Examination of the musculoskeletal system of a canine patient is a necessity and a skill. It is of particular importance when there are orthopaedic and/or neurological issues, although a thorough musculoskeletal examination adds great value even in cases of systemic disease. Repeated application and observation of the entire body of the dog, and its movement, soon result in a skill set which is very useful, and incredibly sensitive. Most of these categories form part of a typical veterinary physical examination but this highlights a few differences.
The subjective information to gather includes a thorough history, signalment and the chief complaint. Of particular importance to a rehabilitation practitioner is the nature of the dog and the relationship of guardian and companion. By paying attention to this aspect rehabilitation programs can become very specific. The environment in which the dog lives and moves, as well as the ‘job’ of the dog, all impact on the choice of program. The end result for a household companion can be vastly different to that of a working dog.
Moving onto the objective portion of the examination begins the moment the dog is removed from the vehicle, and also includes any blood tests or diagnostic imaging performed by the referring veterinarian. Observation, palpation and specific tests are applied.
Begin with static observation. How is the patient standing, sitting or lying down? Is one limb favoured over another? Is weight shifting evident? When asked to walk a few steps is one leg placed in a specific position each time the dog stops? Much information can be gathered by observing the dog whilst taking a history.
Dynamic observation follows. Begin with gait analysis at a walk. Watch the patient moving away from you, coming towards you, and from the side. Paying attention to the swing and stance phase of the gait and looking at stride length give much information which may be missed if only searching for a lameness or head bob. Videography is invaluable for subtle changes that may occur, however, practice improves this skill considerably. Pressure sensor systems are available but usually reserved for academic institutions.
Following on from this examination, asking the dog to perform functional movements provides a wealth of information. Observe the manner in which the dog sits and then rises from that position. Lying down and then standing also provides insight into possible issues. Ascending and descending stairs can be challenging for some patients. Asking for an active spinal stretch can identify cervical discomfort or thoracolumbar stiffness before physically manipulating those areas. Lifting individual legs can identify a weakness which is well masked by the dog. Diagonal leg lifts and pelvic limb slides can show abdominal and gluteal weakness respectively.
Palpation is the next step in a rehabilitation examination. This is typically performed with the dog standing. Range of motion (ROM) is not only palpated, but also measured using a goniometer. Normal ROM values are available for all joints in the fore and rear limbs. Thigh and forelimb circumferences are noted by making use of a Gulick tape measure. The limbs are also palpated in lateral recumbency being certain to check each digit and associated anatomical structures. Finally specific tests can be applied such as cranial drawer and shoulder abduction test.
A thorough physical rehabilitation examination takes 45 – 60 minutes but provides insight into weaknesses, injuries and compensatory movement patterns. This information allows for a program tailored for the individual patient thereby improving the success rate of treatment.