Canine orthopedics

Spondylosis Deformans

A drawing showing different grades of spondylosis deformans

A drawing showing different grades of spondylosis deformans

Spondylosis Deformans is a condition characterized by the presence of bony spurs (osteophytes) along the edges of the spine. These “spurs” may develop in one site or they may be in several locations. They can build a bridge between vertebras and can make your pet appear very stiff.

The most common places for spondylosis deformans can be either in the thoracic region (chest), at the junction between the last rib and the lower back, in the lumbar (lower back) region or even at the lumbosacral region (around the hips and back legs).

The exact cause of spondylosis deformans is unknown but there are theories associated with trauma, inheritance, and degenerative disease of the discs. The bone spurs are the spine trying to stabilize itself.

No certain breed of dog is found to be more prevalent but it does seem to be more common in large breed dogs, usually middle-aged to older and can be found in cats also.

Clinical signs of this condition can include stiffness, lameness, pain, neurologic signs or your pet may be asymptomatic.

Diagnosis is usually found through physical exam, history, and radiographs. Other diseases such as cancer, Diskospondylitis, fracture or luxation can also cause bone spurs or deformities. Myelograms (dye placed in the spinal canal), CT or MRI may be recommended to be sure of the diagnosis.

Treatment usually depends upon the pet – are they painful, are they symptomatic, do they have any lameness? If your pet is asymptomatic, then keeping him flexible and strong is the best medicine and this is usually done through different types of physical therapy and exercise.

If your pet is painful, then NSAIDs are usually the first treatment of choice and once the pain has been addressed then again, physical therapy and exercise are recommended.

Therapeutic laser has been very helpful for these pets in my opinion. We have relieved the pain and allowed the pet to function as a normal pet for longer periods of time. If your pet should have spinal cord compression due to spondylosis deformans then surgery is recommended.

Spondylosis deformans can limit your pet’s movement but with weight control, pain management and exercise your pet can live an active life.

Caudal Cervical Spondylomyelopathy — Wobblers

Sam is a Great Dane but he does not have Wobblers -- just being a great model for me!

Sam is a Great Dane but he does not have Wobblers — just being a great model for me!

Caudal Cervical Spondylomyelopathy or Wobblers is a compression of the spinal cord due to malformation of bony or ligamentous structures typically at C5-C6 or C6-C7 at the base of the neck.  Wobbler is usually found in large breeds such as Great Danes and Dobermans.

Wobblers in Great Danes usually affects the young while in Dobermans it is more of a middle age disease.  The malformation causes an abnormal gait in the rear legs.

Other signs of Wobblers can include:  pain, neurologic deficits, ataxia (staggering), worn nails, muscle atrophy, and even paresis or paralysis.

Wobblers can usually be diagnosed by lateral radiographs but myelograms or even MRIs may be needed for complete diagnosis.  If Wobblers is the diagnosis, then surgery is the recommended treatment.

NSAIDs must be decreased prior to surgery to help combat the possibility of bleeding.  There are two main types of surgery:

  1. Ventral slot – in which the surgeon makes the entrance to the spinal cord through the neck and removes the bony structure that is causing the compression.
  2. Ventral slot with distraction and fusion – the surgeon makes the entrance to the spinal cord through the neck, removes the bony structure causing the compression but he also places a scaffold between the vertebrae and fuses the space closed.

Post-op care must be very consistent and conscientious.  You must watch for pressure sores especially on bony points.  Passive and active range of motion exercises must be performed at least daily but would be better if performed at least three to four times a day.  Another post-op consideration must be for bladder catheterization.  Bladder catheterization is easily performed once you have been successfully taught by the surgeon or rehabilitation personnel.

Rehabilitation facilities are available for help with the care of your pet during the post-op period.  They have the resources and ability to help your pet regain his quality of life and be functional.

Shoulder Injuries – Part Two

Canine Anatomy Bones with NamesThere are a variety of problems that can predispose your pet to shoulder injuries. These can include such things as poor core strength, straight shoulder conformation, poor conditioning, rear leg injuries and other things.

