General Axial Skeletal All-in-One Ortho-Online Forelimb Fracture Planning Rearlimb Limping Louie Orthopedic Exam Neurological Exam Orthopedic Exam: Rearlimb Digits Metatarsal Bones Tarsus Achilles Tendon Tibia Stifle General Axial Skeletal Forelimb Rearlimb Limping Louie Stifle: The initial perform examination of the stifle with the animal standing. Simultaneously palpate both stifles to detect swelling (a.). A swollen stifle usually indicates degenerative joint disease. The patellar ligament becomes less distinct with joint effusion and the medial aspect of the stifle enlarges because of capsular thickening and osteophyte formation (b.). Patella – The remainder of the examination is done with General Axial Skeletal Forelimb Rearlimb Limping Louie the animal in lateral recumbency. Extend and flex the stifle while holding one hand over the cranial aspect of the joint to detect crepitation. General Axial Skeletal Forelimb Rearlimb Limping Louie Examine the stability of the patella in relationship to the femur. Extend the stifle, internally rotate the foot, and apply digital pressure in an attempt to displace the patella medially (i.e., medial patellar luxation). Detect lateral patellar luxation by slightly flexing the stifle, externally rotating the foot, and applying digital pressure to attempt to displace the patella laterally. General Axial Skeletal Forelimb Rearlimb Limping Louie The patella (a.) normally moves slightly medially and laterally, but when it leaves the trochlear groove (b.) it is considered to be luxating. General Axial Skeletal Forelimb Rearlimb Limping Louie Test the integrity of the collateral ligaments by holding the stifle in full extension 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. 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. This is due to the anatomical location of the lateral collateral ligament and internal rotation of the tibia, and is normal. General Axial Skeletal Forelimb Rearlimb Limping Louie 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. General Axial Skeletal Forelimb Rearlimb Limping Louie Test drawer motion with the femur flexed and extended. Usually, the greatest movement is felt with the stifle in flexion. If the patella is luxated, replace it in the trochlear groove before attempting the drawer motion. (To view video on left, click the play button). General Axial Skeletal Forelimb Rearlimb Limping Louie Minimal or partial drawer motion may also occur with incomplete tears. This drawer motion is most evident when the craniomedial band of the cranial cruciate ligament is torn. The craniomedial band must be intact to prevent drawer motion when the stifle is flexed, because the caudolateral band is relaxed at that time. Perform the tibial compression test to detect indirect drawer motion. Detect forward motion of the tibia by placing the index finger along the patella and the tibial tuberosity. With the leg in a standing position, flex the hock to tense the gastrocnemius muscle. This compresses the femur and tibia together causing the tibia to move forward in a cranial cruciate deficient stifle. General Axial Skeletal Forelimb Rearlimb Limping Louie 0:05 / 0:05 General Axial Skeletal Forelimb Rearlimb Limping Louie The presence and amount of drawer motion depends on the animal’s age, size, state of relaxation, and the duration and type of cruciate pathology. There is minimal drawer motion in normal dogs and cats, although very young puppies may have a “lax” stifle. Eliciting drawer motion in larger animals or those that are tense is difficult; sedation or general anaesthesia may be necessary. Minimal drawer motion may be noted with chronic cruciate pathology (especially in large dogs) because periarticular fibrosis restricts stifle motion. Minimal or partial drawer motion may also occur with incomplete tears or stretching of the cranial cruciate ligament. Drawer motion is evident with a torn caudal cruciate ligament; to identify caudal drawer motion start with the stifle in a neutral position. Most caudal ligament ruptures are not discovered until stifle exploration because they are mistaken for cranial ligament injuries. Meniscus – In most cases, meniscal tears are identified during exploratory arthrotomy. A “click” or “pop” may be felt as the stifle is flexed and extended causing the caudal horn of the medial meniscus to displace. General Axial Skeletal Forelimb Rearlimb Limping Louie General Axial Skeletal Forelimb Rearlimb Limping Louie Femur Hip Pelvis Copyright 2020 College of Veterinary Medicine | University of Illinois | All Rights Reserved
