Chapter 13 Evaluation and Rehabilitation Options for Orthopedic Disorders of the Canine Thoracic Limb 339(weakness of carpal flexors), or any combina-
tion of these or other signs of weakness, the
strength score is <3/5 (poor). The test is then
completed on the contralateral limb. If the
patient is able to maintain the position without
compensation on either of the thoracic limbs,
the strength score is at least 3/5 (fair). The limb
must then be tested in a more strenuous posi-
tion with the patient’s pelvic limbs placed on
the box, thus increasing the weight, and there-
fore the force the muscles must produce, into
the thoracic limbs. With the pelvic limbs on the
box, the thoracic limb test is repeated with the
therapist observing whether the thoracic limb is
able to maintain the standing position with the
pelvic limbs on the box. If the patient is unable
to maintain the position the strength score is
3/5 (fair). If the patient is able to maintain the
position the strength score is 3+/5 (good).
When completing the C‐MMT, attention must
be given to musculoskeletal issues that may
interfere with the test such as facet joint dys-
function, which would prevent the patient from
comfortably placing the pelvic limbs on the box.
More objective strength test scores may be
obtained with surface electrode electromyogra-
phy (EMG). Clinical limitations include time
constraints, the need to shave each muscle
group, and the paucity of research directly cor-
relating canine EMG measures and muscle
force production. Further studies are required
to develop canine objective strength measures
that are valid and reliable.
Gait
Gait evaluation is used to examine lameness
and movement quality. Gross lameness and
decreased weight bearing can commonly be
seen subjectively. During gait analysis, move-
ment quality includes measurements of the gait
cycle phases such as swing phase and stance
phase. Observational data from gait evaluation
guides the therapist to in‐depth evaluation of
specific areas. For example, observation of a
right thoracic limb decreased stance phase may
lead the therapist to a detailed assessment of
the right thoracic limb, cervical spine, and
thoracolumbar spine. Historically, it was
thought that subjective capture of low‐grade
lameness may improve with the use of slow
motion cameras but recent evidence suggests
slow motion capture compared with real‐time
video does not improve the accuracy or consist-
ency of subjective gait analysis (Lane et al.,
2015). Currently, the gold standard for objective
measurements of gait analysis is the force plate
(Voss et al., 2007) but novel devices such as iner-
tial sensors may be able to provide alternative
and more real world objective measures of
gait and movement (Duerr et al., 2016). See
Chapter 2 for gait analysis.Passive range of motion
Evaluation of passive range of motion (PROM)
guides a therapist to a deeper understanding of
a patient’s osteokinematic baseline. PROM
evaluation includes objective goniometric
measurements and subjective descriptions of
the end‐feel (see Chapter 6). The objective gonio-
metric measurement determines if the range of
motion is normal, and, if not, the subjective
end‐feel determines which tissue is limiting the
full range of motion. Research has shown that
objective goniometric measurements are both
valid and reliable when tested with a universal
goniometer (Jaegger et al., 2002). Studies com-
paring universal goniometers with electronic
goniometers currently on the market also indi-
cate the universal goniometer to be superior to
the electronic goniometer in reliability (Thomas
et al., 2006).
Subjective descriptions of tissues that may
limit range of motion include effusion (boggy
end‐feel), cartilage (crepitus), joint capsule
(hard capsular end‐feel), ligament (hard liga-
mentous end‐feel), tendon (elastic end‐feel),
and meniscus (springy or click end‐feel). For
the highest quality goniometric objective meas-
urement, the nonaffected side is measured first.
Of tremendous importance during range of
motion testing is ensuring all muscles sur-
rounding the joint are on slack so a valid joint
osteokinematic measurement can be obtained.
In general, if testing flexion, placing the proxi-
mal and distal joints into a flexed position will
place the multi‐joint muscles on slack. If testing
extension, placing the proximal and distal joints
into an extended position will improve PROM
testing. It is important to note that there are
ranges of motion where one‐joint muscles can-
not be placed on slack and this may influence
the quantity of goniometric motion and quality