fourleg.com

This is a video of a SF 4 year old German Shepard 4 months after a R TPLO. She had been cleared by the surgeon but he just recently started to notice the hock when she is walking.

On palpation there is a pronounced trigger point in the R quad with muscle spasms on palpation. Nonpainful in the iliopsoas, gracillis and semimembranous are soft with no palpable thickening. Good PROM in hock, stifle and hip.

Just had a fibrotic myopathy German Shepard last week but this gait seems different, no "snap"

Any suggesions?

https://youtu.be/7GXszZUkBZE (gait video)

Nancy Peterson DVM, CCRT, CVA, CVSMT
Pawsitive Strides Veterinary Rehabilitation & Therapy
Des Moines, IA

Hey Nancy,

The video says 'unavailable' (maybe you've made it private?)

Could it be early Fibrotic Myopathy?

Laurie

Lori techno I'm not. My staff told me if you copy and past the URL you can see if but I can try and have them "unprivate it"

I don't think it is a fibrotic myopathy because I don't get the "snap" but let me know if you still can't see it.

Nancy Peterson

Gait Video has been changed to public viewing. Sorry about that! Here is a copy of the link again.

https://youtu.be/7GXszZUkBZE

Without having seen the video yet.... gait alone is not a reason to diagnose fibrotic myopathy. If FM exists enough to affect gait, then there should be reduced PROM when flexing the hip with an extended stifle, combined with a palpably firm (fibrotic) feeling hamstring that appears to be the cause of the reduced PROM (ie: unreasonably taut when the neighbours still have some palpable laxity or flexibility). Without that finding, then I am comfortable saying it is not FM, no matter what the gait looks like.

Okay... so I just checked out the video now. And that isn't a fibrotic myopathy walk, I'd agree... it's rather hard to see all of the components from behind (a side view show a FM walk a bit clearer), but this hock twist at the end of stance phase is entirely not FM.

So, I'll put on my thinking cap, but reserve making a judgement - because your hands will need to be the final decider.

• I'm not worried about the trigger points. That's pretty common for any knee injury and an offloading of a limb for any period of time.

• Again, hard to see with just a rear view - I'd put in what the Vet World is calling a Pivot Shift in that leg (i.e. the TPLO doesn't necessarily address a rotation instability in the leg...). In humans we could do a drawer with simultaneous rotations one direction, then the other. If this is the case, then the dog may need to have that corrected (i.e. a lateral suture).

• Is there pain on end range stifle extension? Could it be a meniscus in a specific area of the joint that only comes in contact in full extension and the dog is figuring out how to avoid that position?
  I would also question if there is pain in the hips, SIJ, or L7... not because of the tarsal rotation but because I see a correlation with reduced range in the lumbo-pelvic-hip region where the tarsus takes over the end range extension movement.

• Have you checked the collateral ligaments?

The more I watch the first part of the video... the more I am drawn to the 'pivot shift' thought.
WHICH, from what all of us in the rehab field have experienced, needs a surgical correction. Despite aggressive rehab, the consensus seems to be that surgical repair is needed. (Which unfortunately would mean convincing the surgeon that the dog is in fact, not okay! And further more, that he/she needs to do something about that! Good luck there!)

Okay - back to you!

Cheers,

Laurie