procedures pro ORTHOPEDICS

Derek B.Fox, DVM, PhD, Diplomate ACVS, University of Missouri–Columbia

Orthopedic Examination of the

Forelimb in the Dog

D
ogs bear most of their weight with the STEP BY STEP ORTHOPEDIC EXAMINATION OF THE FORELIMB
thoracic limbs. As a result, orthopedic
disease of the forelimb is particularly
challenging. For examination purposes, the
forelimb can be anatomically divided into the
A B C
paw, antebrachium, brachium, scapula, and
interpositioned joints. Causes of lameness,
and the anatomic locations they effect, will
differ by the age, breed, and lifestyle of the
dog. Thus, the orthopedic examination can be
tailored to focus more on areas prone to dis-
ease based on patient signalment. However,
all anatomical aspects of the limb should be
assessed in every patient.

Orthopedic examination of the forelimb starts

with observing the animal ambulate at vari-
ous speeds. Weight-bearing lameness of the
The Paw
front limb typically results in a “head bob” in
Examination of the paw generally swelling, make up a fairly sensitive method to
which the head is lifted during weight-bearing
of the painful limb. Animals affected bilateral- 1 consists of assessing each digit,
including the nail and nail bed (A).
determine whether any part of the paw is a
source of pain. Injury to the paw or digits is a
ly may not exhibit an obvious head bob but
Common sources of lameness arising from frequent source of a non–weight-bearing
can show a shortened stride of each limb. A
these sites include split nails, nail-bed tumors, lameness. Because many dogs are sensitive to
full neurologic examination should accompany
fracture/luxation of the phalanges, penetrating having their paws handled, the examiner
the orthopedic examination to rule out neuro-
foreign bodies, and pad lacerations. Careful should also palpate the feet from the unaf-
logic causes for pain or lameness, such as a
palpation of the digits and manipulation of fected legs to gain a sense of the level of
nerve root signature sign secondary to a later-
the joints in flexion and extension (B, C), an animal’s reluctance to having its paws
ally herniated intervertebral disk or brachial
while observing for evidence of pain or manipulated.
plexus pathology.

PROCEDURE PEARL
Careful palpation of the digits and manipulation of the joints in flexion and extension
make up a fairly sensitive method to determine whether the paw is painful.

c o n t i n u e s

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The Antebrachium
A B C Sources of lameness that can arise
3 from the radius and ulna in the
young dog include hypertrophic
osteodystrophy, eosinophilic panosteitis, and
physeal disturbances; and in young adult and
adult dogs fractures, neoplasia, angular limb
deformities, and hypertrophic osteopathy.
Examination of the antebrachium should focus
on deep palpation of both bones in an
attempt to elicit an osseous source of pain or
to detect focal areas of swelling. The relation-
ship of the carpus to the elbow should also be
observed as evidence of angulation from phy-
seal damage and abnormal development of
The Carpus the radius and ulna. Aberrant growth from
2 Various conditions affecting the car-
pus include degenerative joint dis-
the joint under stress in extension, flexion, physeal disturbances can result in varus, val-
abduction, and adduction for the observation gus, procurvatum, recurvatum, or rotational or
ease, suppurative arthritis, subluxations or of excessive mobility or pain in any of these translational deformities.
luxations from traumatic hyperextension, frac- planes. The carpus should have minimal
tures, and carpal laxity syndrome in young abduction and adduction, may extend 5º to
dogs. Nontraumatic joint inflammation of the 10º (B), and should be able to be flexed com-
radial carpal joint is fairly easy to feel as a fortably until the palmar surface of the paw
depressible distension of the joint capsule (A). nearly touches the flexor surface of the ante-
Palpation of the carpus should include placing brachium (C).

Hyperextension should be accompanied by

A B C only minimal or no discomfort in a normal
dog. While the distal humerus is held, the
antebrachium is abducted and adducted in an
attempt to elicit pain or excessive motion con-
sistent with collateral ligament damage and
subsequent joint laxity. Elbow joint effusion
can be palpated for by digitally feeling both
distal humeral epicondyles simultaneously
with index finger and thumb, while drawing
fingers caudally toward the olecranon (C).
Normally a concave depression exists between
these structures. With effusion, however, this
The Elbow area can become distended. With the chronici-
The elbow is primarily a hinge joint incongruity in the young dog and degenera- ty of the abnormality come hypertrophy and
4 that optimizes flexion and extension
but allows limited abduction and
tive joint disease, suppurative arthropathies,
fractures, subluxations, luxations, and neoplas-
thickening of the joint capsule, which will pal-
pate more firmly. Specific pain localization may
adduction and only slight rotation. Orthopedic tic processes in the adult dog. Examination of be detected with fragmented coronoid disease
diseases affecting the elbow include frag- the elbow consists of putting the joint through by applying digital pressure over the medial
mented coronoid disease, ununited anconeal its range of motion in flexion (A) and exten- coronoid and looking for a painful response.
process, osteochondritis dissecans, various sion (B) while feeling for the presence of
fractures, congenital luxations, and radioulnar crepitus and observing for a painful response.

