In an ongoing series on how different kinds of cases are worked up, today we will look at pet orthopaedic patients.
Most veterinary orthopaedic cases present as dogs or cats that are limping. These patients are in pain, regardless of whether they exhibit their pain vocally or visually. Like their wild ancestors, pets instinctively hide their weaknesses so that they do not become vulnerable to predators. Never mind that domesticated animals don’t have any predators, they don’t know that.
That said, different individual pets have different individual pain thresholds. Some, like me, shrink at the mere thought of a hangnail. Others won’t cry out even when they have a broken bone.
Sometimes our limping patients arrive and the pet lover isn’t even sure which limb is at fault, they just know something isn’t right. We look for clues while the pet walks, trots, sits, stands and shakes, as well as on the pet’s physical examination.
While I was a student at Auburn University’s College of Veterinary Medicine, I took my beagle, Sam, into the school’s Small Animal Clinic for an evaluation. He had been limping, crying in pain and intolerant of exercise. One of my professors roughed up his hair, set him down onto the clinic floor and watched him try to shake his hair back in place. From that one observation the doctor predicted the location of his spinal lesion to within one vertebral disk space, as confirmed by myelogram. The “shake” can be that valuable as a diagnostic tool.
Once the correct limb in a limping case is determined, we next try to localize the source of pain. Knowing dog and cat anatomy is crucial to an accurate diagnosis. Such intimate knowledge enables us to know which leg parts are likely to cause trouble, which parts interact as joints move and which movements are most likely to cause pain.
Some orthopaedic problems have such unique signatures that they can be diagnosed accurately on physical examination alone. Many, however, need further elucidation through radiography (X-rays). Having the source of pain localized is important to prevent taking unnecessary radiographs. Doing so exposes our patients and staff members to unnecessary radiation and our clients to unnecessary cost.
Reading radiographs is another exercise in anatomic study of pets. Knowing the intricacies of joints such as the carpus (wrist) allows us the ability to determine which of many bones in the joint may be causing trouble.
A “negative” X-ray, one that finds no defects, can be just as valuable as a diagnostic one, ruling out a suspicious area and redirecting our exploration of clinical signs.
Once a diagnosis is made in an orthopedic case, treatment may begin.
Sometimes treatment requires surgery to fix a tendon, ligament or joint. For example, Achilles tendon rupture occurs as a result of disease.
Arthritis of the hip joints may indicate hip replacement surgery for your dog.
Broken bones may be repaired by internal fixation (surgery via incision and repair of the bones), external fixation (devices such as Stater-Eimer fixation) or cast material.
Certain soft-tissue injuries, such as sprains, may be treated with rest, pain management and possibly antiinflammatory medications.
MyPetsDoctor.com’s Dr. James W. Randolph encourages you to seek help for your pet right away if he is limping. Early intervention is associated with the best outcome, fewest complications and least pain and suffering.