{"id":15462,"date":"2018-11-02T15:48:24","date_gmt":"2018-11-02T15:48:24","guid":{"rendered":"https:\/\/todaysveterinarypractice.com\/?p=15462"},"modified":"2022-02-15T18:13:54","modified_gmt":"2022-02-15T18:13:54","slug":"gait-abnormality-musculoskeletal-or-neurologic-condition","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/orthopedics\/gait-abnormality-musculoskeletal-or-neurologic-condition\/","title":{"rendered":"Gait Abnormality: Musculoskeletal or Neurologic Condition?"},"content":{"rendered":"

When an animal is presented to you with a history of lameness or a gait abnormality, you need to determine whether the problem is musculoskeletal, neurologic, or both, so you can recommend the appropriate treatment. To arrive at an appropriate diagnosis, you must collect the signalment and a thorough history, conduct a physical examination (including observation of the patient\u2019s ambulation and direct palpation of the joints, extremities, and spine), and perform the appropriate diagnostic testing. This article reviews the clinical tools available to help you make the correct diagnosis and, consequently, make the best recommendations for treatment or referral.<\/p>\n

Signalment and History<\/h2>\n

The signalment (patient\u2019s age, breed, and sex) is especially useful because several musculoskeletal and neurologic conditions have a predilection for animals of certain breeds, of a certain sex within a breed, and in certain age groups (TABLE 1<\/strong>).1-4<\/sup><\/p>\n

\"\"<\/a>When taking a medical history, ask about any past trauma or orthopedic disease (e.g., fractures, hip dysplasia, cranial cruciate ligament rupture) or neurologic disease (e.g., disc disease, seizures, vestibular disease, behavior changes) (TABLE 2<\/strong>). Although you should always ask about onset and duration of lameness or gait abnormality, be aware that musculoskeletal or neurologic conditions can be acute, subacute, or chronic. Current or previous responses to medications, such as changes in gait abnormality after administration of drugs (e.g., nonsteroidal anti-inflammatory drugs, glucosamine\/chondroitin sulfate, or corticosteroids), also provide valuable information. The historical character of the lameness or gait abnormality will also provide critical diagnostic information, such as lameness that worsens after activity or resting (musculoskeletal), a gait abnormality that is always present regardless of degree of rest or activity (musculoskeletal, neurologic), lameness that improves after mild exercise (i.e., \u201cwarms out of the lameness\u201d; musculoskeletal), a gait abnormality that involves unilateral or bilateral limbs (musculoskeletal, neurologic), a gait abnormality that is visible in multiple limbs (musculoskeletal, neurologic), or lameness that seems to be weather-related (musculoskeletal).<\/p>\n

\"\"<\/a>Consider the periodicity of the gait abnormality (intermittent or persistent) and whether the gait abnormality has been progressive or static over time. Although both musculoskeletal and neurologic conditions can cause intermittent or persistent gait abnormalities, determining the time course of the condition will help you prioritize the differential diagnoses for potential musculoskeletal and neurologic disease processes.<\/p>\n

Helpful Clinical Tip:<\/strong> In a busy practice setting, taking the time to obtain the signalment and details of the lameness history can seem daunting to the clinician, but having a veterinary nurse (versed in obtaining these critical data) do this for you can be a great time-saver and can provide essential information for piecing together the cause of the clinical gait abnormality.<\/p>\n

Clinical Examination<\/h2>\n

The clinical examination is performed in 2 parts: gait assessment and physical examination (which includes palpation and manipulation of the patient).1-4<\/sup> As part of the clinical examination, you will need to localize the affected limb or joint, which can be accomplished by assessing gait (directly observing the patient\u2019s ambulation) and directly palpating the patient\u2019s joints, extremities, and spine. Although the gait assessment is routinely conducted before the direct physical examination, we have found that for patients with mild lameness or subtle gait abnormalities, reversing the order of the examinations (i.e., physical examination with palpations\/manipulations followed by gait assessment) may allow for better recognition of a subtle gait abnormality.<\/p>\n

Gait Assessment<\/h2>\n

Gait is assessed with the patient standing, walking, and trotting. Besides observing the patient start, stop, and change pace, you should evaluate its gait from different profiles (right lateral, left lateral, cranial, caudal). Things to look for while assessing gait include variations in stride length, timing of foot contact, relative swing phase of limb\/joint, lameness, ataxia (coordinated versus uncoordinated), head bobs, pelvic swings, circumducted swing phases, dynamic or static rotations (external or internal) of a limb, foot\/nail scuffing, leg crossing (especially during turning), narrow stance in pelvic limbs, tail position, head\/neck position, and hock and carpal position (palmar-grade\/plantar-grade, dorsiflexion) (FIGURES 1 AND 2<\/strong>).\u00a0You should also evaluate whether the gait abnormality is coordinated (usually musculoskeletal conditions) or uncoordinated (usually neurologic conditions).<\/p>\n

\"\"<\/a>

FIGURE 1.<\/strong> A 6-year-old, spayed female Alaskan malamute with cranial cruciate ligament rupture of the left stifle, shown at a walk. Left pelvic limb: late stance phase (A<\/strong>) and early swing phase (B<\/strong>). Right pelvic limb: late stance phase (D<\/strong>) and early swing phase (E<\/strong>). Because of discomfort\/joint instability, the placement of the left (abnormal) pelvic limb foot in the midstance phase is shorter than that of the right pelvic limb foot when the right limb is in late stance phase (C<\/strong>) (compared with part A). The opposite is true when the right pelvic limb is in midstance phase compared with the left pelvic limb foot in late stance phase (F<\/strong>). This difference in foot placement is partially the result of discomfort\/instability during weight-bearing on the affected limb, resulting in a shorter stance phase for the affected than for the unaffected limb during weight-bearing. The observed effect is that the dog more quickly unloads the weight on the affected pelvic limb (shorter stance phase) than on the unaffected pelvic limb (longer stance phase). Arrows demonstrate the respective distances in foot placement.<\/p><\/div>\n

Gait assessment findings that suggest musculoskeletal or neurologic conditions are as follows:<\/p>\n

Musculoskeletal (pain or mechanical)<\/strong><\/p>\n