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 50 NOVEMBER/DECEMBER 2018 todaysveterinarypractice.com that for patients with mild lameness or subtle gait abnormalities, reversing the order of the examinations (i.e., physical examination with palpations/ manipulations followed by gait assessment) may allow for better recognition of a subtle gait abnormality. GAIT ASSESSMENT Gait is assessed with the patient standing, walking, and trotting. Besides observing the patient start, stop, and change pace, you should evaluate its gait from different profiles (right lateral, left lateral, cranial, caudal). Things to look for while assessing gait include variations in stride length, timing of foot contact, relative swing phase of limb/joint, lameness, ataxia (coordinated versus uncoordinated), head bobs, pelvic swings, circumducted swing phases, dynamic or static rotations (external or internal) of a limb, foot/nail scuffing, leg crossing (especially during turning), narrow stance in pelvic limbs, tail position, head/neck position, and hock and carpal position (palmar-grade/ plantar-grade, dorsiflexion) ( FIGURES 1 TO 3 ). To view the full video of FIGURE 3 online, visit TVP.com . You should also evaluate whether the gait abnormality is coordinated (usually musculoskeletal conditions) or uncoordinated (usually neurologic conditions). Gait assessment findings that suggest musculoskeletal or neurologic conditions are as follows: Musculoskeletal (pain or mechanical) ■ Shortened stride but placing limb well ( FIGURE 1 ) ■ Audible clicking or "clunking" ■ Pelvic swaying, head bobbing ( FIGURE 2 ) ■ Narrowed pelvic limb stance Neurologic (weakness) ■ Hypermetria ■ Ataxia, especially during acute turns ( FIGURE 3 ) ■ Lengthened stride with prolonged stance phase ■ Weakness/knuckling/dragging limb/limb crossing ■ Head down with stiff neck ■ Tail down Helpful Clinical Tip: Having a veterinary nurse or assistant video record the patient's gait with a smartphone can be a significant time-saver. Many video functions allow for slow-motion playback, which can help you identify the affected limb and/or joint. The video should capture the animal's right and left lateral, cranial, and caudal profiles at the walk and E A B F D C FIGURE 1. A 6-year-old, spayed female Alaskan malamute with cranial cruciate ligament rupture of the left stifle, shown at a walk. Left pelvic limb: late stance phase (A) and early swing phase (B). Right pelvic limb: late stance phase (D) and early swing phase (E). Because of discomfort/joint instability, the placement of the left (abnormal) pelvic limb foot in the midstance phase is shorter than that of the right pelvic limb foot when the right limb is in late stance phase (C) (compared with part A). The opposite is true when the right pelvic limb is in midstance phase compared with the left pelvic limb foot in late stance phase (F). This difference in foot placement is partially the result of discomfort/instability during weight-bearing on the affected limb, resulting in a shorter stance phase for the affected than for the unaffected limb during weight-bearing. The observed effect is that the dog more quickly unloads the weight on the affected pelvic limb (shorter stance phase) than on the unaffected pelvic limb (longer stance phase). Arrows demonstrate the respective distances in foot placement.

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