Section: Veterinary Care In-depth
Diagnosis In-depth
It is important to discuss the history of the lameness, whether the problem was sudden in onset or appeared gradually over a period of months, improving with rest but always getting worse after exercise.
Observation. Your veterinarian will observe your dog at rest, taking note how your pet stands in the examination room and how he sits. The dog may not touch the leg to the ground in an acute injury or just touch the toes down. Most dogs with cruciate problems will not sit squarely, deviating a partially flexed knee out to the side. A walk, followed by a trot, will be most helpful to define a more subtle lameness perhaps due to a partial cruciate tear.
Palpation. Your veterinarian will carefully palpate the knee to assess for joint swelling and thickening. More long standing cruciate injury results in thickening on the inner aspect of the knee to produce a firm bump called a "medial buttress."
Flexion and extension. The knee will be put through flexion and extension to assess the range of motion prior to evaluation for abnormal range of motion. Popping or clicking of the knee may occur during flexion and extension, which is suspicious for, but not diagnostic of, meniscal injury.
Cranial drawer or tibial compression tests. Performing these tests is extremely important. Both tests are looking for abnormal sliding of the tibia on the femur, a motion that should not be produced with an intact cruciate ligament. Certain partial tears will only produce a cranial drawer sign in knee flexion, and some partial tears will not produce a drawer sign at all.
Radiographs of the knee joint. X-rays can help to evaluate joint swelling and early subtle bony arthritic changes. In more chronic cases, the x-rays can help define the amount of arthritis that already exists to help in discussions about overall prognosis.
Arthroscopy or MRI. In certain cases of suspected partial cruciate injury, these further diagnostic techniques may prove helpful prior to an exploratory surgery of the knee.
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