Practical Physiotherapy for Veterinary Nurses E-Book

Donna Carver

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 265

Veröffentlichungsjahr: 2015

Beschreibung

Reflecting a rapidly growing area of interest in veterinary practice, this practical, pocket-sized guide to small animal physiotherapy has been designed for quick reference, providing the ideal guide for busy practice veterinary nurses when they really need it.

• Reflects the need for a text in this rapidly growing area of interest, providing the first on this topic for veterinary nurses
• Designed in a pocket-sized format so that VNs can carry it around for quick reference
• The author has ideal experience for this field, having worked as both a veterinary nurse and an animal physiotherapist
• This book is accompanied by a companion website which contains videos and self-test questions and answers

Leseprobe

Table of Contents

Cover

Title Page

Acknowledgements

About the companion website

CHAPTER 1: Musculoskeletal physiotherapy

Introduction

Gait analysis

History taking

Physical examination

Exercise plans

Physiotherapy treatment techniques and modalities

Musculoskeletal presenting conditions

Pain management

Physiotherapy musculoskeletal assessment

Self-assessment questions

CHAPTER 2: Neurology

Introduction

Surgical presenting conditions

Non-surgical presenting conditions

Medical neurological presenting conditions

Neurological assessment

Physiotherapy assessment for the neurology patient

Self-assessment questions

CHAPTER 3: Respiratory physiotherapy

Introduction

Chest auscultation and interpretation

Percussion note technique and interpretation

Interpretation of blood gases

Respiratory failure

Cardiorespiratory monitoring

Electrocardiograms

Respiratory presenting conditions

Respiratory physiotherapy treatment techniques

Self-assessment questions

CHAPTER 4: Hydrotherapy

Introduction

The aims of hydrotherapy

Pool chemistry

Properties of water

Hydrotherapy for specific conditions

Self-assessment questions

APPENDICES

Appendix 1: Glasgow Coma Scale (GCS)

Appendix 2: Secretion retention assessment and management plan

Appendix 3: Atelectasis assessment and management plan

Appendix 4: Bronchospasm assessment and management plan

Appendix 5: V/Q mismatch assessment and management plan

Appendix 6: Pain assessment and management plan

Appendix 7: Hypoxaemia assessment and management plan

Abbreviations

References

Self-assessment answers

Chapter 1: Musculoskeletal physiotherapy

Chapter 2: Neurology

Chapter 3: Respiratory physiotherapy

Chapter 4: Hydrotherapy

Index

End User License Agreement

List of Tables

Chapter 01

Table 1.1 Lameness scoring scale.

Table 1.2 Normal canine joint range of motion.

Table 1.3 Patella luxation grades.

Table 1.4 Pain score scale 0–4.

Chapter 02

Table 2.1 Features of upper and lower motor neuron lesions.

Table 2.2 Cranial nerve testing.

Table 2.3 Grading the severity of spinal cord lesions.

Chapter 03

Table 3.1 Normal blood values.

Table 3.2 Simple acid–base disorders.

Table 3.3 Arterial blood gas classification of respiratory failure.

Table 3.4 Cardiorespiratory monitoring equations.

Chapter 04

Table 4.1 Hydrotherapy progression.

List of Illustrations

Chapter 01

Figure 1.1 The K-Laser™ programmed and ready to use on a patient.

Figure 1.2 A patient ascending stairs. Note the reciprocal gait pattern: the right thoracic limb is flexed to step up, and the left pelvic limb is extended to push off onto the step. The right pelvic limb is flexed to place the limb on the stair, and the left thoracic limb is extended as weight is being taken through this limb.

Figure 1.3 Severe hip dysplasia with a left femoral head and neck excision.

Figure 1.4 A patient balancing on a wobble board. The left thoracic limb is lifted to target strengthening and stability in the right thoracic limb.

Figure 1.5 Sequence of cranial cruciate ligament disease events.

Figure 1.6 A patient’s left thoracic limb on the wobble cushion, with the right thoracic limb lifted. This unstable surface will challenge and improve conscious proprioception in the left thoracic limb. This exercise also has a strengthening/stabilising effect on the limb.

Figure 1.7 A patient weight-bearing and balancing on a wobble cushion. The left pelvic limb is lifted to further strengthen and stabilise the right pelvic limb.

Figure 1.8 A right cranio-caudal postoperative tibial tuberosity advancement.

Figure 1.9 A right lateral postoperative tibial tuberosity advancement.

