Locomotor

• Orthopaedic examination


  The most important tool in the investigation of lameness in small animals
• Orthopaedic examination


  • Localizing the source and degree of pain allows you to target further investigations & treatment appropriately
  • Don't waste time and money imaging the whole leg/patient as a "fishing expedition"
  • The only way to evaluate the effect of an abnormal finding on the patient's quality of life is by performing a thorough orthopaedic examination
• History taking


  • Signalment
  • General background
  • Current medication
  • Any concurrent illnesses
  • Current lameness
  • Any previous lameness problems
• Gait abnormality


  Caused by pain, mechanical problem, or neurological dysfunction
• Gait evaluation


  1. Evaluate gait at multiple speeds with the patient moving towards you, away from you and across you

  2. Include circles, stairs/steps, obstacles (particularly for cats)

  3. Decide which limb is the problem "down on sound"

  4. Characterize and score the problem in the affected limb
• Lameness grading


  • 0= sound
  • 1= mild lameness, needing a trained eye to see
  • 2= moderate lameness with a normal stride length and partial weight bearing
  • 3= moderate lameness with a short stride length and partial weight bearing
  • 4= severe lameness with toe touch weight bearing and minimal use of the limb
  • 5= non weight bearing lameness

  
• Hindlimb "skipping" lameness


  A type of lameness
• Ataxia


  A type of gait abnormality
• Physical examination


  1. Palpation while standing: limbs & spine

  2. Palpation with movement

  3. Assess joints

  4. Don't forget the toes

  5. Palpating joint effusions

  6. Always perform a full general clinical examination, particularly in trauma cases

  7. Basic neuro screening examination

  
• Special ortho tests

  • Cranial drawer
  • Cranial tibial thrust
  • Patella luxation
  • Ortolani
  • Barden's hip lift
  • Hip luxation
• Struggling to localise the problem

  1. Trial rest and analgesia and re-examine the patient if there is no improvement

  2. Book in for longer consultation

  3. Admit the patient

  4. Ask a colleague

  5. Multiple repeat examinations at different time points can be helpful

  6. Local anaesthetic joint blocks
• Further investigations


  • Imaging: radiographs, CT, MRI, ultrasound
  • Arthrocentesis
• The orthopaedic examination is the most important tool in the investigation of lameness in small animals
• Localizing the source of pain allows you to identify the relevant clinical problem and target further investigations and treatment appropriately
• If its not clear, repeat on another occasion and/or ask a colleague to look as well
• A through orthopaedic examination takes time- you may need to book a longer appointment or admit the patient, so you're not rushed
• Lameness clinician


  Trains his/her eyes at the presence and alterations of symmetry patterns
• Diagnostic analgesia


  Used to find the source of lameness
• Approach to the lame horse

  • Clinical history
  • Stationary observation
  • Palpation
  • Gait observation: subjective (and objective) assessment
  • Flexion tests and other manipulations
  • Diagnostic analgesia
  • Diagnostic imaging
  • Treatment/management
  • Prognosis

  
• History: basic information


  • Signalment: sex, breed & type, age, activity
  • Current lameness problem
  • Past lameness problems
  • Specific information
• Stationary observation


  Assessing symmetry, posture, conformation
• Palpation


  • Hoof testers
  • Distal sesamoidean ligaments
  • SDFT insertion
  • Digital pulses
  • Tendons: loaded
  • Tendons: unloaded
  • Suspensory ligament origin
  • Joints: distension, temperature, pain response, range of motion
  • Back
  • Pelvis: tuber coxae, tuber ischii
• Limb movement


  Composed of a horse's travel and action
• The main gaits

  • Walk
  • Pace
  • Canter
  • Trot
• Gait observation/movement


  1. First question: is the animal lame

  2. Second question: how lame

  3. Trot is most commonly used gait

  4. Goal: localize the source of lameness in the limb(s) to allow for targeted diagnostic imaging and treatment
• Objective lameness examination using inertial motion sensors

  • Recognizes forelimb lameness by head nod/elevation and asymmetrical pectoral muscle contraction
  • Recognizes hindlimb lameness by pelvic hike/drop and elevation of tuber calcis
• Subjective quantification of lameness

  Uses a grading system

  
• Additional factors in lameness examination

  • Examine on different surfaces
  • Circle (lunge)
  • Different gaits
  • Under saddle
  • High speed treadmill
• Locomotor anatomy

  • Anconeal process
  • Coronoid process
  • Head of the radius
  • Humeral condyle
  • Body of humerus
  • Supratrochlear foramen
  • Olecranon
  • Medial humeral condyle
  • Medial coronoid process
  • Elbow joint
  • Patellar ligament
  • Patella
  • Femoropatellar ligament
  • Fabellae
  • Lateral collateral ligament
  • Fabella
  • Intercondylar groove of femur
  • Tibial tuberosity
  • Fibula
  • Sacroiliac joint
  • Sacrum
  • Ilium
  • Hip joint
  • Greater trochanter of femur
  • Head of the femur
  • Lesser trochanter of femur
  • Pubis
  • Ischium
  • Lumbosacral junction
  • Tuber calcanei
  • Sustentaculum tali
  • Central tarsal bone
  • 1st/2nd tarsal bone
  • Trochlear of talus
  • Sustentaculum tali
  • 2nd metatarsal bone
  • Talus
  • Central tarsal bone
  • Third tarsal bone
  • Metacarpal bone 3
  • Suspensory ligament
  • Metacarpal bone 2/4 (splint bone)
  • Deep digital flexor tendon
  • Common digital extensor tendon
  • Oblique sesamoidean ligament
  • Straight sesamoidean ligament
  • Superficial digital flexor tendon
  • Extensor process of P3
  • Solar canal of P3
  • Distal interphalangeal joint
  • Distal border of navicular bone
  • Flexor surface of P3
• General approach to farm animal lameness

  Thorough history and clinical exam, with differences in handling compared to small animals and horses
• Safe restraint


  Important when examining farm animals
• Individual and herd approaches to lameness

  1. Consider the individual animal and the herd/flock

  2. Measure lameness prevalence and identify lesions involved

  3. Identify animals needing immediate attention
• If you see one lesion in one animal, its unlikely to be the only animal affected
• Individual leading to the herd

  Many clients will already be engaged at both levels
• Reasons for being called to a farm

  • Lame individual(s) that need treatment
  • Many modern farms have routine foot trimmer visits- foot trimmer may recommend vet investigates due to levels of lameness seen
  • Proactive farmers who want routine monitoring
  • Supermarket contracts
• If you see one lesion in one animal, its unlikely to be the only animal affected by what you see
• If the farmer is not already monitoring at the herd level this may be what you need to persuade them to do so
• Herd and flock approaches

  • Measure lameness (mobility scoring)
  • Identify animals that need immediate attention
  • Consider lesions involved
  • Then turn to prevention
• Mobility scoring


  • Identifies lame individuals and enables targeted treatment
  • Helps quantify the size of the issue at the herd level
  • Investigate together helps you identify and treat lame individuals but also identify relevant herd level preventative measures
• AHDB mobility score


  0-3 scale ranging from not lame to non-weight bearing