Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

RE: Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

Alasdair Hotston Moore — Tue, 05 Mar 2024 23:09:39 GMT

Thanks for the update

RE: Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

Elizabeth — Tue, 05 Mar 2024 06:56:02 GMT

Thanks Virginia,

Just to update - it seems I was panicking unnecessarily- the mass was inflammatory. FNA done during initial X-rays, so TPLO performed, and a biopsy taking at the same time confirmed the FNA’s findings. So I’ve still got a dog with 4 legs, and a deeper understanding of the stress of keeping a active dog confined.
Thanks all!

RE: Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

Virginia Campbell — Sat, 02 Mar 2024 22:50:12 GMT

I'm late to the party but to me it would be pretty odd to get OSA

a) in this breed

b) at this location

c) with no lameness - any osteosarcs I have seen have been properly lame quite quickly, and sore even on moderately firm palpation.

All 3 together- rare as rocking horse poo. So I'd leave the leg on the dog for now and see what transpires. If it's some other kind of neoplasia, at least you probably have more time to play with. The cruciate and the whatever-it-is forelimb lesion are probably just coincidental , but I'd be vaguely wondering if I should be joint tapping the stifle and perhaps a couple of other joints, and maybe getting a bit of blood for a C reactive protein, just in case it's some weird slow-burn presentation of an IMPA type thing. Pooch being a spaniel and all. (Is an IMPA joint environment an unhappy place for a cruciate to live? )

RE: Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

Elizabeth — Fri, 02 Feb 2024 17:40:16 GMT

Thanks for all your help. We haven’t got the cytology back yet, but here are the X-rays. There’s never been any lameness in that foot, but the swelling did come up quite quickly.

RE: Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

Andy Moores — Fri, 02 Feb 2024 09:40:07 GMT

[quote userid="4181" url="~/f/clinical-questions/30888/forelimb-tumour-newly-spotted-at-same-time-as-cruciate-injury---what-to-do-first/243587#243587"]If you amputate, then return to 'full athletic function' is rather limited, so I'd be tempted to do a lateral suture at the time of amputation.[/quote]

I would take the opposite view here - if amputation was indicated/performed then actually you would want the best possible function from the remaining three legs to allow the dog to ambulate as well as possible... i.e. TPLO is indicated. Don't make it even harder for the dog with a lateral suture that is likely to result in recurrent stifle instability.

But the bigger issue here is that currently there is not enough clinical info, certainly not enough to be considering amputation at this stage. Would need to see rads at the very least. FNAs may also help. Lots of 'lumps' in the carpal area are innocuous and the absence of forelimb lameness/pain would be very unusual if this was a malignant bone/joint tumour (this would be an unusual location for OSA).

RE: Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

Rob Loxley — Fri, 02 Feb 2024 08:52:55 GMT

[quote userid="24356" url="~/f/clinical-questions/30888/forelimb-tumour-newly-spotted-at-same-time-as-cruciate-injury---what-to-do-first"]Assuming it is a tumour[/quote]

What are the results of the FNA - a good cytopathologist will often be able to give some indication even from FNAs?

I'd really want a more firm diagnosis before amputating - further opinion on the radiographs, maybe biopsy.

If it's an OSA and you're minded for amputation, then you don't want to delay. If you amputate, then return to 'full athletic function' is rather limited, so I'd be tempted to do a lateral suture at the time of amputation.

But I'd still want a more firm diagnosis to try to guess the dog's overall prognosis, as this may influence the 'best' way to manage the CCL, and then it's very much where an owner wishes to go for them and their pet as far as treatment options.

RE: Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

David Mills — Fri, 02 Feb 2024 08:37:26 GMT

Can you post the rads?

RE: Forelimb tumour newly spotted at same time as cruciate injury - what to do first?

Elizabeth — Thu, 01 Feb 2024 09:35:24 GMT

Bony proliferation on metacarpal not metatarsal