Stifle opinions please

Re: Stifle opinions please

Evelyn Barbour-Hill — Tue, 25 Sep 2012 10:58:55 GMT

Great, thank you.

Re: Stifle opinions please

Malcolm Ness — Mon, 24 Sep 2012 21:39:26 GMT

Generally speaking, stifle effusion/synovitis is a strong indicator of a failing cruciate but that is largely because common things occur commonly and by far the most common cause of stifle synovitis is a failing CCL. Clinically, you can try firmly extending the stifle just a little further thn it wants to extend - this is mildly uncomfortable in normal dogs but often significantly painful in dogs with a failing CCL.

wrt this case - if there is point pain over the fabella then I would infer that the fabella is the cause of the lameness and worry less about the rest of the stifle for the time being. Without fabellar pain I would be telling the owner that I think there is a failing CCL but there is not (yet) enough evidence to go further (an arthrotomy would rule in or rule out but that would be over-kill at this stage). I would encourage the dog to exercise as much as is possible on NSAIDs alone and review the case clinically every 2-4 weeks and radigraphically every 4-8 weeks.

The lack of obvious instability, as you know, means very little - the sensitivity of the cranial draw test is pretty poor.

Re: Stifle opinions please

Rajat — Mon, 24 Sep 2012 18:28:07 GMT

[quote user="Evelyn Barbour-Hill"]

Ah, thank you Malcolm.

Is there a good way to determine – or at least increase suspicion of – a failing cruciate, in the absence of abnormal mobility?

[/quote]

I reckon a joint effusion is a decent sign like in this case...will wait for Malcolm to correct me on this one!

Re: Stifle opinions please

Mark Hedberg — Mon, 24 Sep 2012 18:14:34 GMT

[quote user="Evelyn Barbour-Hill"]

Ah, thank you Malcolm.

Is there a good way to determine – or at least increase suspicion of – a failing cruciate, in the absence of abnormal mobility?

[/quote]

Careful, Evelyn, you never know about that newfangled advice on the "internet"!!!!

Re: Stifle opinions please

Evelyn Barbour-Hill — Mon, 24 Sep 2012 18:00:35 GMT

Re: Stifle opinions please

Mark Holmes — Mon, 24 Sep 2012 17:58:49 GMT

And I thought "stifle opinions please" was an instruction for the belligerant.

Re: Stifle opinions please

Evelyn Barbour-Hill — Mon, 24 Sep 2012 17:56:13 GMT

Ah, thank you Malcolm.

Is there a good way to determine – or at least increase suspicion of – a failing cruciate, in the absence of abnormal mobility?

Re: Stifle opinions please

Malcolm Ness — Mon, 24 Sep 2012 09:17:55 GMT

There is a "fracture" of the lateral fabella and that could certainly account for the history you describe. These are often bilateral and Border collies seem to be over-represented with this relatively uncommon condition. In some dogs, the lesion is incidental so the radiographic abnormality is not enough to cement a diagnosis. Firm finger pressure on the affected lateral fabella will cause significant pain if this is the cause of the dog's lameness.

In addition, there is some loss of the patellar fat pad and early/mild osteophyte formation indicative of a synovitis/effusion. This will not happen as a result of the fabellar lesion so a second pathology is likely - this might just be "wear and tear" but the possibility of a failing cruciate exists.

If you can demonstrate point pain over the fabella then I would persist with NSAIDs with a reasonable expectation of improvement in the long term. Occasionally these cases stay painful and lame and those dogs will sometimes benefit from excision of the lateral fabella. If you can't demonstrate point pain then I would be looking elsewhere for the cause of the lameness.