Patient Observation). Stress prevention, which helps successful patient compliance, should also begin before the veterinary technician, patient, and client enter the treatment room.1 Using low-stress handling techniques (see Suggested Reading) and allowing few diversions (eg, mats, water bowls, tables that move) in the examination room ensure a better experience and may improve the quality and reliability of examination findings.
Related Article: Frequently Asked Questions: Caring for Your Pet’s Fracture
Show Where It Hurts
Orthopedic examinations are challenging and vary according to the examiner’s expertise level, so it is critical that team members replicate examinations accurately in every patient.
Whether working in general practice or with a board-certified veterinary sports medicine and rehabilitation specialist, the team should be able to perform a standardized systematic physical examination and take a thorough history. Team members should also be knowledgeable about the underlying condition and its management to prevent omissions of important findings.2
Use simple, direct questioning during the evaluation (see Patient History).2 Clients should always be asked to touch or point to the affected limb they think is causing the problem and to clearly state why the patient is being evaluated. While body systems are reviewed, behavioral and physical responses to pain, which vary from patient to patient, should be recorded. Responses may include body postures (eg, cowering, flattened ears) and facial expressions (eg, grimacing, narrowed eyes) and are usually the first clues to the patient’s behavioral state.3
Do We Speak the Same Language?
Orthopedic examinations can be difficult to interpret and require more than a basic understanding of animal anatomy and directional terms (see Anatomic Locations).4 Each anatomic location has a bony prominence that serves as an attachment point for tendons or ligaments. Depressions house muscle bellies.
Related Article: Overview of Traumatic Fractures
Bone, tendon, ligament, and even nerve interactions and composition are important for assessing joint motion in the fore- and hindlimbs. Joint motions are most commonly named according to the distal bone movement relative to the proximal bone. Normal joint motion involves both physiologic and the smaller, less observable accessory motion and is named by one body segment approaching or moving away from another body segment or movement of some referenced bony landmark.5 Limb motion is usually described by motion of the joint rather than a body segment (see Anatomic Definitions).6
Figure 1. A goniometer is used to evaluate carpal flexion.
Assess objective measurements for joint motion with a goniometer (see Figure 1), which quantitatively records joint angles in degrees using specific bony landmarks for each joint.7
Assess muscle girth at standard anatomic sites using a tension tape device such as a Gulick tape measure, which differs from a regular tape measure by its tension device that provides reproducible measurements (see Figure 2).
Figure 2. Thigh muscle girth is measured with a tension tape device.
Use these measurements to determine muscle size, body composition, swelling, and other changes over time. Tension tape measurements provide baseline information used to monitor progress or severity of muscle loss8 at the thigh and above and below the elbow. Measurements can be taken with the patient in a weight-bearing or nonweight-bearing position and should be recorded in the original measuring position when rechecked.<sup9 sup>
Gait Examination
The veterinary team must work together to assess a patient’s gait. Understanding normal gait patterns and proper handling techniques is critical before interpreting abnormal gaits or troubleshooting handler errors.
Dogs use 4 main gaits: the walk, trot, canter, and gallop10 (see Common Canine Gait Patterns11). The amble and pace are also commonly used but are inefficient (in the author's experience) because of a lifetime of improper gait training by a handler or overall poor conditioning.
Dogs first think about putting their feet down in an ordered pattern and struggle most with the trot.12 Early signs of hip dysplasia (eg, bunny hopping) may become evident at this trotting stage; catching hip dysplasia early allows clients to consider early intervention procedures and make nutritional adjustments.<sup13 sup>
When gaiting a patient, a controlled environment with no distractions will produce the most accurate movement analysis.14 With the patient on a loose lead, the handler should move in a straight line and refrain from looking at the patient and causing inadvertent disturbances. Assess gaits on a firm, nonslippery surface, and observe the patient from the side and from behind, and as he or she moves toward and away from the examiner,15 who should stand at a distance. The handler should walk and trot the patient by the observer at a constant speed. Depending on the patient, the client may be the best handler, but a veterinary technician is preferable.
Team Take-Home Points
Orthopedic examinations are complex, and the veterinary team should have enough experience to properly interpret signalment, history, and examination and gait assessment findings. The veterinarian relies on the veterinary technician to report accurate patient information, observations, and client interpretation of the presenting complaint.
Veterinary technicians who understand how to assess patient behavior, movement, posture, and gait patterns, and have a thorough knowledge of low-stress handling techniques, anatomy, and how to take accurate histories and objective measurements can be the lead caretaker of an orthopedic patient from the moment he or she arrives at the practice.
Editor’s note: Kristen Hagler has more than 10 years' experience with physical rehabilitation patients. She collaborates with veterinarians to develop disease- or performance-appropriate rehabilitation plans to keep patients at their optimal activity levels.