excuse me for my english, I am an Italian vet-rehab practitioner
Alf 9month old mixbreed dog (pittbul X dogue de bordeaux) was presented 20 days ago for an hyperextension of right hock.
Ortho vet performed xrays of hips and hocks: great trocanter avulsion. Surgery not possible, too small piece to be fixed with a screw.
Ultrasounds show small edema to the gluteus medius muscle, no signs of fibrillar structure loss. Suggested rest and FANS: no improvements.
Alf shows pain during hip extension and abduction, at the palpation of gluts/great trocanther area.
No loss of muscle mass.
Here is a link to a video of him walking
https://www.youtube.com/watch?v=S5KZx8W79LU
My therapeutic program would be:
capacitive diathermy
thigh muscle strenght (sit to stand, step ups, three legs standing)
UWTM
Any considerations and suggestions?
Thank you for your help
Erica
great trochanter avulsion
Re: great trochanter avulsion
forgot something...
not sure about the relation between tarsus hyperextension and hip disease (trochanter). JUst read something about hip dysplasia and tarsus hyperextension
not sure about the relation between tarsus hyperextension and hip disease (trochanter). JUst read something about hip dysplasia and tarsus hyperextension
Re: great trochanter avulsion
Hi Erica,
So questions back to you:
Is the greater trochanter displaced much?
Is there concern that movement or strengthening will displace it?
Any idea how long it's been going on?
I cannot make out why there would be more pain with extension and abduction - as both of those movements would approximate / shorten the gluteal muscles and therefore not add any stress to the greater trochanter... especially passively. And the hip (ball and socket) looked good otherwise? No hip dysplasia?
His walk is very characteristic of a dog with painful hips / severe hip dysplasia. I've seen it before. They hyperextend at the hock to try to get more extension of the leg without making the movement come from the hip. It's a catch 22 - do you brace (soft not rigid) the hocks to protect them? Or does doing so cause more hip pain? I had one dog (a vet's dog actually) with horrible hips that we used hock braces (Therapaw) as exercise aids. So the owner would put them on and walk the dog for 15 - 20 minutes with the goal being to increase hip extension range. It worked 'marginally'. The dog was a mess!
So I would suggest:
Ensuring that this dog has adequate pain management: NSAID plus an adjunctive
Add in some pain management therapies as able (i.e. laser, acupuncture, TENS) prior to exercise.
I think your exercise plan for now is appropriate... although he may not have a functional sit to stand - so you might want to try that as a 1/2 distance (i.e. sit to stand onto a higher stool).
If he cannot do the Step Up's then just try simple cavalettis to get him using more ROM in his hip and taking weight through the leg differently.
Easy hill walking might be another simple way to start him out on the path to strengthening and increasing hip extension.
Good luck!
Laurie
So questions back to you:
Is the greater trochanter displaced much?
Is there concern that movement or strengthening will displace it?
Any idea how long it's been going on?
I cannot make out why there would be more pain with extension and abduction - as both of those movements would approximate / shorten the gluteal muscles and therefore not add any stress to the greater trochanter... especially passively. And the hip (ball and socket) looked good otherwise? No hip dysplasia?
His walk is very characteristic of a dog with painful hips / severe hip dysplasia. I've seen it before. They hyperextend at the hock to try to get more extension of the leg without making the movement come from the hip. It's a catch 22 - do you brace (soft not rigid) the hocks to protect them? Or does doing so cause more hip pain? I had one dog (a vet's dog actually) with horrible hips that we used hock braces (Therapaw) as exercise aids. So the owner would put them on and walk the dog for 15 - 20 minutes with the goal being to increase hip extension range. It worked 'marginally'. The dog was a mess!
So I would suggest:
Ensuring that this dog has adequate pain management: NSAID plus an adjunctive
Add in some pain management therapies as able (i.e. laser, acupuncture, TENS) prior to exercise.
I think your exercise plan for now is appropriate... although he may not have a functional sit to stand - so you might want to try that as a 1/2 distance (i.e. sit to stand onto a higher stool).
