Are these stifle radiographs normal?

RE: Are these stifle radiographs normal?

Neil Wheadon — Fri, 11 Sep 2015 05:06:34 GMT

The dog hopped in literally on 3 legs, with its leg held high in the air. it looked just like a cruciate and when we walked it, it could tentatively touch it's foot to the floor.

To be honest I didn't squueze the long bones and again being honest panosteitis is a condition I'm always on the look out in dogs, if anything and this may make people smile, once you've fussed with the foot, to the client the rest of a leg examination is reasonably fast so I find a good press of the long bones gives me time to think. In the past year I've diagnosed maybe 3 panosteitis cases, as the long bones had made the dog go 'ouch' . All have got better as I did get follow up, but then again......

I X-rayed this case as I was sure it had ruptured a cruciate and how wrong I was.

Neil

RE: Are these stifle radiographs normal?

Anthony Todd — Thu, 10 Sep 2015 10:18:28 GMT

[quote user="Thomas Johnson"]Not sure,[/quote]

This might be helpful:

[Canine panosteitis: an idiopathic bone disease investigated in the light of a new hypothesis concerning pathogenesis. Part 1: Clinical and diagnostic aspects].

[Article in German]

Schawalder P1, Andres HU, Jutzi K, Stoupis C, Bösch C.

Author information

Abstract

Panosteitis, an idiopathic bone disease of young dogs, was investigated in the light of a new, empirically based hypothesis governing its pathogenesis. Extensive clinical observations suggest a close relationship between the incidence of this disease and the commercialization of various protein-rich, high-calorie dog foods. The theory of an "osseous compartment syndrome" provides a hypothetical pathogenesis, which corroborates this findings. An excessive accumulation of protein causes intraosseous edema due to its osmotic effects. Because bone is a rigid compartment, this leads to an increase in intramedullary pressure and compression of blood vessels. Subsequent osseous ischemia leads to a deficient metabolic state (decreased oxygenation, inadequate influx of nutritive substances, local acidosis, decreased removal of metabolites, disruption of local biochemical processes, etc.), and a vicious circle is created due to the resulting local inflammation. The disease is aggravated by increased metabolism due to excessive physical activity. Within the context of a pilot study, clinical, radiographic, scintigraphic and thermographic examinations and a therapeutic trial with benzopyron were carried out. In addition, more modern investigative tools, including osteomyelography, magnetic resonance tomography and intraosseous pressure measurements were used to provide objective data concerning the pathogenesis of panosteitis. In most cases, clinical remission was seen within days of monotherapy with the proteolytic substance, benzopyron (Cumartrin). This finding appears to corroborate our hypothesis.

RE: Are these stifle radiographs normal?

Thomas Johnson — Wed, 09 Sep 2015 18:17:59 GMT

[quote user="Anthony Todd"]

[quote user="Thomas Johnson"]Neil has mentioned in his posts that he wasn't able to elicit any pain[/quote]

How does that tie in with Malcolm's diagnosis and description?:

"(pressure on the bone over the lesion hurts a lot)"

Unless the bones and joints were palpated under GA for the Xray???

[/quote]

Not sure, you'd have to ask Neil, but it could be that the dog is very stoical, or pressure wasn't applied exactly over the problem area so no pain was elicited.

RE: Are these stifle radiographs normal?

Anthony Todd — Wed, 09 Sep 2015 16:31:02 GMT

[quote user="Thomas Johnson"]Neil has mentioned in his posts that he wasn't able to elicit any pain[/quote]

How does that tie in with Malcolm's diagnosis and description?:

"(pressure on the bone over the lesion hurts a lot)"

Unless the bones and joints were palpated under GA for the Xray???

RE: Are these stifle radiographs normal?

Thomas Johnson — Wed, 09 Sep 2015 15:42:53 GMT

[quote user="Anthony Todd"]

Nobody seems to mention palpating the joints for swelling, pain etc.

Might give a clue as to site of the problem.

PS. sorry Malcolm did.

[/quote]

Neil has mentioned in his posts that he wasn't able to elicit any pain, and that the stifles were stable.

RE: Are these stifle radiographs normal?

