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CC BY 4.0 · VCOT Open 2022; 05(02): e116-e122
DOI: 10.1055/s-0042-1750036
Original Article

Lameness Localization in Dogs: An Exploratory Study of the Translation of the Equine Flexion Test to Canine Orthopaedics

Diane Grosjean 
1   Department of Medical Imaging and Small Animal Orthopedics, Ghent University – Faculteit Diergeneeskunde, Merelbeke, Belgium
,
Evelien De Bakker 
1   Department of Medical Imaging and Small Animal Orthopedics, Ghent University – Faculteit Diergeneeskunde, Merelbeke, Belgium
,
Amélie Mugnier
2   NeoCare – Néonatalogie des Carnivores, Reproduction et Elevage, Université de Toulouse, ENVT, Toulouse Cedex 3, France
,
Francis Verschooten
3   Department of Large Animal Surgery and Anesthesia, Ghent University – Faculteit Diergeneeskunde, Merelbeke, Belgium
,
Ulrich Rytz 
3   Department of Large Animal Surgery and Anesthesia, Ghent University – Faculteit Diergeneeskunde, Merelbeke, Belgium
,
Franck Forterre 
3   Department of Large Animal Surgery and Anesthesia, Ghent University – Faculteit Diergeneeskunde, Merelbeke, Belgium
,
Yves Samoy 
1   Department of Medical Imaging and Small Animal Orthopedics, Ghent University – Faculteit Diergeneeskunde, Merelbeke, Belgium
,
Bernadette Van Ryssen
1   Department of Medical Imaging and Small Animal Orthopedics, Ghent University – Faculteit Diergeneeskunde, Merelbeke, Belgium
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Abstract

Objectives The aim of this study was to describe the method and feasibility of the flexion test (FT) as a diagnostic tool to localize lameness on dogs.

Study Design Canine FT was designed and based on the FT routinely used on horses. In dogs, the test consisted in a flexion of a joint to its full range of motion for 1 minute. Eventual increased lameness was then evaluated. The gait was evaluated using a visual analogue scale. An increase in the lameness score compared with the baseline score was considered as a positive result.

The method was described for every major joint of the appendicular skeleton and was evaluated in sound and lame dogs. To evaluate the feasibility, the FT was applied for 3 minutes in eight healthy dogs on all joints. On 27 clinically lame dogs, flexion was applied for 1 minute on the joints with a suspected pathology and on their contralateral side used as a control.

Results The FT was feasible and well tolerated by the sound dogs on all joints and no positive results were recorded. On clinically lame dogs, lameness increased in 81.5% of dogs. These cases were afterwards diagnosed with an orthopaedic-related disorder and then defined as true positives. False negative results occurred in 18.5% of the lameness cases.

Conclusion The FT is safe and easy to perform. It did not produce any false positive results. False negatives might occur in a minor number of cases, implying that a negative result does not exclude a joint pathology.

Keywords

lameness evaluation - orthopaedic examination - joint pain - diagnostic tool - locomotor system