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The Brachium
Conditions potentially affecting the frequently forms in the proximal humerus and
5 canine brachium include panosteitis,
hypertrophic osteodystrophy, and
distal radius and ulna. Examination of the
brachium essentially consists of deep palpa-
PROCEDURE PEARL
Examination of the brachium consists of
fractures in young dogs and fractures, neopla- tion along the length of the bone to examine deep palpation to examine for evidence
for evidence of pain and areas of inflamma- of pain and inflammation.
sia, and hypertrophic osteopathy in the adult
dog. One of the most common tumors of the tion or swelling.
canine forelimb is osteosarcoma, which more

A B C

The Shoulder
6 The shoulder joint is considered a
ball-and-socket joint that possesses
PROCEDURE PEARL
A shoulder abduction tests the integrity
of the medial joint capsule and collateral
both passive and active stabilizers. Normal A large component of the examination of the
ligament.
motion includes extension and flexion, abduc- shoulder joint is putting the joint through a
tion and adduction, and internal and external full range of motion to observe for excessive
Young dogs with shoulder pain should be
rotation. Passive stabilization of the joint is excursion, or elicitation of pain in any particu-
examined closely for osteochondritis disse-
provided by both medial and lateral gleno- lar direction. For example, the joint should be
cans, whereas in the adult dog common
humeral ligaments, the shape of the humeral comfortably flexed (A) and extended (B),
sources of lameness localized to the shoulder
head and glenoid, and the cohesiveness of internally and externally rotated, and abduct-
can include degenerative joint disease, biceps
joint fluid. Active stabilization of the shoulder ed and adducted. Limitation in internal rota-
tenosynovitis, shoulder instability or luxations,
is maintained by the musculotendinous units tion can prompt suspicion of contraction of
mineralization of the supraspinatus, infra-
of the rotator cuff: the supraspinatus, infra- the infraspinatus tendon.
spinatus contracture, ununited caudal accesso-
spinatus, teres minor, and subscapularis. As
ry process of the glenoid, articular fractures,
with orthopedic conditions of the dog involv- A shoulder abduction can also be completed
and other causes of suppurative arthropathies.
ing other structures, sources of pain can to test the integrity of the medial joint capsule
depend on the age of the animal. and collateral ligament, during which the
angle between the scapula and humerus is
measured via goniometry during abduction.
Abduction greater than approximately 32º can
PROCEDURE PEARL lead to suspicion of medial shoulder instability
A large component of shoulder joint examination is putting the joint through a full range (C). A shoulder drawer examination, in which
of motion to observe for excessive excursion or elicitation of pain.
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E
the proximal humerus is translated cranially and caudally with respect to the
glenoid, can be completed to assess for instability of the joint in either direc-
tion (D). The biceps tendon should be palpated as it originates on the supragle-
noid tuberosity and courses down the intertubercular groove for evidence of
inflammation (E). Deep digital pressure is applied to the biceps tendon while
flexing the shoulder and extending the elbow in an attempt to elicit pain as
supportive evidence for biceps tenosynovitis (F).

PROCEDURE PEARL
Orthopedic examinations should be followed up with radiography,
ultrasonography, or other imaging to confirm diagnoses.
F

The Scapula Conclusion

6 Although the scapula is the least Observation of gait, neurologic examination, PROCEDURE PEARL
frequently involved structure caus- and systematic palpation of specific anatomic Scapular avulsion is primarily diagnosed
ing canine forelimb pain, certain conditions, structures will allow the elucidation of a by palpation since radiographs can look
such as tumors and fractures, can affect it. majority of orthopedic conditions affecting the deceptively normal.
Furthermore, the supraspinatus and infra- canine forelimb. Most often, presumptive
spinatus muscles and prominence of the inter- diagnoses based on orthopedic examination
posed acromial spine should be felt for muscle should be followed up with radiography, ultra-
atrophy as evidence of any musculoskeletal See Aids & Resources, back page, for
sonography, or other imaging to confirm the
source of forelimb disuse or many neurologic references, contacts, and appendices.
diagnosis and provide clients with treatment
conditions. The muscular attachment of the Article archived on www.cliniciansbrief.com
options and prognoses. ■
scapula can also be avulsed from the thoracic
wall with certain types of trauma. Scapular Acknowledgment
avulsion is primarily diagnosed by palpation The author thanks Dr. David Dismukes for his
of excessive excursion of the scapula from the assistance in preparing the figures.
chest wall since radiographs can look decep-
tively normal.

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