Confusing lameness case!

Re: Confusing lameness case!

ChrisBVSc — Mon, 20 Jan 2014 11:32:35 GMT

So a shot of dex would have done the trick then!

Well at least it was double checked by a specialist, I'd rather that than miss something weird & wonderful until it's too late!

Re: Confusing lameness case!

Anthony Dennison — Mon, 20 Jan 2014 10:17:09 GMT

Letter back from the referral centre: NAD on ortho and neuro exam, marked pedal dermatitis. It would seem the dermatitis was causing the lameness, rather than it being secondary to ortho pain through self trauma!

Woops.

Re: Confusing lameness case!

Anthony Dennison — Thu, 16 Jan 2014 12:36:40 GMT

Referred to Chestergates orthopaedic department this morning. The owner is quite high maintenance and I think would get quite narked if we did all sorts of tests and then referred anyway. This way rather than radiograph limbs, CT can be done for more detail. Will keep you posted.

Re: Confusing lameness case!

Andrew Mellor — Thu, 16 Jan 2014 10:37:32 GMT

With the temp I would treat with antibiotics even though you think low risk of lymes because if you leave it too long the damage will be done to the cartilages , I have had a few multi-limb lameness cases with no tick exposure( the owners think) with temperatures one confirmed Lymes.

Discospondilitis or infected joints from haematogenous spread from split in pad/ ezcema etc can occur and usually respond very quickly to antibiotics, give it a shot of cephalexin preferably and have it back next day if temp down and lameness better continue with ab's if not refer you will look good in there eyes for covering all bases anyway.

Re: Confusing lameness case!

Anthony Dennison — Thu, 16 Jan 2014 09:30:24 GMT

I'm thinking to ortho, as it has a limp. As soon as they realise it's got a temperature and they can't put any metalwork, they'll ship it to a different department

Re: Confusing lameness case!

Michael Woodhouse — Thu, 16 Jan 2014 02:11:09 GMT

[quote user="Anthony Dennison"]Im thinking of possibly referring the case, the dog is insured and referring early means more work-up can be done and we won't be wasting time and money doing unnecessary investigations[/quote]

That would be my plan, but to ortho or neuro?

That is the question.............

Re: Confusing lameness case!

Sibylle — Thu, 16 Jan 2014 00:52:58 GMT

Just check, before you refer, that it's not a teres major strain. Especially if you found restricted movement (extension) in the shoulder, but no pain in shoulder joint. Pinch the trigger points and the dog will let you know for sure whether the muscle is painful or not. My own dog did it, and I found that his lameness responded poorly to non-steroidals. My dog didn't stumble, but he occasionally dragged his front toes, particularly noticeable when walked on the beach, he'd intermittently leave drag marks in the sand.

A muscular injury might at least be not the worst news considering the other differentials on your list!

Here's the link to a good article which helped me to sort my dog out, with good physio exercises, stretching etc www.caninefitness.com/docs/Teres-Major.pdf

Re: Confusing lameness case!

Utlendigur — Wed, 15 Jan 2014 23:23:41 GMT

Might be worth asking a few questions about when the lameness is worse

eg Does it vary with the surface the dog is walking on - if it's fine on soft/smooth surfaces but limps on gravel/rough ground/etc that might indicate a paw problem eg the dermatitis from chewing its foot

Is it worse after rest but disappears after it warms up - which can point to things like OA

Does it get worse the more the dog exercises - eg myasthenia gravis, myopathy, some ligament/tendon strains

Probably worth at least offering referral - CT scans of the elbow are better at picking up things like fragmented coronoid processes than xrays if that is a concern. Plus with these vaguely lame young labradors, Sod's law also operates in that as soon as you contact the referral centre the lameness will miraculously cure of its own accord

Re: Confusing lameness case!

ChrisBVSc — Wed, 15 Jan 2014 23:02:55 GMT

We're over-run with ticks around here, so it always pops into my mind. But I agree it doesn't really fit with what you've described, apart from the potentially 'spreading' lameness. I'd be interested to hear what the outcome is - sounds like an odd one.

Re: Confusing lameness case!

Anthony Dennison — Wed, 15 Jan 2014 22:22:38 GMT

Lymes Disease is fairly low on my differentials list, as the dog hasn't been exposed to ticks and we're not in a high risk area. Also think there would be joint swelling or pain on palpation

Re: Confusing lameness case!

ChrisBVSc — Wed, 15 Jan 2014 22:13:44 GMT

Again, no expert so I'd probably refer if they were keen! Otherwise I'd do a full set of limb & spinal xrays, possibly do joint taps, and maybe run bloods just incase anything useful or unusual shows up. Also, I haven't seen a case myself, but is Lyme's disease worth considering?

Re: Confusing lameness case!

Busybee — Wed, 15 Jan 2014 21:55:36 GMT

Certainly no expert here but I would be leaning towards a neurological cause and neuropathic pain. Consider also that the original episode(s) of lameness are not related to this episode but are more orthopaedic (esp first episode). Any other neuro deficits?

+1 for referral if owners and finances are willing. Otherwise spinal rads would be worth looking at - you never know what you might find!

Re: Confusing lameness case!

Anthony Dennison — Wed, 15 Jan 2014 21:39:24 GMT

Would a joint tap yield anything useful if there is no joint pain or swelling? Lameness is very very slight, more of a stiff gait than anything.

I said I'd discuss the case with colleagues and get back to her because I'm stumped! Sent the dog home on tramadol, CLX wipes for the dermatitis on the foot and low dose diazepam for skeletal muscle relaxation.

Im thinking of possibly referring the case, the dog is insured and referring early means more work-up can be done and we won't be wasting time and money doing unnecessary investigations

Re: Confusing lameness case!

Tim Charlesworth — Wed, 15 Jan 2014 19:56:27 GMT

Not my area but I'd consider multiple joint taps to test for evidence of arthropathy or even polyarthritis, you could do spinal rads (but these would be relatively insensitive if there was some form of low grade spinal compression/nerve root injury) and so may not be rewarding given the breed/history. Could look at CT if funds allow

Re: Confusing lameness case!

Hannah Wynne Richards — Wed, 15 Jan 2014 19:01:42 GMT

I don't know, but I'd go for spinal rads next.

Wynne