Publication History

Received: 03 September 2021

Accepted: 29 March 2022

Article published online:
21 October 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Davidson EJ. Lameness evaluation of the athletic horse. Vet Clin North Am Equine Pract 2018; 34 (02) 181-191
    CrossrefPubMedSearch in Google Scholar
  • 2 Mantell JA. . Use of the flexion test in the pre-purchase examinations in horses. 1998;142(12):314
    PubMed
  • 3 Verschooten F. The locomotory system of the purchase examination in the horse. Equine Pract. 1992; 14 (08) 8-16
    PubMedSearch in Google Scholar
  • 4 Busschers E, van Weeren PR. Use of the flexion test of the distal forelimb in the sound horse: repeatability and effect of age, gender, weight, height and fetlock joint range of motion. J Vet Med A Physiol Pathol Clin Med 2001; 48 (07) 413-427
    CrossrefPubMedSearch in Google Scholar
  • 5 Kearney CM, van Weeren PR, Cornelissen BP, den Boon P, Brama PA. Which anatomical region determines a positive flexion test of the distal aspect of a forelimb in a nonlame horse?. Equine Vet J 2010; 42 (06) 547-551
    CrossrefPubMedSearch in Google Scholar
  • 6 Keg PR, van Weeren PR, Schamhardt HC, Barneveld A. Variations in the force applied to flexion tests of the distal limb of horses. Vet Rec 1997; 141 (17) 435-438
    CrossrefPubMedSearch in Google Scholar
  • 7 Keg PR, van Weeren PR, Back W, Barneveld A. Influence of the force applied and its period of application on the outcome of the flexion test of the distal forelimb of the horse. Vet Rec 1997; 141 (18) 463-466
    CrossrefPubMedSearch in Google Scholar
  • 8 Verschooten F, Verbeeck J. Flexion test of the metacarpophalangeal and interphalangeal joints and flexion angle of the metacarpophalangeal joint in sound horses. Equine Vet J 1997; 29 (01) 50-54
    CrossrefPubMedSearch in Google Scholar
  • 9 Ramey DW. Prospective Evaluation of Forelimb Flexion Tests in Practice: Clinical Response, Radiographic Correlations, and Predictive Value for Future Lameness. Proceeding presented at: Annual Convention of the American Association of Equine Practitioners, Vol 43; 1997
    PubMedSearch in Google Scholar
  • 10 Jull GA, O'Leary SP, Falla DL. Clinical assessment of the deep cervical flexor muscles: the craniocervical flexion test. J Manipulative Physiol Ther 2008; 31 (07) 525-533
    CrossrefPubMedSearch in Google Scholar
  • 11 López-de-Uralde-Villanueva I, Acuyo-Osorio M, Prieto-Aldana M, La Touche R. Reliability and minimal detectable change of a modified passive neck flexion test in patients with chronic nonspecific neck pain and asymptomatic subjects. Musculoskelet Sci Pract 2017; 28: 10-17
    CrossrefPubMedSearch in Google Scholar
  • 12 Ochi K, Horiuchi Y, Nakamichi N, Morita K, Okada E, Hasegawa T. Association between the elbow flexion test and extraneural pressure inside the cubital tunnel. J Hand Surg Am 2011; 36 (02) 216-221
    CrossrefPubMedSearch in Google Scholar
  • 13 Ochi K, Horiuchi Y, Tanabe A, Morita K, Takeda K, Ninomiya K. Comparison of shoulder internal rotation test with the elbow flexion test in the diagnosis of cubital tunnel syndrome. J Hand Surg Am 2011; 36 (05) 782-787
    CrossrefPubMedSearch in Google Scholar
  • 14 Valdes K, LaStayo P. The value of provocative tests for the wrist and elbow: a literature review. J Hand Ther 2013; 26 (01) 32-42 , quiz 43
    CrossrefPubMedSearch in Google Scholar
  • 15 Meek MF, Dellon AL. Modification of Phalen's wrist-flexion test. J Neurosci Methods 2008; 170 (01) 156-157
    CrossrefPubMedSearch in Google Scholar