Shoulder conformation is also known as “layback”. The front leg consists of the shoulder, elbow, carpus (wrist) and toes. The layback is the shoulder angle and it can be determined in the following way. (See photos below)

  1. Put your pet in a stacked position and make him stand symmetrically.
  2. Find the highest point on the shoulder blade.
  3. Find where the shoulder blade meets the humerus (upper arm).
  4. Lay a ruler between these points.
  5. The angle between this line and vertical is the layback.

The layback demonstrates the reach your pet has and how it can affect performance. Now jumping dogs can extend this reach slightly by using their mid back so a dog with too straight of an angle can eventually cause injuries along the spine or in the rear by compensating.

Now some breeds are very straight in the front and that doesn’t mean they can’t compete but it does mean that we need to have a very strong core to save their backs and you need to have a routine of stretching, strengthening and management so they can compete without injury.

The problem with a straight front is that you can get a minor injury which may not be seen or disappears quickly and a slight weakness sets in; this injury continues each time being slight with minute changes in the range of motion and flexibility. This leads to pain, decreased strength and endurance.

The way to treat this is with NSAIDs, cryotherapy (icing the area) for 10-15 minutes, laser therapy works well, and then we must increase the strength, stabilization, range of motion and flexibility.

Simple exercises such as flexion and extension help to increase the range of motion over a period of time – take this slow because we don’t want to hurt the pet and they refuse to let you do it again. Another great way to strengthen your pet’s shoulders is by using the FitPAWS equipment to help with balance and weight shifting.

Your rehabilitation veterinarian has more options for exercise so if your pet seems to be having an issue please see your veterinarian and then the rehab specialist.

Lily demonstrating the "layback". We are going from the top of the shoulder to the shoulder joint.

Lily demonstrating the “layback”. We are going from the top of the shoulder to the shoulder joint.

This is the line from the shoulder joint to the elbow.

This is the line from the shoulder joint to the elbow.

 

Shoulder Injuries

The shoulder of your pet

The shoulder of your pet

It has been a while since this was posted so I thought I would re-post it so when I gave the second part later this week you would be able to find them together.

Shoulder injuries are so difficult to diagnose and they can be extremely hard to rehabilitate. The shoulder blade in your pet is not attached by bone to the body but by a large mass of muscles and this fact makes it hard to see anything on radiographs.

Each front leg supports about 30% of your dog’s weight in normal movement but that weight can increase 3-5 times depending on which activity they are doing — the force can be enormous.

As your dog runs and dodges he also places a large amount of force on the abductors and adductors of the shoulder complex — these are the muscles that allow him to change directions. I am a huge baseball fan — think about all the crazy pictures you have seen of pitchers with their arms back ready to release the ball. I don’t know about you but I have tried to get my arms in those crazy positions and it just ain’t happening.

The typical scenario of shoulder injury is that the pet hurts themselves and limps a couple of days then get better. A few weeks later they are lame again and it may be very subtle — as a friend says, “only a limp a mother would note”. A head bob can also be an indication that there is something wrong on the front end.

Your veterinarian will do a thorough examination and may recommend radiographs to rule out things such as arthritis, elbow dysplasia, and fractures. Radiographs will not show a soft tissue injury so be prepared in case they don’t find a bony problem. If it is a soft tissue injury further diagnostics such as diagnostic ultrasound or MRI may be needed.

This type of injury can be very innocent such as slipping on the floor or from some type of sporting injury such as tripping, hard turns, or jumping. Some signs noted in competition pets are avoiding jumps, decreased stride length, warmth to the shoulder and head bobs. There are, of course, numerous other signs but these are some of the prominent ones.

One of the best ways to prevent shoulder issues is by correctly warming up your pet and doing some basic stretching (you knew it was coming down to this). This can be as simple as having your pet stand up against you or by doing the play bows. Next week we will discuss how to look at your dog’s conformation to see if he runs the risk of shoulder injury.

Have a great week!

Biceps Tenosynovitis

Biceps Tenosynovitis

Biceps Tenosynovitis

A common injury seen in humans and canines are muscle strains or tears. The canine shoulder has 25 muscles to help with movement. Because of the density of muscles and the way our canine athletes compete, Biceps Tenosynovitis (Biceps Tendonitis) has become a common problem especially in agility dogs.