Figure 1.10 A left cranio-caudal fractured radius and ulna.

Figure 1.11 Post-fracture repair. The image shows the patient following surgery with a dressing on the left thoracic limb.

Figure 1.12 A left cranio-caudal radius and ulna repair.

Figure 1.13 The PRICE regime for conservative treatment of musculoskeletal injuries.

Figure 1.14 Gate control theory.

Figure 1.15 Progressive signs of spinal cord or cauda equina symptoms.

Chapter 02

Figure 2.1 Chronic intervertebral disc disease at L1-2 with widespread cord compression.

Figure 2.2 A tetraparetic patient positioned on his right side with his left limbs supported to prevent muscle imbalance (he is weaker on his left side).

Figure 2.3 Right thoracic limb passive range of motion (PROM) exercise to maintain joint range of motion. The operator’s right hand stabilises at the elbow joint to prevent rotation of the joint, the left hand flexes the carpal, elbow and shoulder joints.

Figure 2.4 Left pelvic limb passive range of motion (PROM) exercise to maintain joint range of motion. The operator’s right hand stabilises over the hip joint, the left hand flexes the tarsal, stifle and hip joints together.

Figure 2.5 A left hip flexor stretch. The operator’s left hand is placed on the distal femur and applies a caudal force into resistance; the right hand stabilises the distal limb to avoid any rotation of the joints.

Figure 2.6 A left hamstring stretch. The operator’s left hand is positioned on the distal femur and applies a caudal force; the right hand is positioned at the caudal tarsus and applies an opposing cranial force to stretch the hamstrings.

Figure 2.7 A right triceps stretch. The operator applies a cranial force to the caudal elbow into resistance to stretch the triceps muscle (see also Video 2.4).

Figure 2.8 A right biceps stretch. The operator’s left hand stabilises at the origin of the muscle, and the right hand is fixed on the insertion of the muscle and applies a caudal force into resistance to stretch the biceps.

Figure 2.9 Assisted sitting in a paraparetic patient using The Soft Quick Lift™ sling. Note that the pelvic limbs are positioned in a functional sitting position, and the patient is being supported from behind to maintain his balance, and to prevent him from falling backwards.

Figure 2.10 Assisted standing in a paraparetic patient using The Soft Quick Lift™ sling. Note the patient is taking some weight through the left pelvic limbs, but is knuckling on his right pelvic limb.

Figure 2.11 The image shows a suspected C6-7 fibrocartilaginous embolism (FCE) lesion.

Figure 2.12 The image shows a right-sided intramedullary hyperintensity from C5-6 to caudal C7, more central at the level of C7, associated with cord swelling. These features are consistent with a type III disc at C6-7.

Chapter 03

Figure 3.1 Electrocardiogram of normal sinus rhythm.

Figure 3.2 Electrocardiogram of sinus tachycardia.

Figure 3.3 Electrocardiogram of premature ventricular contractions.

Figure 3.4 Electrocardiogram of atrial fibrillation.

Figure 3.5 Chronic obstructive pulmonary disease.

Figure 3.6 X-ray of bronchitis showing a moderate diffuse bronchial pattern.

Figure 3.7 X-ray showing increased opacity over the ventral thorax with areas of alveolar pattern suggestive of pneumonia.

Figure 3.8 (a) X-ray showing marked retraction of the lung lobes due to pleural effusion. (b) Follow-up X-ray post-thoracocentesis showing poorly defined areas of soft tissue opacity, which could be inflammatory or neoplastic.

Figure 3.9 X-ray showing a left-sided cardiomegaly associated with severe pulmonary oedema.

Chapter 04

Figure 4.1 Patient with left thoracic limb biceps tendinopathy exercising in the underwater treadmill to strengthen the biceps muscle. Additional resistance is provided by the patient working against resistance from the water jets.

Guide

Cover

Table of Contents

Begin Reading

Pages

iii

iv

vii

ix

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

61

62

63

64

65

66

67

68

69

70

71

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

107

108

109

110

111

112

113

114

115

116

117

118

119

120

121

122

123

124

125

126

127

128

129

130

131

132

133

134

135

136

137

138

139

140

141

142

143

144

145

146

147

148

149

151

152

153

154

155

156

157

158

159

160

161

162

163

164

165

166

167

168

169

170

171

172

173

174

175

176

177

178

179

180

181

182

183

185

186

187

188

189

190

191

192

193

194

195

196

197

198

199

200

201

202

203

205

206

207

208

209

210

211

213

214

215

216

217

219

220

221

222

223

Practical Physiotherapy for Veterinary Nurses

Donna Carver BSc (Hons) PhysiotherapyDip AVN (surg), RVN, MCSP

Chartered Physiotherapist, Specialist Veterinary Nurse

School of Veterinary Medicine

University of Glasgow, UK

This edition first published 2016 © 2016 by John Wiley & Sons, Ltd.

