Lameness examinations – 10 top tips

When a dog, cat or rabbit presents as lame, it can sometimes be quite a challenge to work out exactly what is wrong. Just trying to identify which leg is affected can sometimes be difficult. In this article we give a few top tips on how to ensure you are confident with your examination to ensure you make the right diagnosis.

Posted: 25 June 2020

Lameness examinations – 10 top tips

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1. Let them relax – if the patient knows you’re about to check them over, they’ll probably become nervous and may not show signs of pain. You might find some of our previous articles useful. 

2. Be patient – it doesn’t help to rush, so take your time and watch everything. There’s no doubt that the first few moments of the clinical examination needs to be done with patience and from the other side of the room. The worst thing you could do is rush to pick up the animal and start feeling all the joints. Take your time and watch the animal’s behaviour first.

3. History – ask lots of questions and find out as much as you can first. A long and detailed history covering as much as possible is worth a lot. Find out when the lameness started; how it happened; what are the signs; does it wax and wane; does anything help; and so on. 

4. Use the corner of your eye – whilst chatting with your clients, try to be aware of what the patient is doing. By watching the patient without focusing on it, he/she will be more relaxed and give you more clues. You need to get some answers to all of these;

  1. How are they standing? – a leg held off the ground perhaps?
  2. How do they move? – stiff movements and/or with caution?
  3. Are they unsettled and shifting their weight from one leg to another?
  4. Are they comfortable when sitting and standing?
  5. Is there any evidence of panting or excessive licking? This can sometimes indicate pain.

5. Make friends – the examination room should always be used in a way that keeps the patient relaxed. You need them to think of you as a friend and not a threat. With most animals it can help if you get down to their level. Crouch down and let them approach you first. It often helps if you avoid too much eye contact, and keep the conversation going with the owner with a calm, relaxed tone of voice. The more your patient trusts you, the more natural signals they will give back to you. Some suggestions include;

  • Level ground – crouch down onto the floor at their height.
  • Come to me - allow them to approach you first.
  • Don’t hold on – rather than restraining them from the outset, let them wander around the room first.
  • Use their name – and use it often in the same way the owner does.
  • Smell – when they approach you, allow them to check you out by smell.
  • Lick and rub – when they approach you, offer your hand and let them lick you.
  • Avoid white coats – sometimes the clinical clothing we wear is covered in other animal smells which can be quite intimidating. It may help to remove your white coat.
  • Avoid eye contact – absolutely no staring at the patient as this will undoubtedly be considered to be a threat.
  • Gentle tones – speak slowly and with a soft voice.

6. Safe environment – as far as possible make the examination room safe and comfortable for your patient. If they’re relaxed, they’ll be much easier to examine. This is best achieved by;

  • Removing bad odours – the scent of cats, dogs and predators will likely make them feel unsettled. This is especially important if a previous patient has emptied its glands!
  • Keep it quiet – the best consultation rooms are those which are quiet. Some animals are best examined far away from the waiting room and kennels.
  • Examine outside – there may be occasions when it’s more convenient and relaxing for a dog if they are examined outside on a lead. You’ll get a better idea of movement and it’ll make it easier to locate the origin of the limp.
  • Offer treats – many dogs will respond well to rewards, so always keep a store of tasty treats in the consulting room.

7. Client confidence - if the owner is new to your surgery and unfamiliar with your vets, nurses and procedures, it may take a bit of time to gain their confidence and trust. However, this is necessary if you are going to be able to help. A cold, distant and overly clinical approach may make it harder, so try to show empathy, care and a love of animals. You can do this by;

  • Meet and greet – an upbeat welcome with their family pet with confident smiles, usually goes down well.
  • Explain all – tell the owner what you are thinking, doing and planning with their pet. This will ensure they feel comfortable that their pet is in good hands.
  • Use the prep room – don’t make a nervous pet worse by firm restraint in front of the owner. Some animals will be more relaxed when examined away from the owner, so explain this and perform a more detailed second examination in the prep room.

8. The Examination

It’s usually best to examine the patient when it’s standing, as you’ll find it easier to make a good comparison of symmetry. Work from behind, using both hands at the same time to simultaneously palpate both;

  • front limbs
  • pelvic limbs
  • sides of the trunk
  • spine and neck

By doing this you’ll be able to detect even small amounts of swelling, effusion or warmth. Once you’ve compared the symmetry, move on to feeling each limb in turn, checking for ease of movement and any resistance or pain.

9. Look for a reaction

The most effective way to assess the animal’s response to palpation and manipulation is when it’s relaxed and comfortable. This can be made possible if the consulting room is free of other distractions such as phones, other pets and unnecessary people moving about. The subtle clues to look out for are;

  • shifting weight stance
  • respiratory pattern changes
  • anxious look in the eyes with pupil dilation
  • increased muscle tension

If you see any of these signs, repeat the manoeuvre or palpation and see if it’s repeatable.

10) Don’t make these mistakes

Apart from all of the above, there are also some important things to avoid. Our list includes;

  • Don’t take risks - with anxious, dominant dogs, always be aware that if you trigger a pain response when examining a limb, you may get bitten. You’ll need to work with the owner and dog first to ensure that the dog recognises you as being more dominant than them. Take hold of the lead and get them to sit, stay and wait a few times, and offer them some praise for responding to your commands. Once this has been established, you can start your examination. In some cases, sedation may become necessary.
  • Don’t make quick, loud or sudden movements – this will more than likely frighten the animal and risk a fear response.
  • Don’t ignore subtle patient responses – remember to look for those ear movements, facial grimaces and withdrawal movements.
  • Don’t rush to sedate – this will almost certainly reduce your chances of identifying a normal response to a stimulus.
  • Don’t rush to perform radiographs – many conditions can be identified by a history, clinical examination with palpation alone.

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