Radiograph(s) of the week

RE: Radiograph(s) of the week

James Dunne — Fri, 07 Jun 2019 08:48:36 GMT

hi Neil

I think I've attached the file - I'll try again if it is not visible. If the diagnosis is not obvious, I would do an arthrotomy - there are things other than CrCL that can cause the effusion and symptoms. I don't think 8 weeks non-responsive lameness is totally atypical of small breed cruciates. We see a decent number of them fitting that description prior to full rupture of the ligament at least.

Kind regards

James

RE: Radiograph(s) of the week

Alistair Graham-Evans — Thu, 06 Jun 2019 23:58:12 GMT

Maybe not typical history of cruciate injury - not much improvement after 8 weeks in a small dog.

Enthesiophytes more on lateral aspect ( evidence on R as well ) and no medial buttress. With that displaced head of gastrocnemius I would be carefully examining lateral and caudal soft tissues as well as assessing cruciate stability. Difficult to assess effusion on those X-rays. Is that calcification of the meniscus in the lateral joint space?

The patellae seem to be positioned quite distally and the R tibial tuberosity is a stranger shape than normal - wonder if there is any previous history of surgery?

PS I would have missed the gastroc sign

RE: Radiograph(s) of the week

Neil Wheadon — Thu, 06 Jun 2019 14:56:17 GMT

I think we all looked at James's response in awe and thought 'follow that!!'

What's the gastroc sign on the X-Ray, James?

Neil

RE: Radiograph(s) of the week

David Mills — Thu, 06 Jun 2019 14:40:35 GMT

Thanks for all the responses. This is a colleague's case that has been passed onto me, so haven't actually examined the dog yet.

Dog has been on full dose NSAIDs for 8 weeks already with minimal response so have booked in for taps and possible surgery. I haven't opened a stifle joint for cruciate surgery in years, so if the signs are compatible with ACL then I suspect an athrotomy may not be indicated.

RE: Radiograph(s) of the week

Julie Innes — Thu, 06 Jun 2019 11:00:51 GMT

I'm no orthopod, but I would be going for cruciate injury. We send a lot of our xrays for advice to our local orthopaedic service, and they seem to say it can still be cruciate without a forward drawer. I'd be going down the "NSAIDs and rest" route (rightly or wrongly!)

RE: Radiograph(s) of the week

Beats — Tue, 04 Jun 2019 20:04:36 GMT

Cruciate disease, degenerative - bilateral.

Suspect probably grade 1 or 2 MPL also, but not the cause of current lameness?

Assuming:

1) there is no signs of a polyarthritis (i.e. no pain response to carpal flexion etc)

2) there is pain on forced extension of the left hind stifle, and not pain elsewhere (such as, for example, full extension of hip with internal rotation and digital pressure over "iliopsoas region")

3) there is no obvious focal pain on palpation elsewhere around the stifle

4) the patient is of a lean body condition already

I would continue to give NSAIDs and see it back in a month to 6 weeks unless it worsened significantly.

PS - I am purely playing along for my own educational enjoyment, so please don't consider this to constitute sensible or knowledgeable advice!

RE: Radiograph(s) of the week

James Dunne — Tue, 04 Jun 2019 12:32:48 GMT

Hi David

There is evidence of periarticular enthesiophytosis bilaterally and also potentially evidence of avulsion of the lateral head of the gastrocnemius on the left. I'd say though, with a stifle effusion, it's a cranial cruciate ligament degeneration until proven otherwise. No drawer may just mean a partial tear. I would tap the joints - if the cytology is mainly neutrophils, you may be dealing with an immune-mediated disease. If that's the case, you go down the road of further investigation or empiric treatment. If the cells are mainly mononuclear and if you have a decent number of foamy macrophages, something confined to the joint or its surrounds is bothering the dog and most likely CrCL and this warrants exploration of the joint if there is no response to further treatment. Hope that is of some help; other forum contributors may have better ideas.

kind regards

James