Registered OfficeJohn Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK

Editorial Offices9600 Garsington Road, Oxford, OX4 2DQ, UKThe Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK1606 Golden Aspen Drive, Suites 103 and 104, Ames, Iowa 50010, USA

For details of our global editorial offices, for customer services and for information about how to apply for permission to reuse the copyright material in this book please see our website at www.wiley.com/wiley-blackwell

The right of the author to be identified as the author of this work has been asserted in accordance with the UK Copyright, Designs and Patents Act 1988.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher.

Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought.

The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.

Library of Congress Cataloging-in-Publication Data

Carver, Donna, 1968– , author.  Practical physiotherapy for veterinary nurses / Donna Carver.    p. ; cm.  Includes bibliographical references and index.

  ISBN 978-1-118-71136-1 (paper)  I. Title.  [DNLM:  1. Physical Therapy Modalities–nursing.  2. Physical Therapy Modalities–veterinary. 3. Hydrotherapy–veterinary.  4. Physical Examination–veterinary.  5. Veterinary Medicine–methods. SF 925]  SF925.C37 2016  636.089′5853–dc23          2015015321

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Acknowledgements

I would like to dedicate this book to the patients and clients I have worked with throughout my career.

I would also like to thank the staff at the University of Glasgow Veterinary School for their support and for helping me make this book possible, with special thanks to Clare Skea (RVN) for her photography skills and patience.

About the companion website

Practical Physiotherapy for Veterinary Nurses is accompanied by a companion website:

www.wiley.com/go/carver/physiotherapy-veterinary-nurses

The website includes:

Videos showing examples of exercises and treatments

Self-assessment questions and answers taken from the book are offered in interactive form on the companion website to make testing yourself easier

CHAPTER 1Musculoskeletal physiotherapy

Introduction

Gait analysis or assessment is a skill that requires close observation of the patient at walk and trot, to determine the cause and location of the lameness. A start point is to become familiar with a normal gait pattern, taking into account breed variations (i.e. dachshund vs bull mastiff). Once you are familiar with normal gait pattern, any deviation from this can be recognised.

Animals should be on a loose lead at walk and trot to observe for anatomical symmetry (normal gait pattern). Animals should be observed in a straight line towards, and then a straight line away from the observer. Pay particular attention to how the animal turns to both the left and right side – this may show reluctance to transfer weight onto the affected limb, or that the animal has issues with balance. The observer should then view the animal moving from both left and right sides. Subtle lameness may not readily be observed at walking pace; however, at trot the animal will only have one thoracic limb and one pelvic limb in contact with the ground, and these limbs will be placed under greater pressure meaning a lameness may be easier to detect.

Videoing the gait pattern, then slowing it down on playback, may be a useful way to detect lameness.

Gait analysis

Observe muscle symmetry, weight-bearing (paw and toe position) and conformation at rest.

Observe gait in a quiet area at walk and trot; thoracic limb lameness is often associated with head bobbing. When the animal takes its bodyweight through the painful thoracic limb the head will bob upwards in an attempt to unload the ground reaction force passing through the limb.

Pelvic limb lameness can be observed by a hiking up in the gluteal region in an attempt to offload or shift weight from the painful limb; this may be towards the contralateral pelvic limb, or forwards usually towards the contralateral thoracic limb. Lameness in pelvic limbs may also present with a bunnyhopping gait pattern. This may be related to a reduction in pelvic limb power, often observed with stair climbing or running. The bunnyhopping gait pattern may also be related to a reduced range of motion within the coxofemoral joint, which would be confirmed on physical examination.

Lameness is a general term used to describe an abnormal gait pattern; it may be:

Congenital

– chondrodystrophic abnormalities, i.e. valgus (lateral deviation of the distal limb), often seen in dachshunds.

Or

Pathological

– related to a disease process such as osteoarthritis, which can affect any breed but is often seen in larger breeds.

