Chapter 13 Evaluation and Rehabilitation Options for Orthopedic Disorders of the Canine Thoracic Limb 335With the prioritized problem list in place,
including tissue type injured and chronicity of
injury for each problem, the treatment plan is
then developed. Treatment interventions may
include modalities, manual therapies, and ther-
apeutic exercise—all of which should include
intensity, frequency, and duration of treatment
intervention.
Within a session and throughout a treatment
plan, re‐evaluation of treatment interventions
should be completed allowing modifications to
the plan of care for the most effective outcomes.
A home exercise program should always be
part of the treatment plan and it should include
principle‐based frequency, intensity, and dura-
tion for each exercise. When a follow‐up evalu-
ation reveals that the patient has reached the
client’s rehabilitation goals for their dog, the
patient is discharged to a health maintenance
program.
Specific guidelines for determining injury
location and tissue type
Consideration of anatomy, osteokinematics,
and arthrokinematics during each objective test
will guide the therapist to a deeper understand-
ing of the injury location and tissue type that
will, in turn, promote more efficacious treat-
ment plans. A thorough evaluation observes
muscle origins and insertions and their impact
on normal passive range of motion, or osteokin-
ematic movement, including: scapular protrac-
tion (scapula moves away from the midline)
and retraction (scapula moves toward the mid-
line); glenohumeral flexion, extension, abduc-
tion, adduction, and internal and external
rotation; elbow flexion and extension; carpal
flexion, extension, supination, and pronation;
and manus flexion and extension. Limitations
in osteokinematic motion at a joint may indi-
cate a limitation in joint play, or arthrokinematic
motion. Normal arthrokinematic movement
includes glenohumeral joint cranial, caudal,
medial, lateral, internal, and external rotational
glides; elbow (ulnar) glides toward flexion or
extension; elbow (radius) cranial and caudal
glides; carpal palmar and dorsal glides; and
manus plantar and dorsal glides. Each of these
arthrokinematics requires joint capsule stabil-
ity, which is maintained via the inherent integ-
rity of the joint capsule and surrounding
ligaments that provide additional resistance to
external forces. Ligamentous stability in the
thoracic limb includes the medial and lateral
collateral ligaments of the glenohumeral joint
that prevent excessive medial and lateral glides,
respectively, of the humerus in the glenoid
fossa; the medial and lateral collateral liga-
ments of the elbow, carpus, and digits that
counteract varus and valgus forces through
each of these joints; and the oblique ligament of
the elbow that may counteract hyperextension
forces. Keen observation of anatomy, osteokin-
ematics, and arthrokinematics in each of the fol-
lowing tests will assist the therapist with the
critical thinking skills to develop a precise
problem list and the correct treatment plan.Posture
The purpose of postural evaluation is to deter-
mine positional inequities that may lead the
therapist to further evaluate particular areas of
the body. Posture is observed with the patient
in a natural static standing position. The thera-
pist describes appendicular skeletal posture
from the front, side, back, and top of the patient.
The therapist first takes into consideration head
position relative to back height and midline.
Changes in neck position may change the
posture of the entire body, predisposing the
thoracic limbs, spine, and pelvic limbs to com-
pensatory issues. For example, due to a number
of multi‐joint muscles including the brachioce-
phalicus and omotransversarius, primary or
compensatory injuries of the thoracic limb can
affect neck position, which in turn can affect
active and passive range of motion which, over
time, may limit cervical spine facet joint arthro-
kinematics. Position of the scapulae on the
thorax should then be reviewed taking into
consideration breed‐specific angulation (visit
http://www.akc.org for breed‐specific angulation).
Inequities in scapular position can indicate
tightness, weakness, or injury to the muscles
that connect the scapula to the thorax including
the serratus ventralis cranial and caudal fib-
ers, rhomboids, and cranial and caudal heads
of the trapezius.
Postural evaluation of the peripheral limbs is
then completed, taking care to note the stand-
ing angle of the glenohumeral, elbow, and