Locomotor - Orthopaedic Disease in Animals - The Lame Dog Case Study
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Clinical case focusing on the topic of orthopedic disease. The case aims to highlight commonly presenting orthopedic concerns and how the similar presenting complaints can represent very different disease processes. The cases are presented in a fashion so that they can be worked through in the same approach a working vet would. The level is intended for pre-veterinary students and veterinary students. For more information please go to my website at http://www.IWantToBecomeAVet.com
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Locomotor - Orthopaedic Disease in Animals - The Lame Dog Case Study
- 1. The Lame Dog Clinical scenario highlighting the approach to orthopaedics in small animals
- 2. IWantToBecomeAVet.com History ✤ Slowing down on walks over last year and now reluctant to exercise at all ✤ Very stiff after laying down ✤ Trouble going up stairs or jumping into car Poppy 9 yo FN Labrador Retriever
- 3. IWantToBecomeAVet.com Physical Exam ✤ BCS 7/9 ✤ Tachypnea ✤ Gingivitis and tartar but basically ... NAD
- 4. CS + Hx PE Orthopaedic Exam Neurological Exam Diagnostic Imaging Arthrocentesis Rx CT MRI US Fluid analysis Cytology DX
- 5. IWantToBecomeAVet.com Orthopaedic Exam ✤ Head to tail approach ✤ Palpate each bone of each limb ✤ Flex, extend and check ROM of each joint ✤ Palpate spine ✤ Check for joint effusion, buttress, muscle atrophy, pain, heat, decreased ROM, instability and creptitus
- 6. IWantToBecomeAVet.com Neurological Exam Mentation Posture Spinal Reflexes Postural Reactions Gait Cranial Nerves Nociception Palpation Level of consciousness; (cerebral, brainstem or systemic dz) alert, obtudned, stupor, coma and quality of consciousness; appropriate if inappropriate (compulsion, delirium) Head- tilt (vestibular dz) or turn (forebrain dz) Limbs- wide based stance (proprioceptive loss), narrow based stance (weakness), decreased weight bearing (pain) Body- decerebrate (FL, HL and neck extended), decerebellate (FL extension, nexk extended, HL flexed), Schiff- Scherrington (rigid FL) Normal or abnormal? What limbs affected? Paresis- decreased voluntary movement (UMN or LMN?- asses postural, spinal reflexes and muscle tone) Ataxia- incoordiantion, sensory (wide based stance, increased stride length, knuckling) or cerebellar ( disorder of rate and range, hypermetria intention or postural tremor) or vestibular (unilateral or bilateral, cicrling, head tilt, crouched) Lameness? A combination? Integration of proprioceptive and motor systems Paw positioning, hopping, wheelbarrowing, hemiwalking, placing tactile, placing visual, extensor postural thrust Testing: SENSORY, CENTRAL and MOTOR (* UMN indirectly) Tendon reflexes: biceps musculocutanous C6-8, triceps radial C7-T2, patellar femoral L4-s2, Gastrocnemius sciatic L6-S2 Flexor withdrawal: Thoracic multiple nn C6-T2, pelvic limb sciatic L6-S2 Additional: perineal pudendal S1-S3, Cutaneous trunci Vision: II optic -> forebrain Menace response: II-> forebrain-> cerebellum->brainstem->VII Facial PLR: II->brainstem->III Occulomotor (direct and indirect) Fundic exam: Optic II Horner’s Syndrome: miosis, ptosis, enopthalamus (sympathetic denervation) Strabismus: eye position VIII Vestibulocochlear -> central vestibular/braistem-> III,IV, VI Nystagmus: eye movement VIII-> CV/brainstem-> III,IV Trochelar, VI Facial sensation-:V Palpebral: V-> brainstem -> VII Corneal: V -> brainstem -> VI Abducent Muscles of mastication: V Muscles of facial expression and lacrimal glands: VII Gag reflex: IX&X -> Brainstem -> IX &X Motor to tongue: XII Hypoglossal Light palpation: swelling or atrophy of HEAD, SPINE and LIMBS Deep palpation: pain perception in HEAD, SPINE and LIMBS Conscious perception of pain Superficial: skin Deep: bone
- 9. IWantToBecomeAVet.com Diagnostics ✤ Orthopaedic exam: ✤ Bilateral HLs: lame 3/10, muscle atrophy, medial buttress of hips, with crepitus, mild joint effusion ✤ Neuro exam: normal ✤ Rx: L and R Lateral and DV ✤ Arthrocentesis of both hip joints ST effusion Osteophytes Bone lysis Example of DJD joint (stifle)
- 15. IWantToBecomeAVet.com Pathophysiology of DJD ✤ Multifactorial disorder of joints ✤ Degeneration of articular cartilage ✤ Bone changes = osteoarthritis ✤ Osteophytes- new bone formation ✤ Bone lysis
- 17. IWantToBecomeAVet.com DDX for DJD ✤ Trauma ✤ Acute ✤ Repetitive ✤ Infectious or non-infectious inflammation ✤ Developmental disease ✤ Dysplasia ✤ Angular or flexural limb deformity ✤ OCD Initial cause is unknown in Poppy’s case, and this is often the situation
- 21. IWantToBecomeAVet.com Surgical Treatments ✤ Excision arthoplasty ✤ Arthrodesis ✤ Total joint replacement
- 22. IWantToBecomeAVet.com Prognosis ✤ Poppy was managed well on the long term use of medical management and supplements. ✤ Lameness reduced to 1/10 ✤ Poppy also went to the QMH for 2 weekly hydrotherapy sessions and her owners changed two of her long walks a week to swimming in the local lake
- 23. Ok. Thank you. THE ENDTHE END