Clinical techniques in small animal practice最新文献

Companion animal rehabilitation, a collaborative practice of physical therapy and veterinary medicine, can only demonstrate the effectiveness of its theories, techniques, interventions, and modalities through evidence-based practice, utilizing standardized, reliable, and valid outcome measures, correlated with objective diagnostic data. This essay examines existing and potential objective outcome measures utilized in companion animal rehabilitation and physical therapy regarding pain, vital signs, body condition and composition, range of motion, muscle strength, inflammation, functional mobility, and gait. Discussion is included of the traditional disablement model and the evolution of the physical therapy diagnosis, prognosis, and plan of care.

Physical therapy is commonly used postoperatively in humans to decrease pain, inflammation and recovery time. The same goals can be achieved in our veterinary patients using similar modalities such as; cryotherapy, passive range of motion, massage, transcutaneous electrical stimulation and low-level light laser therapy. When used in the first 48 hours following surgery, the reduction in pain, increased mobility, and decreased inflammation will aid in early return to normal function. Applied appropriately these treatments have both immediate and long term benefits.

The shoulder joint is the most mobile of all main limb joints. While its primary motion is in a sagittal plane, the shoulder has a significant amount of abduction and adduction, and internal and external rotation. Its stability is ensured by the joint capsule, by its specialized bands (medial and lateral glenohumeral ligaments), and by large tendons located inside (eg, tendon of origin of the biceps brachii muscle) or immediately outside the joint (eg, supraspinatus, infraspinatus, teres minor, and subscapularis). Sprains or strains of all supporting structures of the canine shoulder have now been reported and the shoulder pathology resembles the pathology of the human shoulder that includes strains and tears of the rotator cuff muscles, adhesive capsulitis, and calcific tendonitis.

Many problems in the hip area show movement dysfunctions of the hip joint in combination with the lumbar spine, sacroiliac joint, neurodynamic structures, and the muscular systems. Muscle strain injuries pertinent to the canine hip have been reported in the iliopsoas, pectineus, gracilis, sartorius, tensor fasciae latae, rectus femoris, and semitendinosus muscles. Physical diagnoses of this type of injury require palpation skills and the ability to specifically stretch the suspected musculotendinous tissue. Treatments shall incorporate modalities, stretches, specific exercises, and advisement on return to normal activity. Canine hip dysplasia (CHD) is a common finding in many large breed dogs. Physical treatments, preventative therapies, and rehabilitation could have a large role to play in the management of nonsurgical CHD patients with the goal to create the best possible musculoskeletal environment for pain-free hip function and to delay or prevent the onset of degenerative joint disease. Osteoarthritic hip joints can benefit from early detection and subsequent treatment. Physical therapists have long utilized manual testing techniques and clinical reasoning to diagnose early-onset joint osteoarthritis and therapeutic treatments consisting of correcting muscle dysfunctions, relieving pain, joint mobilizations, and advisement on lifestyle modifications could be equally beneficial to the canine patient. As well, sacroiliac joint dysfunctions may also afflict the dog. An understanding of the anatomy and biomechanics of the canine sacroiliac joint and application of clinical assessment and treatment techniques from the human field may be substantially beneficial for dogs suffering from lumbopelvic or hindlimb issues.

Cranial cruciate ligament (CCL) injury is a leading cause of lameness in dogs. Recent advances in diagnostic visualization and surgical treatments for CCL injury have stimulated an increased emphasis on early clinical recognition and an early return to function. Many surgical treatments have been described that aim to restore stifle joint stability and minimize the progression of osteoarthritis. Major advances have occurred not only in the treatment of CCL injury, but also in postoperative recovery, specifically, rehabilitation therapy. The benefits of rehabilitation therapy following CCL surgery are multifaceted including pain relief, decreased inflammation and swelling, increased tissue flexibility, strengthening, improved proprioception, improved limb and joint biomechanics, and improved weight-bearing. In this article, we introduce a variety of rehabilitation therapy options for postoperative CCL patients including modalities, manual therapy, therapeutic exercise, and the benchmarks for a full return to function.

Physical rehabilitation modalities such as therapeutic ultrasound (TU), transcutaneous electrical neuromuscular stimulation (TENS), neuromuscular electrical stimulation (NMES), cold or low-level laser therapy (LLLT), and pulsed magnetic field therapy (PMF) can all, when used properly, assist in treating orthopedic injuries, neurological conditions, and chronic conditions brought about by normal aging in our small animal companions. TU uses sound waves to produce both thermal and nonthermal effects that aid in tissue healing, repair, and function. TENS uses different frequencies of electrical current to decrease pain and inflammation. NMES also uses an electrical current to stimulate muscle contraction to assist in normal neuromuscular function in postorthopedic and neurological injuries. LLLT uses light energy to reduce pain, decrease inflammation, and stimulate healing at a cellular level. PMF uses magnetic field to stimulate normal cellular ion exchange and oxygen utilization and promote generalized healing of tissues. These modalities are discussed in detail covering mechanism of action, parameters, settings, and indications/contraindications of use in our small animals. Although these modalities are important in the physical rehabilitation of small animals, they need to be incorporated with a proper diagnosis, manual therapy, and home exercise program into a specific and individualized patient treatment protocol.

Therapeutic exercise is a key component of any rehabilitation program and should be included as part of the concurrent care of any patient whether that patient has two or four legs. Physical therapists have been utilizing therapeutic exercises with great success since the conception of the profession in the beginning of the twentieth century and it has been demonstrated to be fundamental in improving function, performance and disability. Therapeutic exercise can consist of a variety of exercises inclusive of balance, strengthening, range of motion, endurance, and plyometric activities. The goals of therapeutic exercises include the restoration of movement, improvement of function and strength, improvement in gait and balance, and the prevention and the promotion of health, wellness, and fitness. Specific exercises are aimed at restoring strength, power and work, or endurance, or a combination. Therapeutic exercises are also utilized to increase range of motion, decrease pain, improve balance and proprioception, and restore function.

Pancreatic disorders in dogs and cats are recognized with increasing frequency, and abdominal ultrasonography has assumed an important role in their diagnosis. The normal pancreas is a small, inconspicuous organ of comparable echogenicity to surrounding mesentery and may be difficult to identify. Therefore, knowledge of anatomic landmarks such as portal vein and contributing vessels, duodenum, and stomach is necessary to facilitate identification and examination. Pancreatic diseases and abnormalities frequently investigated by means of ultrasonography include pancreatitis, pseudocysts, abscesses, neoplastic lesions, and nodular hyperplasia. Disorders less commonly seen include exocrine pancreatic insufficiency, pancreatolithiasis, congenital anomalies, and pancreatic edema. Unfortunately, ultrasonographic findings in various pancreatic disorders overlap, and incidental findings or age-related changes may mimic pancreatic disease. On the other hand, pancreatic disorders may not cause changes in ultrasonographic appearance. Ultrasonographic findings, therefore, have to be judged in light of signalment, history, and laboratory data. Cytology or histopathology may be needed to establish a definite diagnosis. Despite these limitations, ultrasonography is useful in diagnosing pancreatic disease, guiding aspirates and biopsies, and monitoring response to treatment.

This article is a brief review of ultrasound beam formation. Some detailed components of the ultrasound machine are discussed as a primer for the subsequent article on recent technological advances. The components of the ultrasound transducer responsible for broad bandwidth technology and electronic focusing are discussed in the context of optimizing resolution. Other aspects of ultrasound physics, including artifacts and interactions with matter, are not discussed.