popping while walking

[rita]

I am hoping that you can help me with the following case. Woodley is a 6 year old Shepherd X with an acute onset lameness 2 weeks ago. The family suspects Woodley had a traumatic encounter with a bed mattress and frame. He was in the bedroom and vocalized and was found hiding in the closet.
Woodley has been seen by two other clinics. He was prescribed Rimadyl and later, meloxicam. Neither has been of benefit. He was sedated given his anxious nature and rads were taken (VD pelvis and lat stifles). The veterinarian was unable to appreciate a drawer while sedated.
The owner provided a video taken shortly after the incident. Woodley was pacing and unable to settle. He would attempt to sit, hold his LH in a guarded manner, gets up and repeats.
Woodley does not have a medial buttress, nor any appreciable stifle effusion. I am unable to obtain a drawer or tibial thrust. He is reactive at his L iliopsoas and is reluctant to have his legs extended caudally. He is reactive at T11 and mildly at his LS. His patellae have some lat movement but I am unable to luxate. There are TP's at his prox quads (bilat, R>L). He is very anxious to ascend stairs (there are 2 risers to get into the home, concrete) and he will launch off his front legs and avoid taking the stairs one at a time. He used to jump on the owners legs and chest but is now refusing to do so. A typically playful dog, he will not engage.
So my current diagnosis is a L iliopsoas strain. However, there is another video that the owner provided where there is an audible click or pop as Woodley walks. This was not happening when I saw him. The owners say that it is becoming less frequent as the days pass. I am trying to attach the video as it can be appreciated there, but I am unable to attach it to this conversation. I am wondering if I missed a luxating LDE? I did not feel anything odd when I was flexing the stifle. Given the lack of a medial buttress, could a meniscal tear be possible?
I realize that these are difficult situations when you can't put your hands on him, but I would appreciate any thoughts or comments.
Thank you,
Rita

[David Lane]

A couple of thoughts:

I couldn't see any video, but by "popping", I assume you mean a skipping gait, typical of luxating patella dogs.

The clicking sound raises the possibility of meniscal tear, but such tears are pretty much only documented in boxers unless there is concurrent instability. If cruciate disease has been looked for, can't be palpated and there is no effusion on radiographs, then it probably isn't present. Also, for such audible clicking, I would expect the dog to be profoundly lame on the affected side.

If you checked for LDE luxation and can't find it, it probably isn't that either.

Iliopsoas a/o psoas major pain will cause a skipping gait, so that may well be the Dx - fix that and see what happens.

The other common cause of skipping gaits is SIJ issues. Aspects of the history (the trigger points, difficulty ascending stairs, etc.) also support this possibility. Do both SIJs have a full PROM and does the pelvis return to a neutral standing position when the dog is standing square?

I periodically see dogs that make clicking sounds that I can never isolate, but that resolve when I fix the underlying problem. I've always assumed it was abnormal muscle tension causing fascia to snap over a bony prominence, but that is more or less a theory that I pulled out of my ass, so I would love to hear what other people think of this phenomenon.

[rita]

Thank you so much for your help. I was not able to upload the video from the email(and others that are more computer savy tried as well). Sorry. If it is possible to email the video to another address, that would be an option. I would just need to know where to forward it to. You would see that there is no hopping, no skipping, no profound/nwb lameness during the video, just the popping noise. However, there were times of profound lameness in the days prior to the video.

This may well be one of those cases where it's not obvious. Your reply has been very helpful!
Rita

[lehughes]

Hey Rita!

I like all of David's comments above.
And I too have had cases where the owners (and I) can hear a click but I can't put my hands on it or make sense of it on examination. I like the fascia-flick hypothesis.

In addition to David's thoughts on where to look next, I'll add in 'The Tarsus'.
Wobble the calcaneus and look for differences from side to side (which could indicate a short collateral ligament injury). Also see if you can push the SDFT off of the calcaneous. I found this short, but interesting article online: https://mckeevervetderm.com/wp-content/ ... cement.pdf

It does sound MOST likely that you have a nasty iliopsoas strain. The click could be the red herring... Check the other 'oddball' things, and then treat the iliopsoas and see what you find as you do.

Best of luck!

Laurie
PS If you can put the video on Youtube, you can share the URL here. (That's the only way I've found to share videos.)

[rita]

Thanks again! Just for curiosity's sake, here is a Youtube link to the dog walking. You have to listen above the noise of his long toe nails.
https://youtu.be/Wgw0x13b7MI
(I hope that it works!)

[lehughes]

Crazy! It took me about a dozen times of watching this video to figure out what I was listening for and then what / when it was occurring.
So, the thud / clunk seems to occur with the swing phase of the LH. That leg is held in slight external rotation as it moves through - slight, but still.
It SOUNDS 'hip' to me... like the deep clunk when getting a positive ortolani.

So in addition to the things David and I said above, also look for pain at the deep gluteal & pectineus (for hip pain). See if there is pain with internal rotation (in neutral - flex-ext). Is there pain with pure hip extension (block the ilium from moving). Can you get pain, or clunking, with doing a Barlow + Ortolani or a Barden + Ortolani?

I'm going to throw hip laxity or labrum tear into the differentials.

Laurie

[rita]

Once again, thank you. I did not perceive any hip laxity or "clunking" (although he is a very nervous dog in the clinic) and pelvic rads were done by the rDVM, who examined him while sedated (I can put some trust there). I'll let you know how it goes. I will ask them for another look this week. Have a great week!!

Rita