Laurie's Blogs.

Hi Laurie,

I was hoping to ask you a quick question about a case.  I went to CRI and I am a member of your online group.  I read your blog notes on the condition and they were very helpful, I was just hoping for a little clarification.

It is a 4 year old F/S border collie (agility dog) with a history of iliopsoas strains and anaplasmosis.  Now the dog is having intermittent non-weight bearing lameness in the rear.  It is never consistent between legs, severity, duration.  Usually it is just a couple minutes at most and she seems to warm up out of it?  It does not seem worse after exercise.  I could not get any pain response in the leg.  I got some mild soreness on palpation of the iliopsoas (psoas major) under the cranial lumbar vertebrae, but I felt like it was more of a compensatory soreness than a primary injury.  She has mild atrophy of her right rear leg.

I felt like it was possibly more of a nerve entrapment type issue, but I sent her to have the iliopsoas ultrasounded to confirm they were not the issue.  I was worried about possible fibrosis due to the prior iliopsoas injuries.  On the ultrasound they found bilateral fibrosis of the pectineus muscle.  I did not get any pain on abduction of the limb, but I am not honestly sure that I did it with the stifle in flexion.  I plan to check again tomorrow, when I recheck the dog.

My questions are:

1.  Would you agree that this could be causing the lameness that we are seeing?

2.  Do your blog notes on fibrotic myopathy apply in this case as well?

3.  Could this be a result of the original iliopsoas injury?

Thank you so much in advance for your advice,

LW, DVM, CCRT

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Hi LW,

Interesting case!

So first off, I think I would not even worry about the pectineus.  

I would look elsewhere... in fact, I'd check the lumbosacral junction (definitely the rest of the lumbar spine too) AND test for the motor control & timing... AND, get really anal-retentive about feeling the TONE of the lumbar epaxial / multifidus muscles... I'd expect LOW tone with this being a chronic case.

To me it almost sounds like it's a brief nerve irritation.

I'm thinking if it were pectineus fibrosis... that the sudden non-weight bearing would be because of micro-tearing... which would create a longer-term lameness.

However if it were a mild facet joint issue - perhaps causing a sudden nerve impingement... then it could be a short lived 'zinger' that warms out.

And so... perhaps the original iliopsoas injury also jammed a lumbar facet (or a few different facets).  And your current iliopsoas tenderness could be the result of the spine / joint issues vs the old iliopsoas and could be as you say, compensatory.

So... if you find facet issues or pain & dysfunction in the back, then traction & mobilizations & motor control & timing exercises + E-Stim of the epaxials with the 3-leg stands.  Plus modalities to settle things down & make the nerves & joints happy.

I hope this helps!

Laurie