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Approach to the orthopaedic patient

02 January 2023
16 mins read
Volume 28 · Issue 3
Figure 3. Landmarks for the palpation of tarsocrural joint effusion. Blue star represent lateral malleolus, black star calcaneus and red stars usual location of synovial effusion. Lateral view of the tarsus.
Figure 3. Landmarks for the palpation of tarsocrural joint effusion. Blue star represent lateral malleolus, black star calcaneus and red stars usual location of synovial effusion. Lateral view of the tarsus.

Abstract

Approaching orthopaedic patients represents a common challenge for first opinion practitioners. Knowledge and understanding of the correct steps necessary to narrow down the list of differential diagnoses, and selection of appropriate diagnostic modalities, is crucial to success. The approach to orthopaedic patients should comprise obtaining a history, observing the standing patient, gait analysis, orthopaedic examination and a brief neurological examination. Orthopaedic examination can be separated into palpation and manipulation. This methodical approach allows the clinician to avoid the common mistakes of delayed diagnosis and subsequent owner dissatisfaction. This article will focus on a methodical approach to orthopaedic patients, with particular attention on the common challenges encountered by first opinion practitioners.

Orthopaedic patients represent a moderate proportion of first opinion practice caseloads (Belshaw et al, 2020). To reach a diagnosis efficiently, clinicians need to appreciate the importance of obtaining an accurate history, observation of the standing animal, gait analysis, orthopaedic and neurological examination and how their findings influence the selection of appropriate diagnostic tests to confirm the suspected diagnosis. The methodical approach to every orthopaedic patient listed in this article will help clinicians in this process.

Taking the patient's history can be one of the most time-consuming and challenging parts of the orthopaedic examination. General questions should be followed by focused questions. The owner should be asked to provide information about signalment, diet, duration of ownership, vaccination status, the function of the patient (for example, working, competition or pet animal), current medications, previous injuries or illnesses, exercise regimen and travel history. Signalment is particularly important, as breed, sex and age can predispose to certain orthopaedic diseases, such as elbow dysplasia (Baers et al, 2019) and hip dysplasia (Lopez and Schachner, 2015). Similarly, a poorly balanced diet has been associated with rickets, hypervitaminosis A and hypervitaminosis D (Bennett, 1976).

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