The biceps tendon attaches on the shoulder blade, goes through the shoulder joint, widens into the belly of the muscle and attaches onto the lower leg at the radius and ulna bones.

Biceps tenosynovitis is inflammation of the biceps brachii muscle tendon. This inflammation can be caused by repeated strain injury, quick turns, trauma and even chronic osteochondritis dissecans of the shoulder joint. Tendons have poor blood supply and that makes them even more susceptible to injury.

Muscle contraction strength is greatly affected by even minor strain injury and since the blood supply is so poor, healing of the lesion can be problematic. Scar tissue in the muscle predisposes it to contracture and reinjury.

Biceps tenosynovitis is seen more commonly in medium to large breed dogs that are mature. There can be intermittent lameness that may become worse with exercise. Loss of muscle on the affected leg can be seen and it may be painful upon palpation of the tendon.

Radiographs are not very specific for this problem and MRI or ultrasound may be used to identify the condition. Arthroscopy can be used as a diagnostic and therapeutic tool.

If surgery is recommended then the options include a tenodesis (reattaching the tendon at a new location) or a tendon release by arthroscopy. Medical management of biceps tenosynovitis includes pain management, exercise restriction, and rehabilitation therapy.

Rehabilitation is the main ingredient in recovery whether you choose medical or surgical management of the problem. Treatments will include pain management with NSAIDs, laser therapy, ultrasound therapy, passive range of motion movements, and possibly acupuncture. Exercises will be prescribed for your pet and slowly increased over time.

Strengthening exercises will be incorporated later in the rehabilitation program but the important component is controlled activity. Full recovery may take 4 to 6 months so try not to be too impatient and push your canine athlete too quickly; slow and steady will win the race.

Whether you wish to pursue medical or surgical options, ARCC – Animal Rehab & Conditioning Center is here to help you with your canine athlete during his recovery.

Osteosarcoma or Bone Cancer

marvistavet.com

Typical sites of bone cancer

I hate writing about depressing things but we all must face some hardship periodically. In the veterinary world, we usually see things in threes — 3 dogs with bladder stones, 3 cats that have urinary blockage, and cancers.

So when I saw the first pet a week or so ago with possible osteosarcoma I crossed my fingers and sent him to his veterinarian but the news was not good; I hoped that since I was in a “different” avenue of veterinary medicine that the superstition would not hold.

Unfortunately, this also was not to be true — a second patient was referred back to his vet and bone cancer was found again. I am still hopeful that I won’t see another but I am being very vigilant with every pet to make sure there isn’t anything kind of wonky.

Osteosarcoma is a malignant tumor of the bone and among the most common bone tumors seen in dogs. It metastasizes (goes to other parts of the body) quickly and because of this has a poor prognosis.

It is more commonly found in large breed dogs and on the long bones of the legs. Most of these pets are seven years or older and we do tend to see more of them in males.

The pet usually is lame and the owner may think it is due to some type of trauma. Lameness can be subtle or even to non-weight bearing but eventually the swelling begins. Radiographs are recommended and your veterinarian may not see anything that looks like cancer but if the swelling or lameness continues another x-ray may be needed.

If bone cancer is suspected then x-ray films of your pet’s chest is recommended since the lungs are one of the favorite areas to metastasize.

Osteosarcoma is not a good prognosis but if the lungs appear clear, there are some treatment options:

  • Amputation — this is the very first thing that any veterinarian is going to recommend. Bone cancer can cause your pet’s bone to fracture with the slightest trauma even just lying down so this is the reason we recommend this treatment.
  • Amputation with steroids — not the best option but it will help for a short while and make your pet more comfortable.
  • Amputation with chemotherapy — this is the best option and gives your pet a greater chance at longevity.

None of the options are great but it will make a difference in your pet’s quality of life and longevity.

There is truly no way of telling who is going to get bone cancer and all we can do is to love our pets and do the best we can for them. I hope to not see the third one but if I do I will hold them in my thoughts like I do all of you.

