equis - Articles
Musculoskeletal: physical examination – adult
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Introduction
Uses
- Diagnosis of forelimb and hindlimb lameness.
- Evaluation of back pain Musculoskeletal: back pain.
- Part of conformation evaluation Musculoskeletal: conformation.
- Part of neurologic examination Neurology: examination - adult Neurology: examination - foal.
- Part of pre-purchase examination Pre-purchase examination.
- Preliminary to gait evaluation Musculoskeletal: gait evaluation, manipulative tests Musculoskeletal: manipulative tests, local analgesia Anesthesia: analgesia - overview and other diagnostic tests, eg response to exercise Musculoskeletal: exercise response test, myelography Myelography.
Advantages
- Important information can be easily gained.
- Non-invasive opportunity to examine horse at rest.
- Minimal stress to animal.
- Information can influence interpretation of gait, as well as influence the prognosis and treatment options of some pathology.
Disadvantages
- Localizing signs are not always present → false-negative results.
- Clinical signs often occur at sites distant to the source of lameness and therefore can be misleading if misinterpreted → false-negative results.
- Requires reasonably relaxed horse to permit evaluation of response to palpation.
- Individual variation of response to palpation and manipulation.
- Wide range of 'normal' conformation Musculoskeletal: conformation, the assessment of which will still largely be based on empirical rather than scientific evidence.
- Manipulation of fracture sites may → further soft tissue injury, even convert closed fracture Musculoskeletal: fracture to open.
Technical problems
- Experience with range of normal individual variation valuable.
- Some abnormalities of stance, symmetry and response to palpation maybe subtle.
Alternative techniques
- Examination at exercise Musculoskeletal: gait evaluation.
- Perineural analgesia, forelimb Forelimb: perineural analgesia, hindlimb Hindlimb: perineural analgesia.
- Intrasynovial anesthesia, forelimb Forelimb: joint anesthesia, hindlimb Hindlimb: joint anesthesia.
- Radiography of the forelimb Forelimb: radiography, hindlimb Hindlimb: radiography.
- Magnetic resonance imaging Magnetic resonance imaging.
- Ultrasound Ultrasonography: musculoskeletal.
- Scintigraphy Bone: scintigraphy.
- Thermography Thermography.
- Rectal palpation Musculoskeletal: rectal palpation.
- Arthroscopy Joint: arthroscopy - overview.
- Tenosynovioscopy Tenosynovioscopy.
- Bursoscopy Bursoscopy: overview.
- Arthrocentesis Synovial fluid: collection.
Time required
Preparation
- Negligible.
Procedure
- 5-15 min.
Decision taking
Criteria for choosing test
- Temperament - stress of unfamiliar surroundings, transport Transport, separation Behavior: separation distress may confound interpretation or make some tests impossible.
- Sedation may alter response to manipulation and palpation, posture and muscle tone Behavior: pain assessment.
- Obvious fractures may require immediate stabilization Musculoskeletal: fracture - first aid or sedation Anesthesia: standing chemical restraint.