Lameness advise in 7yr old Tibetian Terrier

Re: Lameness advise in 7yr old Tibetian Terrier

Malcolm Ness — Thu, 03 Jul 2014 19:07:46 GMT

[quote user="Kishor Mahind"]Does this sound more likely to be a brachial plexus neuritis / tumour?[/quote]

It is certainly circumstantial evidence in support of a brachial plexus lesion, though far from pathognomonic. If a BP tumour, then nothing will help in the medium or long term. Given the owners' reluctance/inability to investigate further I would consider giving pred at 2mg/kg bid - if it improves then gradual reduction and withdrawal over many weeks. If it doesn't then euthanasia is on the cards.

It has been said that it is verging on professional negligence to let an un-diagnosed case die without first trying an immunosuppresive dose of cortico-steroids.

Re: Lameness advise in 7yr old Tibetian Terrier

Thomas Johnson — Thu, 03 Jul 2014 15:06:21 GMT

[quote user="Kishor Mahind"]

But now the dog has developed pain around the scapula - especially on medial aspect of the scapula, when I try to palpate that region she screams in pain. There is no muscle wastage (too early maybe?), she has got deep pain sensation present in the paw and not having classical 'dropped elbow' appearance of radial nerve injury.

[/quote]

I saw a cat last year with a similar presentation, forelimb lameness which didn't respond to Metacam, radiographs of the limb unremarkable. It then developed an injection site sarcoma that invaded into the scapula. Obviously not likely to be an ISS in a dog, but you could be right to consider neoplasia as a possibility.

Re: Lameness advise in 7yr old Tibetian Terrier

Kishor Mahind — Thu, 03 Jul 2014 10:49:44 GMT

Hi Malcolm,

Thanks for your input. I saw the dog last night and distal limb examination didn't reveal anything significant - no pain or discomfort and no corns/cracked pads or FBs. Cervical spine palpation didn't reveal any pain and has good ROM on neck and elbow and shoulder joints.

Does this sound more likely to be a brachial plexus neuritis / tumour? I understand that cervical spine involvement still cannot be completely ruled out.

Further investigations or referral are not possible due to the costs.

The dog is on NSAIDs only at the moment (gabapentin didn't help). Owners would go for PTS if doesn't improve but they are willing to try any medical treatment if it would help - what would you suggest - will steroids help?

Thanks again

Re: Lameness advise in 7yr old Tibetian Terrier

Malcolm Ness — Tue, 01 Jul 2014 15:29:54 GMT

It is most likely coincident with interosseous ligament attachments - a pair of accurately positioned orthogonal rads with the good leg for comparison would allow more certainty. A metastatic tumour is always possible but rather unlikely!!

Re: Lameness advise in 7yr old Tibetian Terrier

Martin Atkinson — Tue, 01 Jul 2014 14:39:19 GMT

What is the significance of the 'nibbled out' lesion in the proximal 1/3 of the left radius?

Re: Lameness advise in 7yr old Tibetian Terrier

Malcolm Ness — Tue, 01 Jul 2014 11:28:31 GMT

Sorry, I missed this one earlier.

The videos look like a fairly severe, unilateral forelimb lameness to me.

The radiographs don't give any major clues.

Looking at the videos, I would be considering either a distal limb lesion - problems in the pads and digits can cause a disproportionate amount of lameness and are often overlooked - corns in greyhounds are an example. Careful and systematic examination of each nail, pad, toe and distal joint will reveal a seat of pain if there is one. If nothing is found I would then consider a neurogenic lameness - for example, cervical intervertebral disc extrusion with nerve root impingement or perhaps a brachial plexus neuritis or tumour. Again, a careful ortho and neuro exam might steer you in the right direction.

If you repeat the rads, take a couple of carefully positioned lateral views of C spine (upper and lower) as well as two orthogonal views of other joints which need to be carefully positioned for maximum diagnostic yield. Use GA and take the opportunity to examine the dog while asleep including range of motion of each joint and palpation into the axial/brachial plexus.

Re: Lameness advise in 7yr old Tibetian Terrier

Kishor Mahind — Tue, 01 Jul 2014 11:06:01 GMT

Hi again,

Sorry to be a pain, but wanted to bump the post up on the forum list, any ideas/suggestions on this case will be much appreciated.

Thanks again

Kishor