{"id":4144,"date":"2020-11-24T22:08:53","date_gmt":"2020-11-24T22:08:53","guid":{"rendered":"https:\/\/vetmed.illinois.edu\/demo-sa-orthopedics\/?page_id=4144"},"modified":"2021-01-26T21:15:05","modified_gmt":"2021-01-26T21:15:05","slug":"orthopedic-exam-rearlimb","status":"publish","type":"page","link":"https:\/\/vetmed.illinois.edu\/demo-sa-orthopedics\/orthopedic-exam-rearlimb\/","title":{"rendered":"Orthopedic Exam: Rearlimb"},"content":{"rendered":"

<\/i><\/i><\/span>Digits<\/span><\/a><\/h4><\/div>
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\"digits-1a-b\"<\/span><\/div>
\"Digits<\/span><\/div>
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Digits:<\/h3>\n

Examine the paw closely to determine if there is any foreign material present. Spread the toes and nails apart and inspect the webbing and pads. (a.)<\/p>\n

Palpate each digit to determine if the bones are intact and whether there is soft tissue swelling. (b.)<\/p>\n<\/div>

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Extend and flex the phalangeal joints and palpate the corresponding extensor and flexor tendons to see if they relax and tighten appropriately.<\/p>\n

Test the lateral and medial stability of each joint in extension.<\/p>\n

* Forelimb is used as an example only.<\/p>\n<\/div>

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<\/i><\/i><\/span>Metatarsal Bones<\/span><\/a><\/h4><\/div>
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\"metacarpal-1a-b\"<\/span><\/div>
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Metatarsal Bones:<\/h3>\n

Palpate the areas adjacent to the metacarpal pad and over the palmar sesamoids of metacarpophalangeal joints 2 and 5 for sensitivity to pressure (a.). Palpate the metacarpal bones (b.) to determine if there is pain, swelling or instability (fracture).<\/p>\n

* Forelimb is used as an example only.<\/p>\n<\/div>

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<\/i><\/i><\/span>Tarsus<\/span><\/a><\/h4><\/div>
\"Palpate<\/a><\/span><\/div>
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Tarsus:<\/h3>\n

Palpate the tarsal joints<\/strong> for fluctuant swelling indicative of joint effusion.<\/p>\n

This may be a subtle finding in the hock and is more easily noted when the animal is standing because loading the joint forces the fluid peripherally. Firm swelling is suggestive of degenerative joint disease<\/strong>.<\/p>\n<\/div>

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\"Extend<\/a><\/span><\/div>
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Extend and flex the hock.<\/strong> Normal flexion should be about 45\u00b0.<\/p>\n<\/div>

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Decreased flexion<\/strong> indicates degenerative joint disease which may be secondary to osteochondritis dissecans<\/strong>.<\/p>\n<\/div>

\"Decreased<\/a><\/span><\/div>
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\"painful<\/a><\/span><\/div>
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Pain on manipulation of the joint (especially coupled with soft tissue swelling and instability) may indicate a fracture or luxation<\/strong>.<\/p>\n

Extend, adduct, and abduct the hock and metatarsal bones to demonstrate instability of the collateral ligaments.<\/p>\n<\/div>

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<\/i><\/i><\/span>Achilles Tendon<\/span><\/a><\/h4><\/div>

Achilles Tendon:<\/h3>\n

With the stifle in extension and the hock stressed into flexion, palpate the Achilles tendon.<\/p>\n

Rupture of the entire tendon complex<\/strong> allows hock flexion while the stifle is extended. Rupture of the gastrocnemius tendon<\/strong> and common tendon of the biceps femoris, gracilis, and semitendinosus muscles, with preservation of the superficial digital flexor, allows partial flexion of the hock while the stifle is extended and causes simultaneous flexion of the digits.<\/p>\n<\/div>

\"achilles<\/a><\/span><\/div>
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<\/i><\/i><\/span>Tibia<\/span><\/a><\/h4><\/div>
\"Palpate<\/a><\/span><\/div>
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Tibia:<\/h3>\n

Palpate the tibia for instability – fracture, swelling (fracture, tumor) and pain response to deep bone palpation – panosteitis.<\/p>\n<\/div>

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<\/i><\/i><\/span>Stifle<\/span><\/a><\/h4><\/div>
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Stifle:<\/h3>\n

The initial perform examination of the stifle with the animal standing. Simultaneously palpate both stifles to detect swelling<\/strong> (a.). A swollen stifle usually indicates degenerative joint disease<\/strong>. The patellar ligament becomes less distinct with joint effusion and the medial aspect of the stifle enlarges because of capsular thickening and osteophyte formation<\/strong> (b.).<\/p>\n<\/div>

\"a.<\/a><\/span><\/div>
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Patella <\/strong>– The remainder of the examination is done with the animal in lateral recumbency. Extend<\/strong> and flex<\/strong> the stifle while holding one hand over the cranial aspect of the joint to detect crepitation.<\/p>\n<\/div>

\"Flex<\/a><\/span><\/div>
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\"Extend<\/a><\/span><\/div>
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\"extend<\/a><\/span><\/div>
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Examine the stability of the patella in relationship to the femur. Extend the stifle, internally rotate the foot, and apply digital pressure<\/strong> in an attempt to displace the patella medially (i.e., medial patellar luxation<\/strong>).<\/p>\n<\/div>

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\"stifle<\/a><\/span><\/div>
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Detect lateral patellar luxation<\/strong> by slightly flexing the stifle<\/strong>, externally rotating the foot<\/strong>, and applying digital pressure<\/strong> to attempt to displace the patella laterally.<\/p>\n<\/div>

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\"examine<\/a><\/span><\/div>
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The patella<\/strong> (a.) normally moves slightly medially and laterally, but when it leaves the trochlear groove<\/strong> (b.) it is considered to be luxating.<\/p>\n<\/div>

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\"Testing<\/a><\/span><\/div>
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Test the integrity of the collateral ligaments by holding the stifle in full extension<\/strong> and attempting to “open” the stifle on the medial and lateral aspects. Test the medial collateral ligament by using one hand to brace the femur while the other hand abducts the tibia. Normally the medial collateral ligament will not allow joint laxity.<\/p>\n

Test the lateral collateral ligament by bracing the femur with one hand and using the other hand to adduct the tibia. An intact lateral collateral ligament will prevent joint laxity. If the stifle is allowed to flex while the tibia is adducted, it may feel as though there is lateral laxity of the joint.<\/strong> This is due to the anatomical location of the lateral collateral ligament and internal rotation of the tibia, and is normal.<\/p>\n<\/div>

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\"Elicit<\/a><\/span><\/div>
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To elicit direct drawer motion, place the index finger and thumb of one hand over the patella and lateral fabellar regions, respectively. Place the index finger of the opposite hand on the tibial tuberosity, and with the thumb positioned caudal to the fibular head, slightly flex the stifle. Stabilize the femur, and gently move the tibia cranial and distal to the femur. Do not allow tibial rotation. Tense muscles may prevent drawer motion. If tibial rotation occurs, gently flex and extend the stifle to relax the animal, and repeat the procedure.<\/p>\n<\/div>

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