Scoring systems are often used to grade the degree of lameness, and in veterinary practice a typical 1–10 scale is used where 1/10 would indicate barely lame, whereas 10/10 would indicate non-weight-bearing lameness. The scale is very subjective, as only descriptive terms are allocated to the very mildest and most severe lameness. If one observer rated lameness as 4/10, then a second observer may rate the same lameness as 6/10; does this indicate the lameness is progressing? This is why it is important to obtain a full and accurate history from the owner, who will probably observe the animal’s gait every day and be able to state if the lameness is improving, staying the same, or deteriorating. A simpler alternative scoring 0–5 system is available (Table 1.1).

Table 1.1 Lameness scoring scale.

From Summer-Smith (1993). Reproduced with permission from Elsevier.

Score

Description

0

Normal

1

Reduced weight-bearing through affected limb in stance

2

Mild lameness at trot

3

Moderate lameness at walk and trot

4

Intermittently carries limb, lame in trot

5

Non-weight-bearing lameness

Elbow dysplasia gait analysis findings include abduction of the affected limb in an attempt by the patient to reduce the amount of bodyweight passing through the elbow joint. This will be most evident when the animal is ambulating on hard ground as the concussive forces passing through the elbow joint will be greater.

Flicking of the carpal joints is also evident with elbow dysplasia; this is a compensatory mechanism for the reduced range of motion, especially elbow flexion, that is characteristic of advanced elbow dysplasia. The condition is often bilateral, so it is important to observe how the animal turns (weight transfer) and observe (or ask the owner about) functional activities such as how or if the animal is able to descend stairs or jump from the car; this will increase load on the elbow joint and will be uncomfortable for the animal so he may avoid these functional activities.

Hip dysplasia gait analysis findings may include a short stride length; this is usually shown as reduced hip extension and can be readily observed as the animal climbs stairs as a weak or short hip extension/push-off. The reduction in hip extension is a characteristic of hip dysplasia, with associated osteoarthritis and joint remodelling.

Adduction of the affected limb is also evident. This can be due to weakness in the hip flexor muscle groups, and may also be associated with secondary osteoarthritic changes and compensatory coxofemoral joint remodelling. As discussed earlier hiking up of the gluteals to shift bodyweight from the affected limb, and bunnyhopping with bilateral hip dysplasia are also gait characteristics observed with this disease.

Cruciate rupture patients usually present with an abnormal gait pattern. Lameness can vary from mild 1/5 (usually chronic) to 5/5 (usually acute). The degree of lameness often correlates with the level of pain the animal is experiencing. A short stride length, especially reduced extension, is evident; also the animal will tend to limit stifle flexion. The animal will usually guard or resent stifle end-of-range flexion. Clicking of the joint may be evident and may indicate associated meniscal damage; this may be evident when the animal flexes the stifle joint, and loads the joint with bodyweight, such as in stair climbing. In acute presentation a joint effusion may be present. In chronic presentations thickening of the joint on the medial surface often with a tibial buttress is common. Stifle range of motion (ROM) is reduced as a result of scar tissue formation and secondary osteoarthritic changes.

The animal may abduct the limb to alter the direction of ground reaction forces passing through the joint, and if there is fatigue or weakness in the hip flexor muscle groups.

The animal will be reluctant to fully weight-bear through the affected limb; at rest, toe touch weight-bearing is often evident; the animal may also adopt various strategies to reduce weight-bearing in stance and will often position the affected limb in a cranio-medial plane.

The long-term muscle changes associated with pelvic limb lameness are short, tight hip flexor muscles, with, weak hamstring muscles. The goal for the physiotherapist is to stretch the short, tight muscles, whilst strengthening the weak, muscles.

History taking

This should include:

Age –

Young dogs

: When taking a history consider hip dysplasia, elbow dysplasia, oesteochondrosis dissecans (OCD).

           Adult dogs: Consider osteoarthritis, cruciate disease and neoplasia.

Breed –

Toy breed

: Often show patella luxation, Legg–Calvé–Perthes disease.

               Large breed: May present with cruciate disease, elbow dysplasia, neoplasia.

Onset of lameness:

May be sudden or subtle or traumatic.

Can be episodic or cyclic.

Is it consistently the same limb or a shifting lameness?

Duration of lameness:

Can be continuous or intermittent.

Is the patient’s condition deteriorating, remaining static or improving?

Association:

Does exercise or rest effect the condition?

Does the patient appear worse in the morning or night?

Is there a seasonal pattern when symptoms are seen in summer or winter?