Anthony Todd — Wed, 09 Sep 2015 12:50:30 GMT

Nobody seems to mention palpating the joints for swelling, pain etc.

Might give a clue as to site of the problem.

PS. sorry Malcolm did.

RE: Are these stifle radiographs normal?

Martin Atkinson — Wed, 09 Sep 2015 10:03:26 GMT

[quote user="ChrisBVSc"]

Thanks for the explanation Malcolm!

[/quote]+1, its obvious when pointed out. I need to review my interpretation of panosteitis lesions. I've always been led to believe they are more patchy and there would also be some irregularity of the endosteum.

RE: Are these stifle radiographs normal?

Malcolm Ness — Wed, 09 Sep 2015 08:04:38 GMT

We have done a number of MMP operations on dogs with a TT looking like this as well as some skeletally immature dogs. Surgery has been uneventful and outcomes as with any other dog.

RE: Are these stifle radiographs normal?

Neil Wheadon — Wed, 09 Sep 2015 05:34:57 GMT

It's subtle and probably far easier to see on the orriginal x-rays. It's about 1cm long and on the cranial border. of course I may be wrong and it may be normal, as has been suggested by the vet who saw the originals.

Likewise my thanks to Malcolm and the red arrows, very interested in the developement of radiographic signs over time.

Neil in Astoria

RE: Are these stifle radiographs normal?

Emily Rainbow — Tue, 08 Sep 2015 22:30:09 GMT

That's brilliant, another thank you Malcolm!

RE: Are these stifle radiographs normal?

ChrisBVSc — Tue, 08 Sep 2015 20:35:27 GMT

Thanks for the explanation Malcolm!

RE: Are these stifle radiographs normal?

Tom Ward — Tue, 08 Sep 2015 15:02:52 GMT

I saw a similar set of xrays today. A 15mo ASD with a complete cranial cruciate ligament rupture in the R stifle. Wondering if the unusual tibial tuberosities would affect an MMP procedure?

RE: Are these stifle radiographs normal?

Malcolm Ness — Tue, 08 Sep 2015 13:56:38 GMT

There is an area of increased radio-density - approximately between the red arrows - apparently within the medullary "cavity". Contrast this appearance with the same part of the other tibia. This radiographic lesion represents calcification of the inflammatory panosteitis lesion. Focal pain (pressure on the bone over the lesion hurts a lot), pyrexia and lameness are seen early in the course of an episode and this typical radiographic change develops over the following several days. Consequently, if you are too quick off the mark, you can radiograph a very early panosteitis case and find little if any radiographic abnormality. The referral centre a few days later has a much easier job! Sometimes. a periosteal reaction can be seen adjacent to the intra-medullary lesions but I can not see that in this case.

The lesion on these rads might well become more obvious over a few more days.

RE: Are these stifle radiographs normal?

ChrisBVSc — Tue, 08 Sep 2015 12:42:55 GMT

If anyone has time would it be possible to circle or arrow the panosteitis on one of the xrays & upload it again? I'm sure I wouldn't be the only one who would benefit from the learning experience!

RE: Are these stifle radiographs normal?

Martin Atkinson — Mon, 07 Sep 2015 11:28:35 GMT

[quote user="Neil Wheadon"]I had spotted the periostial reaction on the cranial tibial border[/quote]Well I hadn't I can still can't!

RE: Are these stifle radiographs normal?

Mark Hedberg — Mon, 07 Sep 2015 08:25:41 GMT

[quote user="Neil Wheadon"]

Mmmm...... swapping the Pacific NorthWest for England. we were once tempted by Vancouver.

We're on bikes, so trying to avoid the interstate!!

Portland - Vernonia - Astoria - down the coast to Reedsport - Cottage Grove - Oakland - Maupin - Madras - Cascade Locks - Portland. 19 days moving on tour.

We're staying in a guest house where 300 cyclists are clocked/hour so cycling is big in these parts

If a see a Hedberg I'll say hi

Neil

[/quote]

If you have time, http://www.aquarium.org/ the Oregon Coast Aquarium is *very* worth the detour.

RE: Are these stifle radiographs normal?