Here’s to you and your pet’s health — blessings.

 

Ilio Whatsus?!

This is my rendition of the ilio psoas

This is my rendition of the ilio psoas

We have a lot of pets in the area competing in agility, obedience, hunt, field, along with a ton of other athletic events as well as older pets who suddenly come up lame and we can’t figure out why.

Ilio Psoas is a combination of two muscles – the Psoas Major and the Iliacus. The muscles begin under the lumbar (lower back) spine and from the underside of the pelvis; they come together on the femur or thigh bone. This muscle helps with flexing the hip, extending the lower back and with hip/pelvic movement.

Why is this muscle so important? This muscle helps with propulsion and activities such as running, jumping, turning and working rely on this combination of muscles working properly. The Ilio Psoas is one of those pesky core muscles we keep harping about to you.

Proper maintenance of this muscle includes core strengthening, warm ups and cool downs.

How does your dog hurt his Ilio Psoas? He can injure the muscle by just playing and carrying on but we tend to see it injured by over extending when jumping, repetitive activities such as fetch or Frisbee, slipping on the flooring, etc. general ways in which we all can pull a groin muscle.

A lot of dogs will pull up lame at an event and then once they get home appear normal – this can happen with small injuries but then the body begins its amazing ability to compensate and before you know it, you have a full blown problem.

Your dog can give a lot of subtle hints that something may be wrong such as a curved back, avoiding weave poles, not wanting to jump, turning just one way instead of both ways – things that most of us think are training issues may be actually compensation for pain.

Your pet does not have to be an athlete to hurt his ilio – he can be older and slip, a weekend warrior, or just constant wear and tear.

Your veterinarian will diagnose ilio psoas by doing an examination, palpating the area, a gait analysis and possibly range of motion or stretching. Soft tissue diagnosis are difficult to find so they may also want to take radiographs (x-rays) to make sure there is a fracture, arthritis or a tumor. Your veterinarian may also want to run a tick panel especially if you live in areas that have a lot of ticks.

Your pet can be predisposed to ilio psoas if they have any of the following conditions:

  • Hip dysplasia or arthritis of the hips
  • Cruciate problems (even if it is in the past)
  • Long backed dogs
  • Dogs with weak cores (especially lower back and pelvic region)
  • Young dogs training too early
  • Repetitive motion in dogs (too many jumps)

Once your veterinarian diagnoses ilio psoas he may prescribe pain meds such as NSAIDs along with rest. Other treatments would include laser therapy, cryotherapy (ice in the first 3-4 days), thermotherapy (heat after 72 hours), therapeutic ultrasound and slow increases in exercise.

If you are treating your pet for ilio psoas it is vital that in the first few weeks that he avoids any explosive or powerful movements such as running or jumping; they should be leash walked on a short leash and a flat surface. Three ten minute walks a day would be okay but you must comply with the rest portion.

Weight shifting is one of the exercises that your rehabilitation veterinarian would recommend along with hydrotherapy. Hydrotherapy is recommended because it allows the hip to extend and decreases the stress on the joints plus the heat of the water is helpful.

Swimming should be avoided until the area is almost completely healed along with diving or jumping into the water.

Balance and ball work are essential to the healing process so you should speak with your rehabilitation veterinarian for their recommendations on exercises.

Your pet is going to take at least 4-6 weeks for them to recover but most take almost 12-16 weeks for full recovery so the key is to be slow and steady. It is difficult to wait patiently that long but unfortunately if you return your pet too quickly then you may end up with a bigger injury that could take much longer to heal, if ever.

The key to any recovery is slow and steady. Make sure that you are doing your range of motion exercises, good warm up and a good cool down to keep any problems from developing.

Elbow Dysplasia — Not So Funny Bone

Hey guys! It has been a long week with lots of new friends, lots of old friends and work, work, work. I started to blog about elbows last week and just could not work up the enthusiasm but then I saw quite a few pets with terrible elbow arthritis. Karma seems to be telling me it’s time to talk about the Not So Funny Bone.

This picture is from vetsurgerycentral.com -- it helps explain perfectly where all the elbow problems are seen.

