Front Matter

Chapter 11 Veterinary Orthotics and Prosthetics 287

complaint, signalment, and patient condition.
Evaluation of cranial nerves, spinal reflexes,
conscious proprioception, and postural reac­
tions reveals additional information that aids in
decision making, prescription, therapeutic plan,
expectations, and prognosis, regardless of
whether the presenting complaint is primarily
neurological. For example, a Doberman Pinscher
that presented for Achilles tendinopathy with
concomitant evidence of cervical myelopathy
may or may not be a candidate for an orthosis or
may require specific design and rehabilitation
prescription adjustments.
A thorough orthopedic examination is
important to document primary and second­
ary orthopedic issues. For example, patients
presented for an acute on chronic carpal
hyperextension injury may exhibit contralat­
eral carpal hyperextension. This may be sec­
ondary to temporary overloading with
decreased weight bearing on the acutely
affected limb. These cases resolve with treat­
ment of the affected limb and weight‐bearing
equilibration over the paired thoracic limbs.
Alternatively, contralateral carpal hyperex­
tension may represent a second unstable joint
requiring treatment. This can be distinguished
by assessing the passive range of motion
(PROM) relative to a video analysis of AROM,
or by treating the first issue and re‐evaluating
the second within a few weeks. If the PROM is
normal compared with the AROM, often the
carpal hyperextension is dynamic and due to
temporary overloading and/or weakness.
Special tests are included in the orthopedic
examination. In the pelvic limb, these include
tests for patellar stability because patellar luxa­
tion is not uncommon in skeletally immature
pelvic limb amputees or in dogs with congeni­
tal pelvic limb deformity. Cranial drawer and
tibial thrust are important general stifle tests
easily performed. The Ortolani and Barden
tests are performed to assess hip laxity. Lastly,
the Achilles tension test is used to evaluate the
integrity and flexibility of the Achilles complex.
In the thoracic limb, particular attention is paid
to the elbow and PROM testing should include
supination and pronation of the antebrachium
to test for elbow pain.
The next component of V‐OP evaluation is
myofascial examination. Muscle symmetry as
well as lean muscle mass are assessed. Patterns

of hypertrophy and atrophy can be important

diagnostic clues. Deeper palpation and mobili­

zation can reveal myofascial trigger points,

muscle tension, and pain, as well as tendon or

ligament laxity. These are important points for

treatment planning and follow‐up assessment.

The last portion of the evaluation is PROM

goniometry. As a minimum, PROM should be

measured for the major joints of the affected

and contralateral limb. Additionally, any

restrictions in flexibility (muscle or tendon),

joint laxity (ligament, joint capsule, muscle

atrophy, denervation), or alterations in the

osteokinematics of the other limbs should be

explored with goniometry.

Diagnostics, analysis, and diagnosis

Common diagnostic tests salient to the V‐OP

evaluation include radiography (survey and

stressed views), MRI, CT, and ultrasonography.

Not uncommonly, bilateral impairment is found,

for example in CCL insufficiency, Achilles mech­

anism injury, and elbow dysplasia.

Critical analysis of videos using the analysis

applications mentioned above is invaluable in

diagnosing, assessing severity, prognosticating,

and following treatment progression.

Laboratory work, including complete blood

count, serum chemistry, urinalysis, and thyroid

titer, can be helpful especially in the aged

patient. Additionally, ancillary tests such as the

SOD1 genetic test for degenerative myopathy

may be beneficial when concomitant neurologi­

cal signs are noted.

The purposes of this comprehensive V‐OP

evaluation are to ascertain all primary and

secondary issues relevant to the presenting

complaint, to determine the appropriateness

of a V‐OP device, and to align client and ther­

apeutic goals with the proposed device.

Observation, media analysis, diagnostic

imaging, and laboratory results are vital in

achieving these purposes. The clinician must

determine if the proposed device will accom­

modate a nonresolvable issue (e.g., chronic

Achilles tendinopathy with plantigrade

stance in a 13‐year‐old dog) or whether the

device will augment a treatment plan with

intent to heal (e.g., acute Achilles tendinopa­

thy in a 2‐year‐old field trial dog).