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 todaysveterinarypractice.com NOVEMBER/DECEMBER 2018 53 ■ Imaging (radiography, ultrasonography, arthroscopy, fluoroscopy, myelography, computed tomography, magnetic resonance imaging, nuclear scintigraphy) ■ Synoviocentesis ■ Cerebrospinal fluid analysis ■ Electromyography ■ Nerve conduction studies Advanced diagnostics should confirm your tentative diagnosis of a musculoskeletal or neurologic condition, or both. DIAGNOSTIC ERRORS The importance of performing a complete physical examination of the patient cannot be overemphasized. We have found that among referrals to our practice for subclinical or nonclinical hip dysplasia, 33% had been misdiagnosed because of incomplete physical examination and actually had cranial cruciate ligament disease causing the clinical lameness. 5 The following factors can lead to an incorrect diagnosis of musculoskeletal or neurologic conditions: ■ Incomplete or no gait assessment performed. ■ Incomplete musculoskeletal palpation of all 4 limbs, especially of what may be the affected limb/joint. ■ Failure to radiograph the affected limb or joint, usually because of an incomplete physical examination and gait assessment. ■ Not obtaining a complete history and character of the patient's lameness or gait abnormality. ■ Not following up soon enough after instituting treatment, which may delay consultation with or referral to a specialist. CONCLUSION To be able to correctly discern between musculoskeletal and neurologic conditions, it is essential that you obtain a complete medical history and perform a clinical examination, which includes gait assessment and a complete physical examination, including palpation. Being aware of the qualitative differences in gait in a patient with a musculoskeletal (pain/discomfort, mechanical) or neurologic (weakness/ataxia) condition can help lead you to a correct diagnosis. Advanced diagnostics should confirm your tentative diagnosis of a musculoskeletal or neurologic condition, or both. For patients for whom the distinction is not clear during initial evaluation, timely re-evaluations may be considered as needed. Consultation with a specialist can also help you arrive at the correct diagnosis for patients with musculoskeletal or neurologic conditions. TABLE 5 Physical Examination Findings Suggestive of Major Tentative Diagnoses of Musculoskeletal or Neurologic Conditions FINDING SUGGESTIVE OF Shoulder atrophy; pain during extension, flexion, or abduction of shoulder Osteochondritis dissecans, shoulder instability, bicipital tenosynovitis, supraspinatus tendon disease General forelimb atrophy, especially supraspinatus, infraspinatus muscles; pain during extension of shoulder Cervical disease, radiculopathy, nerve sheath tumor Elbow synovial popping/crepitus, discomfort during medial collateral ligament pressure, thickened joint Elbow osteoarthritis secondary to elbow dysplasia Medial buttress, decreased patellar tendon definition, synovial popping/crepitus, generalized stifle thickening, discomfort during hip extension, no discomfort during hip abduction, no drawer sign Cranial cruciate ligament rupture Discomfort over lumbosacral area and during tail-base extension Lumbosacral instability Discomfort during hip extension and abduction Hip osteoarthritis Discomfort during hip internal rotation with extension and direct palpation pressure over iliopsoas region Iliopsoas myopathy/tendinopathy Acute ataxia, hyperreflexia, decreased proprioception, decreased or loss of deep pain Central neuropathy, disc disease, neoplasia, fibrocartilaginous embolic disease Progressive and chronic wearing of dorsal skin of paws, muscle atrophy, hyperreflexia, hyporeflexia Central neuropathy, disc disease, neoplasia, degenerative myelopathy

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