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 52 NOVEMBER/DECEMBER 2018 todaysveterinarypractice.com joint radiating through the joint capsule because of joint effusion) and crepitus (articular surface grating). During joint manipulation, assess ligament-based stability by direct palpation, evaluating for things such as loss of collateral constraint or cranial drawer sign. Note any joint swelling/thickness, heat, or pain during manipulation. Differentiate between pain caused by direct digital pressure (e.g., direct pressure over the medial compartment of the elbow, over the biceps brachii tendon of origin at the intertubercular groove of the humerus) versus pain caused during flexion or extension of a joint. Lastly, evaluate myotactic reflexes and deep pain before progressing to the next limb. If possible, avoid sedation during this portion of the examination because it could influence the patient's response to manipulations and palpations. Remember that deep pain is a conscious response to noxious stimuli and not just a reflex withdrawal of the limb. Helpful Clinical Tip: As a time-saver, if after assessing gait and while performing the physical examination you believe that the patient is affected by a musculoskeletal and not a neurologic condition, then you may not need to perform full myotactic reflex and deep pain assessments. However, for all patients for which you suspect a musculoskeletal condition, as a minimum neurologic assessment you should still test conscious proprioception reflexes. If deficits are detected, then consider performing more focused myotactic reflex assessments on the affected and contralateral limbs, evaluating epaxial muscle reflexes, and performing additional neurologic evaluations as necessary to localize the neurologic lesion. ADVANCED DIAGNOSTIC TESTING After you have performed a through physical examination and formed a list of differential diagnoses ( TABLE 5 ), you can perform advanced diagnostic testing. Advanced diagnostics include but are not limited to the following: TABLE 4 Examination Findings Suggestive of Musculoskeletal or Neurologic Conditions in Patients in Lateral Recumbency FINDING MUSCULOSKELETAL NEUROLOGIC Muscle atrophy + + Muscle enlargement + Joint thickening, enlargement, heat + Decreased joint range of motion + Crepitus + Synovial popping + Joint ligamentous instability + Hyperreflexia + Hyporeflexia + Absence of deep pain + PAIN/DISCOMFORT DURING JOINT MANIPULATION Hip - Extension + + Hip - Abduction + Tail base extension + PAIN/DISCOMFORT DURING BONE MANIPULATION Long bones + Spine/cervical column + During joint manipulation, assess ligament-based stability by direct palpation, evaluating for things such as loss of collateral constraint or cranial drawer sign.

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