Does soft or hard ground affect the severity of symptoms?

Behavioural changes:

Is the patient showing aggression?

Does the patient have sleep disturbance?

Is the patient reluctant to play/jump?

Exercise – Ask about type, frequency and duration.

Response to treatment:

Is the patient on any medication, has this made any difference?

Has the patient had any previous physiotherapy treatment? If so what was the response or outcome?

Explore the owner’s expectations of physiotherapy.

Physical examination

When assisting with a physical examination try to find a quiet area. Adopt a systematic anatomical approach each and every time. With the animal standing each limb will be lifted in turn to gauge weight-bearing through the limbs. Obviously the animal will be taking least weight through the affected limb, but lifting each limb in turn may give an indication of where the animal is shifting his bodyweight as a compensatory measure. Compensatory measures can often lead to secondary musculoskeletal issues so these should be noted during the physical exam and addressed later.

When assessing muscle mass compare with the unaffected contralateral limb for muscle mass symmetry. A standard tape measure can be used to measure the circumference of muscle bulk. Again, try to be systematic to ensure accuracy. For example, when measuring pelvic limb muscle bulk try to measure in standing, measure at the thickest point – this usually corresponds to the level of the muscle belly. Try to have a landmark – say in the pelvic limb the greater trochanter of the femur – where the two ends of the tape measure should meet and record the measurement. A difference of more than 1 cm would be considered significant. It is good practice to measure three times and take the average measure from the three readings and record this average reading in the notes.

Conscious proprioception may be delayed or absent in the presence of a joint effusion, which is often evident in acute cranial cruciate ligament injury.

Exercise plans

Exercise plans are designed to rehabilitate patients back to their highest level of function; they can be staged and should be progressive:

Early phase

(approximately 0–2 weeks): this time scale will depend on the patient’s condition. The aims will be to control inflammation, maintain joint ROM and muscle length.

Mid-phase

(approximately 2–6 weeks): during this phase the patient should be progressing. The aims are to build on the progress from the early phase and also to improve strength, balance and proprioception.

Late phase

(approximately 6–12 weeks): this stage is when the patient will continue to gain strength, regain balance and improve stamina.

Early stage post-surgical rehabilitation will begin on day 1 postoperatively. Aim to minimise pain and inflammation, ensure non-weight-bearing (NWB) status on affected limb, maintain joint ROM and muscle length.

Mid-stage rehabilitation can commence 14 days postoperatively, following a satisfactory check-up from the veterinary surgeon and suture removal. The aims are to begin to increase joint ROM of the affected limb, and increase muscle length and mass on the affected limb. Begin gentle partial weight-bearing (PWB) exercises to increase function and strength, and prevent secondary compensatory postures and complications from developing.

Late-stage rehabilitation can commence at 6 weeks postoperatively following a satisfactory check-up from the veterinary surgeon, who may take survey radiographs at this stage to check healing. Rehabilitation goals will be to continue to strengthen the muscles of the affected limb. The patient may be full weight-bearing (FWB) on the affected limb at this stage.

Commence balance and proprioceptive exercise training using wobble cushions, wobble boards and cavaletti pole work. Address compensatory postures, which may be associated with trigger points.

Address secondary complications such as muscle imbalances (tight in flexor muscle groups, weak in extensor muscle groups, which is a common finding in animals with long-term lameness). Finally, the aim of the rehabilitation programme is to return the patient back to the highest level of function, so late-stage rehabilitation will address cardiovascular fitness or stamina, which will have been effected by the graded return to function rehabilitation programme.

Also consider the owner’s ability and commitment to carry out the rehabilitation programme, plus environmental factors. The owner may work full time and have other family commitments. The rehabilitation home exercise programme should fit in with the animal’s needs and the owner’s time restrictions. Do not advise a rehabilitation home exercise programme that takes any more than 30 minutes twice daily to ensure owner compliance. Environmental factors to consider would include: are there other animals in the house, and are there stairs in the house that the patient needs to use?

Physiotherapy treatment techniques and modalities

Cold therapy

Cold therapy aims to control and minimise inflammation postoperatively or following acute injury. The body responds to injury by triggering an inflammatory reaction in the cells. The normal inflammatory phase in healthy tissues is approximately 72 hours. This is the period of time when cold therapy is recommended to minimise the inflammatory response.

Signs of inflammation

Pain

– from swollen or damaged nerve endings.

