VETgirl Forelimb Lameness Webinar 12-2015 · 2019-11-21 · 12/11/15 1 Deciphering the Head Bob Forelimb Lameness in Dogs Michelle Trappler, VMD, DACVS December 16, 2015 Garret Pachtinger,

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Deciphering the Head Bob�Forelimb Lameness in Dogs �

Michelle Trappler, VMD, DACVS�December 16, 2015 �

Garret Pachtinger, VMD, DACVECC �

COO, VETgirl �

Introduction�

Justine A. Lee, DVM,�DACVECC, DABT�

CEO, VETgirl �

Introduction�

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Conflict of Interest Disclosure�

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Michelle Trappler, VMD, DACVS�

Surgeon at Hospital Veterinario San Francisco de Asis�

Introduction�

Forelimb Lameness �

  History and Presentation�

  Gait Observation�

  Orthopedic and Neurologic Exam�

  Specific Conditions�

History and Presentation�

  Acute vs. Chronic?�

  Progressive- improving vs. worsening?�

  Exacerbated by activity?�

  Changes with medications?�

  Why presenting now?�

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Gait Observation�

  Watch from afar �

  Check posture�

  Look for asymmetry and muscle atrophy�

Gait Observation�

  Look at relationship of carpus and elbow �

Gait Observation�

  Straight line walk and trot �

  Circles to both sides� Video Credit: Dr. Sherman Canapp, VOSM �

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Gait Observation�

  Abduction/ Adduction�

  Stride length�

Orthopedic/Neurologic Exam �• Start at the toes and work your way up�

• Palpate each bone for pain, fractures�• Metaphyseal vs Diaphyseal �

• Check joints for increased/decreased/painful/abnormal ROM �

• Localize any swelling�• Joint effusion vs soft tissue swelling�

• Check tendons and ligaments as you go �

• Save injured limb for last �

ROM Normals�

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Orthopedic/Neurologic Exam�

• Paw pads�• Interdigital areas�• Nails�

• Nail bed�• Toe ROM �• Flex and extend toes�


• Metacarpals �• Carpal joint effusion�

• Carpal ROM �• Med/Lat Stability�


• Radius/Ulnar palpation�

• Look for angular limb deformities�

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•  Flexion/Extension of elbow �•  Hyperextension�•  ROM, Effusion�

•  Isolate medial compartment �•  Medial/Lateral instability �•  Crepitus�


• Humerus palpation�


•  Flexion/Extension of shoulder �•  Abduction/Adduction�• Biceps stretch�• Supraspinatus stretch�• Palpate biceps tendon�• Palpate supraspinatus tendon�

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•  Palpate scapula for fx, pain�•  Note scapular spine�•  Note any supra/infra atrophy�•  Check relationship to thoracic wall �


  Check ROM of neck �

  Check CPs�

  Check withdrawl, biceps, triceps reflexes�

  Check toes for scuffing�

  Palpate axillary area�

Specific Conditions�  Carpal Hyperextension�

  Elbow Dysplasia Complex�

  Shoulder OCD �

  Biceps tendonopathy �

  Supraspinatus Tendonopathy�

  Medial Shoulder Syndrome/Instability�

  Cervical IVDD �

  Brachial plexus�

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Carpal Hyperextension�

  Can be seen in puppies due to excessive ligament laxity, as a result of trauma, or due to degeneration�

Carpal Hyperextension�

  Stressed radiographs- very important!�

Elbow Dysplasia Complex�

  Radio-ulnar incongruity (RUI) �

  Ununited Anconeal Process (UAP) (2) �

  Fragmented Medial Coronoid Process (FMCP) (3) �

  Humeral OC/OCD (4) �

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Elbow Dysplasia Complex�  Leading cause of forelimb lameness in dogs�

  Large to giant breed, juvenilles�

  Genetic basis, *Heritable* �


  Unilateral or bilateral forelimb lameness �

  Lameness exacerbated by activity�

  Abduction of limb on gait analysis�


  Decreased ROM (normal flexion 70-75o) �

  Pain on hyperflexion, hyperextension�

  Pain on isolation of medial compartment �

  Thickening of elbow, effusion�

  Crepitus with ROM �

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  Look for radiographs signs that point to elbow:�

  Osteophytes along anconeus �

  Sclerosis of ulnar notch�

  Osteophytosis, Osteoarthritis�

Elbow Dysplasia Complex- RUI�

  Radio-Ulnar Incongruity (RUI) �

  Asynchronous growth between radius and ulna�

  Step defect in joint �

  May put excess pressure on medial coronoid process�


  Diagnosis�

  Radiographs�

  CT�

  Arthroscopy�

  MRI�

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  Radius too short? �

  Osteotomy of proximal radius�

  Ulna too short?�

  Ulnar lengthening�

Elbow Dysplasia Complex- UAP �

  Ununited Anconeal Process (UAP) �

  Large to giant breeds, Males�

  German Shepherds overrepresented�

  Clinical signs at 6-12 months�


  History of intermittent lameness, worse after exercise�

  Circumduction of forelimb during swing phase�

  Effusion in caudal compartment �

  Crepitus �

  Pain on hyperextension�

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  Diagnostics�

  X-rays�

  Arthroscopy*�

  CT�

  MRI�

Elbow Dysplasia Complex- FMCP �

  Fragmented Medial Coronoid Process (FMCP) �

  Large breeds overrepresented �

  Clinical signs at 5-7 months �

  Can see older dogs with secondary OA�


  Acute or chronic lameness�

  Worsens after exercise, heavy activity�

  Abduct forelimb on gait analysis�

  Decreased ROM of elbow �

  Crepitus, Effusion�

  Pain on hyperextension, hyperflexion�

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  Diagnostics�

  X-rays�

  Arthroscopy*�

  CT�

  MRI�

  Treatment �

  Fragment removal �

Elbow Dysplasia Complex- OCD �

  CS at 5-10 months�

  Large breeds, Males > Females�

  Exacerbated by exercise�

  Pain on elbow hyperextension or flexion�

  Often bilateral �

Elbow Dysplasia Complex- OCD �

  Diagnosis�

  Radiographs�

  CT�

  Arthroscopy*�

  MRI�

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Shoulder OC/OCD �

  Large, giant breed, Males > Females�

  27-68% have bilateral lesions, unilateral lameness* �

  Clinical signs at 4-8 months�

  Caudal humeral head most often affected�

  May be painful in extreme extension�

  May see shoulder muscle atrophy, OA if chronic�

  Rads- subchondral bone defect, sclerosis +/- mineralized flap in caudal pouch�

Shoulder OC/OCD �

  Conservative tx: Exercise dog until flap falls off �

  Surgical tx: Arthroscopy recommended, Arthrotomy�

Shoulder OC/OCD �

Good long-term prognosis with prompt treatment �

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  Can be primary or secondary�

  Middle-age to older, medium- to large breed dogs �

  No breed or sex predilections�

  Chronic or progressive lameness, worse with exercise�

  Non-responsive to NSAIDs�

Biceps Tendonopathy�


  PE findings�

  Biceps “stretch” test �

  Shoulder drawer test �

  Biceps reaction test �


  Diagnosis�

  Radiographs�

  Ultrasound �

  Arthroscopy�

  MRI�

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Supraspinatus Tendon�  Middle-age to older, medium- to large

breed dogs �

  Rotties and Labs predisposed, No sex predilections�

  Chronic or progressive lameness, worse with exercise�

  Non-responsive to NSAIDs �

Supraspinatus Tendon�  PE: Supraspinatus stretch�

Video Credit: Dr. Sherman Canapp, VOSM �

Supraspinatus Tendon�

  Diagnosis:�

  Radiographs�

  Ultrasound�

  Arthroscopy�

  MRI�

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Medial Shoulder Syndrome/Instability�

  MSS/MSI�

  Congenital: CS at 3-10 months. Toy breeds.�

  Luxation usually medial.�

  Acquired: CS with injury/overuse. Large breeds.�

  Subluxation: Middle-aged, Male, Large Breed dogs�


  Chronic, intermittent or continual lameness�

  Can be intermittently severe�

  Minimal to no response to NSAIDs�

  Worse with excercise�

  May have agility history, history of getting leg caught �


  Physical Exam�

  Shoulder muscle atrophy�

  Increased abduction of shoulder �

  Normal abduction approx. 30o �

  Compare to contralateral limb!�

  May only show under sedation�

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  Diagnosis�

  Radiographs�

  MRI�

  Arthroscopy*�

Shoulder/Elbow Pathology�

  Can be a combination of multiple shoulder pathologies�

  Can also be “shelbow” �

Cervical IVDD �

  60% cervical IVDD dogs had no neuro deficits, only pain�

  Root signature in 22-50% of dogs with cervical IVDD �

  55% of dogs have chronic onset �

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Brachial Plexus Tumors�

  Unilateral paresis/ lameness�

  Significant muscle atrophy�

  Pain in axillary area�

  +/- reduced CPs, withdraw �

  +/- ipsilateral Horner’s/miosis�

Brachial Plexus �

  Palpate axillary region to feel for any masses �

  MRI - diagnostic modality of choice�

  Tx - Amputation +/- chemo vs RT�

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Documents

VETgirl Forelimb Lameness Webinar 12-2015 · 2019-11-21 · 12/11/15 1 Deciphering the Head Bob Forelimb Lameness in Dogs Michelle Trappler, VMD, DACVS December 16, 2015 Garret Pachtinger,