Differential diagnosis help....

[K9Rehab]

Hi everyone,
I've come across a case that I have never seen before. Laurie will attach the gait video for me. 6 year old Rotti/Lab X with insidious onset lameness on RH a month ago. Initially rested for 4 weeks with no change then referred to me. Vet reports radiographs show mild degenerative changes in hips bilaterally and mild effusion at right stifle (dog had undergone surgery for L elbow dysplasia and now shows significant OA L elbow and mild in R elbow, yet no front end lameness). On assessment neuro testing was all WNL. Hip, stifle, hock, tarsus ROM and palpation was all unremarkable. Some guarding at EOR hip extension bilaterally. Cruciate testing was WNL and sits square with stifles flexed underneath her. Full rotation in spine and I didn't find any tenderness or asymmetries over her thoracolumbar spine or pelvis. She was tender with palpation over gracilis and semitendinosis and a bit over iliopsoas but pectineus was fine. I took this as a soft tissue muscle strain involving gracilis/iliopsoas since she's a frequent off-leash romper in the woods and we started on massage, stretching and on-leash loading (and laser). But she has come back two weeks later with unchanged symptoms on the RH and the same pattern starting on the LH. I've never seen it but I was wondering if this could be gracilis fibrotic myopathy... and if yes what my best treatment options are? Thanks...

[lehughes]

Sorry.... only getting to uploading the video now!
Here's the link:

https://youtu.be/eFHG6B0JRQQ

[lehughes]

Okay... and now my 'eyes' and 'brain'.

It looks like a lateral collateral ligament injury at the stifle.
There is a distinct blowing at the stifle joint with each step.

And/Or check the tarsus for the same. But I think I see it coming from the stifle.

Your rDVMs don't usually look for collaterals at the stifle joint... so I think it's safe to say that it likely hasn't been ruled out.

Also check the tarsus to see if you can slip the SDFT off of the point of the hock, and or if it seems to be slipped off already.

My thoughts of where to look next anyways...

Back to you!

Laurie

[K9Rehab]

Thanks for your thoughts... I'll certainly check both her lateral collateral and her tarsus, owner is also considering an orthopedic consult in Calgary. The wrench was also that after a few weeks of relative rest she seems to be starting to demonstrate the same type of lameness on the contralateral side. Will keep you posted...

[lehughes]

Weird... maybe some kind of soft tissue / autoimmune thing...
???? (If the contralateral side started showing similar signs out of the blue.)

L

[K9Rehab]

An interesting ending to this story (or maybe a middle as it's not over quite yet). I'll be seeing this dog at the end of January after not seeing her since the last post. Ended up going for an orthopedic consult in Calgary and is now having bilateral TPLOs done three months apart, first one this week... the local vet and I were both scratching our heads at how this dog had two fully blown cruciates and this presentation.

[lehughes]

Interesting. I'd still err on the side of, "Are you sure?"
See what comes back for a surgical report...

Laurie