Redness

– from damage of local tissues.

Heat

– from dilation of local blood vessels.

Swelling

– from the associated capillaries becoming more permeable resulting in oedema of the local area.

Cold can be applied to the affected area in several ways. Broken ice chippings wrapped in a plastic zip-lock bag covered by a damp cloth, applied to the affected area for 10–20 minutes can be effective. This treatment can be repeated every 4–6 hours as required.

Usually begin the treatment early to minimise the inflammatory response. If an animal is recovering from surgery and is hypothermic, treatment may be postponed until the patient’s body temperate returns to normal.

Cold therapy works by causing vasoconstriction of the local damaged blood vessels, thereby reducing swelling, damage to local tissues, and oedema.

Contraindications

Cold hypersensitivity.

Altered skin sensation.

Cautions

Cardiac conditions.

High blood pressure.

Open healing wounds.

Areas over superficial nerves.

Heat therapy

Various methods can be used to apply heat to the superficial tissues, such as wheat bags and heat discs that can be warmed in the microwave. Alternatively a damp towel can be microwaved, placed in a zip-lock bag and applied to the affected area for 10–20 minutes. This can be repeated every 4–6 hours.

Heat therapy can commence once the inflammatory phase has passed (usually 72 hours post-injury).

The principle of heat therapy is to vasodilate local blood vessels thus increasing blood flow to the local area to promote healing. Increased cellular activity results in an increase of oxygen and nutrients delivered to the cells.

Heat therapy can be used to reduce pain, stiffness and muscle spasm. Heat improves the elasticity of tissues and can be use prior to stretching.

Contraindications

Sensory changes.

Burns/scalds.

Thrombus/embolism.

Hyper- or hypo-sensitivity to heat.

Infections.

Malignant tumours.

Positioning and supports

Positioning aids and supports are used to maintain muscle length and support the weight of the affected limb. The animal may not have full function or control of the affected limb postoperatively. This may be exacerbated by factors such as pain or discomfort, bulky dressings or external fixators.

The animal will usually choose not to lie on the same side as the affected limb. However, the animal may find it difficult to find a comfortable position in which to rest. In most circumstances the animal will be more comfortable if the affected limb is supported in a neutral position, or slightly elevated in the early stages of recovery, and this will also prevent any muscle imbalances from developing. Folded beds, towels and pillows can be used to maintain the required position. Gentle handling and support of the affected limb and reassuring the animal are essential to aid compliance.

If a patient is placed with the injured limb uppermost and appears uncomfortable, or if the animal continually changes his position to lie on the injured limb, leave the animal in this position as he obviously finds it more comfortable. However, it is preferable not to allow the animal always to lie on one side, so attempt to gently reposition the animal on his non-affected side even if he only tolerates this position for a short period.

Ensure that if the patient’s trunk is positioned in sternal recumbency and the patient has a support at his lateral thorax so he is not weight-bearing excessively or unevenly through his elbow joints. Ensure the elbows are equally abducted to prevent uneven weight-bearing, which could result in pressure sores. If the affected limb is positioned uppermost an adductor wedge or internal rotator wedge should be placed between the limbs to prevent muscle imbalance – for instance, weak gluteals versus tight adductors. Aim to use the adductor wedge to place the affected limb in a neutral position as this will be most likely tolerated by the patient.

Many waterproof animal mattresses are available to assist in preventing pressure sores. However, this will create an unstable surface when the animal is standing, and walking in and out of the kennel. Position yourself on the opposite side of the affected limb when assisting the patient to stand and walk in and out of the kennel. When positioned on the unaffected side you are able to assist the animal to shift his weight onto his unaffected limb to ensure he does not lose his balance.

Manual aids

Slings

Slings are used to assist the animal when he is mobilising. A variety of slings are available for veterinary use, most commonly used with orthopaedic patients is The Soft Quick Lift™ (Four Flags Over Aspen, Inc.) abdominal sling. This type of sling is useful following pelvic limb surgery, is easy to use, and is usually well tolerated by the patient. If you are using a sling to assist the patient to mobilise, position yourself on the same side as the unaffected limb in line with the pelvic limb. In this position you can tilt the patient slightly onto his unaffected limb and assist with balance if necessary and prevent him from falling.

In the early stages following orthopaedic surgery it is not desirable for a patient to weight-bear on the affected limb. This is because the soft tissues and bones are still healing, stabilising and remodelling. Early weight-bearing is not a sign of successful surgery