This picture is from vetsurgerycentral.com — it helps explain perfectly where all the elbow problems are seen.

Elbow Dysplasia is the term used for arthritis in the elbow joint.  The arthritis is usually due to an abnormal development of the joint so genetics play a large part but it can also be due to trauma.

It tends to be a problem in young, large breed dogs and can be found in both elbows.  It is the most common problem of front limb lameness.

The elbow joint consists of an intersection of three bones namely the radius, ulna, and humerus.  The three bones come together and must fit precisely in order for the joint to work otherwise we end up with dysplasia.

There are 4 main types of elbow dysplasia but they all have loose pieces in the joint which can be very painful.  This pain is compared to having a rock in your shoe.

The different types are:  1) Ununited Anconeal Process (UAP), 2) Fragmented Medial Coronoid Process (FMCP), 3) Osteochondritis Dissecans (OCD), and 4) Joint Incongruity. 

UAP is where the bone on the side of the joint does not unite with the ulna during growth.  This union usually occurs by 20 weeks of age.

FMCP is a small piece of bone off of the inner aspect of the ulna.

OCD is when a piece of cartilage becomes loose and forms a joint mouse which is very painful.

Joint Incongruity is where the joint does not fit together properly.

Symptoms are usually a mild to moderate lameness seen at 4-10 months of age.  Diagnosis of elbow dysplasia is by physical exam in which your veterinarian may find pain, heat, and swelling or decreased range of motion.  Radiographs can be difficult to diagnose either OCD or FMCP and you may need to get a CT scan for your pet.  Surgical exploration of the joint is also a viable option for diagnosis and it is usually done with an arthroscope.

Arthroscopic surgery is a good option for OCD and FMCP but UAP usually has a small incision on the lateral aspect of the joint.  Recommendations for your pet include surgery, nsaids, glucosamines, and omega-3 fatty acids.  Elbow replacement is a new treatment that is on the rise.

Recovery after surgery depends on the type of surgery.  Arthroscopic surgery means that most pets will use their leg on the first day of surgery.  You can expect mild lameness at 2 weeks post-surgery and usually the pets are using the leg well by 2-3 months post-surgery. 

Rehabilitation of elbow dysplasia includes cryotherapy, therapeutic laser, and passive range of motion exercises, leash walks, underwater treadmill exercise and other types of balance exercises.  Exercises are added slowly throughout the recovery period with no jumping or running for at least 8-10 weeks.

If you should have any problems with lameness in the front please consult your veterinarian and we are here for your rehab needs. Have a good week and talk to you soon —-

Skipping Dogs — Patellar Luxations

The knee joint -- the knee cap is under the ligament and rides on the upper bone (femur)

The knee joint — the knee cap is under the ligament and rides on the upper bone (femur)

I figured we would continue our discussions on the knee and give you one more article on pathology in the knee. I just happened to see a dog this week with luxating patella and I felt this article would be appropriate.

Patellar luxation is a dislocation of the knee cap and may be congenital or traumatic in origin.  The knee joint is comprised of the femur (thigh bone), tibia (shin/lower leg), knee cap (patella) which is located inside the patellar ligament and ligaments to each side (collateral).  The tibia has a V-shaped groove in it called the trochlear groove and the patella should ride in this groove.

Patellar luxation usually occurs by one of three methods:

  1. Collateral ligament is too tight and pulling the patella out of alignment.
  2. Collateral ligament is too loose and not holding the patella in alignment.
  3. The trochlear groove is not deep enough and the patella scoots where it wants to go.

Most patellar luxations occur in small dogs with a medial or inward luxation being the most common.  Large dogs tend to have a lateral or outward luxation.  Most of the small dog luxations are due to conformation issues with the legs usually being bowlegged.  You usually don’t see signs of a problem until later in life but you can see evidence of patellar luxation at early as four months on a radiograph.

