Group 11 - Plan of Action

1. Ask client if there was any specific event that was associated with the initial discovery of Bonnie's lameness.

2. Perform cytology and culture and sensitivity on joint fluid acquired in tap done during orthopedic exam.  Culture and sensitivity should indicate the presence of any infectious agents and what pharmaceuticals would be most appropriate for treatment.  The following chart indicates how we can evaluate the joint tap cytology:
Normal:    250-3000 nucleated cells/mm^3    94-100 mononuclear    0-6 neutrophils
DJD:    1000-5000 nucl. cells/mm^3    88-100 mono.   0-12 neutro.
Erosive arthritis:    8000-38000 nucl. cells/mm^3    20-80 mono.    20-80 neutro.
Non-erosive arthritis:    4400-371000 nucl. cells/mm^3    5-85 mono.    15-95 neutro.
Septic arthritis:    40000-267000 nucl. cells/mm^3    1-10 mono.    90-99 neutro.

3. Radiographs:  Perform all of the following views on both stifle joints for comparison.
a. Cranio-caudal view
b. Lateral view
c. Optional shearing stress lateral radiograph on the right stifle to confirm CCL tear if cranial drawer is at all in doubt.  This is done by taking a radiograph while applying a cranial drawer displacement to the left stifle joint.  Considering the positive cranial drawer sign, this view may be of no additional benefit. 

The expected radiographic findings for each of our hypothesis are as follows:
Cranial cruciate ligament rupture: Radiographs are rarely diagnostic for rupture of the CrCL, however radiographs can be helpful in confirming intra-articular disease.  Common findings include:  joint effusion with capsular distention and compression of the infrapatellar fat pad, periarticular osteophytes, enthesiophytes, CrCL avulsion fractures, calcification of the CrCL. The shearing stress radiograph may show, in addition to the above findings, 
Septic arthritis: In the early stages of the disease radiographs may indicate thickened and dense periarticular tissues, and possible synovial effusion.  In the later stages of the disease there is evidence of bone destruction including:  osteolysis, irregular joint space, discreet erosions, and periarticular osteophytes.
Degenerative joint disease: These changes may include any of the following: joint capsular distension, osteophytes, enthesiophytes, soft tissue thickening, narrowed joint spaces, and subchondral sclerosis in severely affected patients.  Osteophytes would likely be found on the trochlear ridges, caudal surface of tibial plateau, and/or the inferior pole of the patella.  

4. CBC to determine the presence of an inflammatory leukogram to help rule in/out septic arthritis and as part of a pre-surgical anesthetic profile if Bonnie needs to undergo surgery.

5. Pre-anesthetic chemistries including ALT, BUN, and TP are indicated if surgery is elected to check for liver, renal, and vascular oncotic pressue/hydration status.