Front Matter

Chapter 13 Evaluation and Rehabilitation Options for Orthopedic Disorders of the Canine Thoracic Limb 343

is due to joint surface abnormalities, joint
capsule restrictions, or musculotendinous
restrictions of the biceps or supraspinatus.
Determination of joint play requires extensive
manual therapy training as subjective capture
of joint movement quality and quantity is a
learned skill and incorrect application of man-
ual forces through a joint can be injurious. See
Chapter  6 for further discussion of joint play
techniques.

Special tests

Special tests for the thoracic limb consist pri-
marily of ligament stress tests to determine
baseline joint stability. They include the medial
shoulder instability test, elbow varus and val-
gus stress tests, and carpal varus and valgus
stress tests. All tests are completed in a closed‐
pack position with the ligaments positioned for
highest tensile resistance.

Development of the rehabilitation
assessment

At completion of evaluation, the problem list is
developed by describing the location, tissue
type, and chronicity of each clinical finding.
Location is described as precisely as possible in
specific anatomic terms so that a second
therapist could immediately locate the injury.
Tissue type is delineated in very clear terms

differentiating muscle belly, musculotendinous

junction, tendon, ligament, joint capsule, carti-

lage, or bone. The chronicity of injury must be

determined for each impairment location and is

defined as acute, subacute, or chronic.

At completion of the problem list, the thera-

pist critically analyzes the list and prioritizes

the problems in descending order from the

most painful tissues to primary tissues to com-

pensatory tissues. The outcome of this critical

analysis leads the therapist to write an assess-

ment, the hypothesis that supports all of the

problems on the list. For example, a primary

diagnosis may be “left glenohumeral joint oste-

ochondritis dissecans (OCD) lesion with surgi-

cal excision,” and the rehabilitation problem list

may be “left glenohumeral joint acute pain due

to postoperative edema with compensatory

pain in left biceps brachii at musculotendinous

junction, left latissimus dorsi decreased flexibil-

ity, and palpation pain of bilateral paraspinals

T6‐L2.” Analysis of the problem list will often

reveal complex iterations of location, tissue

type, and acuity, requiring the therapist to care-

fully consider treatment options for the most

efficacious interventions.

Development of the treatment plan

Using the rehabilitation problem list as the tem-

plate, a treatment plan is developed to meet the

client’s goals for the patient. Each treatment in

Figure 13.8 If, during the course of range of motion assessment, a restriction in glenohumeral joint flexion is noted, the
therapist will assess joint glides. Assessment of the cranial glide requires stabilizing the scapula then gliding the head of
the humerus cranially, the arthrokinematic movement associated with glenohumeral joint flexion. If a restriction is noted
during joint play, the therapist carefully captures manual assessment data including joint surface quality and end‐feel,
the outcomes of which will guide the treatment plan.