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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FEATURES NOVEMBER/DECEMBER 2018 51 trot and should be made in areas with good lighting and on surfaces with good traction for the patient. PHYSICAL EXAMINATION Examining the Standing Patient During the physical examination (palpation and manipulation), initially the patient is standing and the examination is performed head to tail, or tail to head. The examination should include cervical manipulation (dorsal, ventral, lateral flexion); direct digital pressure over the cervical, thoracic, lumbar, and lumbosacral spine; and assessment of limb symmetry, including muscle atrophy and joint effusion ( TABLE 3 ). Observe the stance and position of each limb, assessing for angulation (valgus, varus, external rotation, internal rotation). During palpation, pay careful attention to any swellings of the joints, muscles, or long bones (firm or soft swellings). It is critical that you evaluate conscious proprioception in all 4 limbs while the patient is standing. Examining the Patient in Lateral Recumbency After you have examined the standing patient, perform palpation and manipulation with the patient in lateral recumbency ( TABLE 4 ). Begin your examination at the distal aspect of the limb and proceed proximally. Check the plantar/palmar foot surfaces for evidence of corns, foreign material, abscesses, and irregular wear patterns of the nails. Next, assess the range of motion (flexion, extension, adduction, abduction) of all joints while isolating joint motion. During the range-of-motion assessment, note any abnormal joint-based sounds or sensations and differentiate between synovial popping (a palpable light and subtle popping sensation during flexion and extension of a FIGURE 2. A 3-year-old spayed female yellow Labrador retriever with nonmineralized supraspinatus tendinopathy of the right shoulder, shown at a trot. (A, B) The head is transposed upward (head-bob up) upon weight-bearing on the affected right thoracic limb during the stance phase. Head movement upward dynamically unloads the affected limb during the stance phase to reduce discomfort during weight-bearing. (C, D) The head is lowered to a neutral position upon weight-bearing on the unaffected left thoracic limb. Vertical black arrows on the frames and horizontal lines on the wall are reference points for head position during the gait cycle. A B C D TABLE 3 Examination Findings Suggestive of Musculoskeletal or Neurologic Conditions in Standing Patients FINDING MUSCULOSKELETAL NEUROLOGIC Asymmetric or symmetric muscle atrophy + + Asymmetric or symmetric muscle enlargement + Asymmetric or symmetric joint thickening, enlargement, heat + Valgus, varus, external or internal rotation of limb + Hyperextension + + Plantar-grade or palmar-grade stance + CONSCIOUS PROPRIOCEPTION DEFICITS Severe + Mild to moderate + +

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