  • 16 Goubau JF, Goubau L, Van Tongel A, Van Hoonacker P, Kerckhove D, Berghs B. The wrist hyperflexion and abduction of the thumb (WHAT) test: a more specific and sensitive test to diagnose de Quervain tenosynovitis than the Eichhoff's test. J Hand Surg Eur Vol 2014; 39 (03) 286-292
    CrossrefPubMedSearch in Google Scholar
  • 17 Ergen E. Bülent U. Clinical sports medicine Chapter 18 Proprioception and Coordination. Saunders Elsevier; 2007. 17 p
    Search in Google Scholar
  • 18 Ellenbecker TS, Davies GJ, Bleacher J. Proprioception and Neuromuscular Control. In: Physical Rehabilitation of the Injured Athlete [Internet]. Elsevier; 2012 [cited 2021 Aug 2]. p. 524–47. Available from: https://linkinghub.elsevier.com/retrieve/pii/B9781437724110000241
    PubMed
  • 19 Kholinne E, Kim D, Kwak J-M. et al. Topography of sensory receptors within the human glenohumeral joint capsule. J Shoulder Elbow Surg 2021; 30 (04) 779-786
    CrossrefPubMedSearch in Google Scholar
  • 20 Çabuk H, Kuşku Çabuk F. Mechanoreceptors of the ligaments and tendons around the knee. Clin Anat 2016; 29 (06) 789-795
    Search in Google Scholar
  • 21 Abdo H, Calvo-Enrique L, Lopez JM. et al. Specialized cutaneous Schwann cells initiate pain sensation. Science 2019; 365 (6454): 695-699
    CrossrefPubMedSearch in Google Scholar
  • 22 DeCamp CE, Johnston SA, Déjardin LM, Schaefer SL. Brinker, Piermattei, and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. Fifth edition. St. Louis, Missouri: Elsevier; 2016. 868 p.
    Search in Google Scholar
  • 23 Koch D, Fischer MS. Diagnosing Canine Lameness. Stuttgart:Thieme; 2020. 249 p.
    Thieme ConnectSearch in Google Scholar
  • 24 Clarke E, Aulakh KS, Hudson C. et al. Effect of sedation or general anesthesia on elbow goniometry and thoracic limb circumference measurements in dogs with naturally occurring elbow osteoarthritis. Vet Surg 2020; 49 (07) 1428-1436
    CrossrefPubMedSearch in Google Scholar
  • 25 Formenton MR, de Lima LG, Vassalo FG, Joaquim JGF, Rosseto LP, Fantoni DT. Goniometric assessment in French bulldogs. Front Vet Sci 2019; 6: 424
    CrossrefPubMedSearch in Google Scholar
  • 26 Chong TE, Davies HMS. Investigating canine elbow joint stabilisation through mechanical constraints of the deep fascia and other soft tissues. J Anat 2018; 232 (03) 407-421
    CrossrefPubMedSearch in Google Scholar
  • 27 Armentrout AR, Beard WL, White BJ, Lillich JD. A comparative study of proximal hindlimb flexion in horses: 5 versus 60 seconds. Equine Vet J 2012; 44 (04) 420-424
    CrossrefPubMedSearch in Google Scholar
  • 28 Moreira JPL, Tichy A, Bockstahler B. Comparison of the vertical force distribution in the paws of dogs with coxarthrosis and sound dogs walking over a pressure plate. Animals (Basel) 2020; 10 (06) 986
    CrossrefPubMedSearch in Google Scholar
  • 29 Schnabl-Feichter E, Tichy A, Bockstahler B. Evaluation of a pressure plate for detection of hind limb lameness in cats. PLOS ONE. 2020 Apr 22;15(4)
    PubMed
  • 30 Starke SD, Willems E, Head M, May SA, Pfau T. Proximal hindlimb flexion in the horse: effect on movement symmetry and implications for defining soundness. Equine Vet J 2012; 44 (06) 657-663
    CrossrefPubMedSearch in Google Scholar
  • 31 Marshall JF, Lund DG, Voute LC. Use of a wireless, inertial sensor-based system to objectively evaluate flexion tests in the horse: Sensor-based system to objectively evaluate flexion tests in horses. Equine Vet J 2012; 44: 8-11
    CrossrefPubMedSearch in Google Scholar
  • 32 Aulakh KS, Dongaonkar KR, Barnes K. et al. Influence of orthopedic examination on lameness scores and interobserver and intraobserver agreement in dogs with naturally occurring elbow osteoarthritis. Vet Surg 2020; 49 (03) 455-462
    CrossrefPubMedSearch in Google Scholar