Today's Veterinary Practice

NOV-DEC 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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PEER REVIEWED 46 NOVEMBER/DECEMBER 2018 aware that musculoskeletal or neurologic conditions can be acute, subacute, or chronic. Current or previous responses to medications, such as changes in gait abnormality after administration of drugs (e.g., nonsteroidal anti-inflammatory drugs, glucosamine/ chondroitin sulfate, or corticosteroids), also provide valuable information. The historical character of the lameness or gait abnormality will also provide critical diagnostic information, such as lameness that worsens after activity or resting (musculoskeletal), a gait abnormality that is always present regardless of degree of rest or activity (musculoskeletal, neurologic), lameness that improves after mild exercise (i.e., "warms out of the lameness"; musculoskeletal), a gait abnormality that involves unilateral or bilateral limbs (musculoskeletal, neurologic), a gait abnormality that is visible in multiple limbs (musculoskeletal, neurologic), or lameness that seems to be weather-related (musculoskeletal). Consider the periodicity of the gait abnormality (intermittent or persistent) and whether the gait abnormality has been progressive or static over time. Although both musculoskeletal and neurologic conditions can cause intermittent or persistent gait abnormalities, determining the time course of the condition will help you prioritize the differential diagnoses for potential musculoskeletal and neurologic disease processes. Helpful Clinical Tip: In a busy practice setting, taking the time to obtain the signalment and details of the lameness history can seem daunting to the clinician, but having a veterinary nurse (versed in obtaining these critical data) do this for you can be a great time-saver and can provide essential information for piecing together the cause of the clinical gait abnormality. CLINICAL EXAMINATION The clinical examination is performed in 2 parts: gait assessment and physical examination (which includes palpation and manipulation of the patient). 1-4 As part of the clinical examination, you will need to localize the affected limb or joint, which can be accomplished by assessing gait (directly observing the patient's ambulation) and directly palpating the patient's joints, extremities, and spine. Although the gait assessment is routinely conducted before the direct physical examination, we have found TABLE 2 Historical Features That May Characterize a Gait Abnormality as a Musculoskeletal or Neurologic Condition HISTORY LAMENESS TYPE CONDITION Lameness Acute, chronic, insidious Musculoskeletal or neurologic Present initially, then improves (is warmed out of) or worsens with activity Musculoskeletal Persistent Musculoskeletal or neurologic Tetraparesis, paraparesis, or paralysis Neurologic MEDICAL Response to pharmaceutical: NSAIDs* Improves or resolves Musculoskeletal No effect* Musculoskeletal or neurologic* Response to pharmaceutical: steroid (after initial trial with NSAIDs with no effect) Improves or resolves Neurologic Response to nutraceutical Improves or resolves Musculoskeletal No effect Musculoskeletal or neurologic Rest Improves or resolves Musculoskeletal No effect Neurologic NSAIDs, nonsteroidal anti-inflammatory drugs. *May require the administration of at least another NSAID to determine efficacy for lameness improvement or resolution.

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