 

Clinical signs are seen as:

  • Rear leg lameness

  • Skipping gait

  • Carrying a rear leg for a few steps before putting it down

  • Kicking back of a rear leg

  • “Dance” to move leg into place

  • A popping noise may also be heard or felt

There are four grades of patellar luxation:

Grade 1 is seen with intermittent luxation and lameness, full flexion and extension with no crepitus (crunchiness) and the patella can be luxated manually but returns to normal when released.

Grade 2 has frequent luxation, pet may carry the leg partly flexed, crepitus may be present, and the patella can be manually luxated or may luxate spontaneously when the leg is flexed (bent) but when extended the patella returns to normal or can be manually reduced.

Grade 3 has a patella that is luxated most of the time, the leg is almost always flexed, degenerative changes are seen, and the patella can be reduced manually with the joint extended but flexion and extension of the knee results in relaxation of the patella.

Grade 4 has a permanent luxation and it cannot be placed back into the groove, the pet usually walks in a crouched position, and the trochlear groove is not present or very shallow.

Surgery is recommended for grades 2, 3, and 4.  Grades 1 and 2 may be able to have rehabilitation for strengthening and may not need surgery.  Grades 3 and 4 are always recommended for surgery to help correct the misalignment and to decrease pain.  Surgeons do not know exactly which surgery they will be doing until they are in the joint.  They may need to release a ligament, tighten a ligament, deepen the groove or even realign the femur and/or tibia.

Rehabilitation or physical therapy is recommended for all grades of patellar luxation.  Post-surgical rehabilitation focuses on cryotherapy, short leash walks, and pain medications for the first few weeks after which strengthening exercises are then incorporated.

Cranial Cruciate Rupture — TPLO Surgery

The bone labeled "B" is cut and rotated to make a level plateau for the femur

The bone labeled “B” is cut and rotated to make a level plateau for the femur

We had computer problems this week and the blog is late in being published. This is the third series in surgical repair for cranial cruciate rupture. Hopefully you all can get an idea about how the repair is done but if you have any questions, please don’t hesitate to ask or call me at 864 962 0101.

The femur (thigh bone) meets the tibia (lower leg bone) behind the patella (knee cap) and the cruciate ligaments (cranial and caudal) have the important function of keeping the femur from sliding back and forth on the tibia.  Cranial cruciate rupture can happen due to predisposing factors such as breed, age-related wear, trauma, abnormalities of formation, or a steep slope on the tibia.

TPLO surgery is designed to decrease the slope of the tibia thereby keeping the femur from moving too far.  The surgeon first removes the torn ligament from the area and examines the meniscus.  The meniscus is the shock absorber of the knee and in 40-50% of dogs it is torn.  The surgeons try to repair or save as much of the meniscus as possible.

The slope of the tibial plateau is measured and a curved cut through the bone is made.  The cut head of the tibia is then rotated until the plateau reaches an angle between 2 to 14 degrees with 5 degrees being the original recommendation.  A metal plate with screws is used to hold the bone in place.  A plateau of 0 degrees is avoided since it can cause strain and tear the caudal cruciate ligament.

About 50% of dogs will start to walk on the limb within 24 hours of surgery.  Within 5 days most will begin weight bearing on the leg and by 2 weeks will be moderately weight bearing.  Radiographs are taken 6-8 weeks post-surgery.

2 months post-surgery leash walks are gradually increased with most restrictions of exercises being discontinued by 4 months but full working activities such as hunt, field, agility, etc. should not begin until 6 months post-surgery.  Radiographs should be taken yearly to monitor arthritis.

Complications of this surgery can be due to many factors including anesthesia, age and weight of the pet and surgical competence.  Steroids given post-surgery can cause decreased bone healing so should be avoided.

The most common cause of complication is letting the pet have too much activity too soon.  Too much activity in the early period of healing (first 2 months) can lead to:

1)    Poor healing of the bone

2)    Straining of the patellar ligament

3)    Plate breakage

4)    Loosening of the screws with subsequent shifting of the plateau

All recommendations for post-surgery should be followed closely by the pet and owner.  Rehabilitation trained therapists are found to be one of the best things you can do for the successful recovery of your pet. 

I have some articles that I can email you and your surgeon concerning the benefits of rehabilitation immediately post-surgery — let’s get your pet healthy!