Neil Wheadon — Sun, 06 Sep 2015 20:45:18 GMT

Mmmm...... swapping the Pacific NorthWest for England. we were once tempted by Vancouver.

We're on bikes, so trying to avoid the interstate!!

Portland - Vernonia - Astoria - down the coast to Reedsport - Cottage Grove - Oakland - Maupin - Madras - Cascade Locks - Portland. 19 days moving on tour.

We're staying in a guest house where 300 cyclists are clocked/hour so cycling is big in these parts

If a see a Hedberg I'll say hi

Neil

RE: Are these stifle radiographs normal?

ALASDAIR MATHIESON — Sun, 06 Sep 2015 13:20:51 GMT

This is exactly the same as one we had two weeks ago. Rads sent away for expert opinion, and : the tibial crests are normal, the problem is panosteitis.

RE: Are these stifle radiographs normal?

Mark Hedberg — Sun, 06 Sep 2015 10:13:20 GMT

[quote user="Neil Wheadon"]

Stable knees , not neutered no trauma.

neil in heathrow, Oregon calling

[/quote]

lovely, i'm from Portland, loads of Hedbergs there. Still time to turn around and go home! ;) seriously though, BA to seattle, the drive down I-5 is gorgeous!

RE: Are these stifle radiographs normal?

Neil Wheadon — Sat, 05 Sep 2015 13:08:36 GMT

I had spotted the periostial reaction on the cranial tibial border but hadn't made the pan osteitis connection , still learning!!!

RE: Are these stifle radiographs normal?

Neil Wheadon — Sat, 05 Sep 2015 13:04:35 GMT

Thankyou Malcolm and for the kind words on the quality. I used a wedge under the hock to get them straight , but obviously didn't succeed on the left as took this to see if it was 'normal' I hadn't spotted the panosteitis but could elicit no pain and so this seems like the most likely. The case is on 10 days metacam and rest with a review after that (or before if the forum said, mmmmm that needs fixing.)

I've alerted the practice owner to check Vetsurgeon in my a absense so Rachel there you go and thank you to everyone

Neil

RE: Are these stifle radiographs normal?

Malcolm Ness — Sat, 05 Sep 2015 12:43:43 GMT

My thoughts:

The tibial tuberosity physes are unusual: the left and right appear different from one another but that might be (and probably is) nothing more than positional artefact. The femoral condyles are almost super-imposed on each of the lateral views of the right stifle, indicating that these are near true laterals, but markedly offset on the left, indicating that this is a rather more oblique view. There is no evidence of displacement of the tibial tuberosity, neither is there any evidence of the adjacent soft tissue inflammation that accompany any avusion/fracture and which would almost certainly be obvious given the high quality of these rads. While the radiographic appearance of these tibial tuberosities is unusual, I can't see anything to support the suggestion that they are abnormal/fractured/avulsed. Even if they were, the lack of displacement would lead to conservative management - medical pain control and radiographic review after a week or two.

Both stifle joints appear normal with no evidence of effusion, synovitis or any sign of primary bone disease in the epiphyses or metaphyses.

The joint mice are popliteal sesamoids.

As Chris B points out, there is a panosteitis lesion evident in the proximal tibial diaphysis and this is much the most likely cause of this dog's lameness. I would continue with medical pain control and clinical review every 5-7 days. If the dog remains lame, I would repeat rads after a week or two. Prognosis for a full recovery is excellent though one or two further episodes of transient lameness might be seen over the next few months.

RE: Are these stifle radiographs normal?

Neil Wheadon — Sat, 05 Sep 2015 12:32:40 GMT

Stable knees , not neutered no trauma.

9 months old, world's fasted microchip

neil in heathrow, Oregon calling

RE: Are these stifle radiographs normal?

Neil Wheadon — Sat, 05 Sep 2015 12:27:23 GMT

Stable knees , not neutered no trauma.

neil in heathrow, Oregon calling

RE: Are these stifle radiographs normal?

Paul Stevens — Sat, 05 Sep 2015 12:10:16 GMT

Am I the only one seeing joint mices?
or is it a wondering microchip?