If he cannot do the Step Up's then just try simple cavalettis to get him using more ROM in his hip and taking weight through the leg differently.
Easy hill walking might be another simple way to start him out on the path to strengthening and increasing hip extension.
Good luck!
Laurie
LAURIE EDGE-HUGHES
Re: great trochanter avulsion
HI!
Sorry to be absent the last few days.
So...I have many news about ALF
For Laurie : the greater trochanter is 0,5 mm displaced and no, I am not concerned about movement could displaces it more. We think it could have been happened 20 days before the first visit.
NO hip dysplasia.
BUT...
during the last re-evaluation he wasn't in pain anymore in the hip area, but the hock was worsening. I thought he had a mechanical lameness (something blocked hoch flexion) and his gastroc was very tense.
another xray and US was performed on Alf's knee and gastrocs.
SURPRISE!!!!
periosteal reaction on caudal aspect of distal femour and calcification on the lateral gastroc on his proximal insertion.
Ortho surgeon want to perform a tenothomy of laterl gastroc and suggested to fix a hook on his proximal tibia where I could attach an elastic cord (hook-toes) to keep hock flexed for prolonged periods (prolonged stretching of medial gastroc). I could disassamble the elastic structure whenever I want to work on strenghtening the medial gastroc.
Any thought?
Thank you
Erica
Sorry to be absent the last few days.
So...I have many news about ALF
For Laurie : the greater trochanter is 0,5 mm displaced and no, I am not concerned about movement could displaces it more. We think it could have been happened 20 days before the first visit.
NO hip dysplasia.
BUT...
during the last re-evaluation he wasn't in pain anymore in the hip area, but the hock was worsening. I thought he had a mechanical lameness (something blocked hoch flexion) and his gastroc was very tense.
another xray and US was performed on Alf's knee and gastrocs.
SURPRISE!!!!
periosteal reaction on caudal aspect of distal femour and calcification on the lateral gastroc on his proximal insertion.
Ortho surgeon want to perform a tenothomy of laterl gastroc and suggested to fix a hook on his proximal tibia where I could attach an elastic cord (hook-toes) to keep hock flexed for prolonged periods (prolonged stretching of medial gastroc). I could disassamble the elastic structure whenever I want to work on strenghtening the medial gastroc.
Any thought?
Thank you
Erica
Re: great trochanter avulsion
Hey!
So I've heard of hooks being inserted into bone to allow such things, but I've never seen it in practice. Naturally there would be concern over infection. I would think that you could so the same with theraband. In fact, I would love to try conservative management first before surgery... since a tenotomy is not reversible!!
Would the surgeon give you a couple of weeks to see if you could make a change - based on what the next X-ray / US found?
Laurie
So I've heard of hooks being inserted into bone to allow such things, but I've never seen it in practice. Naturally there would be concern over infection. I would think that you could so the same with theraband. In fact, I would love to try conservative management first before surgery... since a tenotomy is not reversible!!
Would the surgeon give you a couple of weeks to see if you could make a change - based on what the next X-ray / US found?
Laurie
LAURIE EDGE-HUGHES
Re: great trochanter avulsion
hi!
Surgery was done 2 weeks ago.
first week: Prolonged stretching with tape, US, massage, transverse frictions and manual streching
second week: prolonged stretching with elastic band of different lenght alternated with US, massage and transverse friction, manual stretching during the day, very short elastic band at night.
So far I am plased with the outcome, but still scared about scar tissues!
what do you think?
https://www.youtube.com/watch?v=rzvwTyjo13A
https://www.youtube.com/watch?v=JNw_mdU_JnI
Thank you
Erica
Surgery was done 2 weeks ago.
first week: Prolonged stretching with tape, US, massage, transverse frictions and manual streching
second week: prolonged stretching with elastic band of different lenght alternated with US, massage and transverse friction, manual stretching during the day, very short elastic band at night.
So far I am plased with the outcome, but still scared about scar tissues!
what do you think?
https://www.youtube.com/watch?v=rzvwTyjo13A
https://www.youtube.com/watch?v=JNw_mdU_JnI
Thank you
Erica