Popliteal enthesophytosis

[lehughes]

Hey Laurie....
How would you deal with a moderate Popliteus tendinitis with moderate enthesophytosis (ultrasound findings) in a young (14 month) GSP. Original injury was suspected partial CCL tear & was rehabbed (not by me). No overt signs of lameness in the left stifle but owner feels right rear compensating (I have found some SIJ issues on the right). Just not sure what I can do for the left stifle.....continue rear end strengthening, laser etc. but anything else?? Owner considering PRP.
AT

[lehughes]

Wow!!! I've never heard of such a thing!!! Okay, so my plan of attack would be laser for sure. When I googled, shockwave came up frequently. Which makes me think that anything that would increase circulation / promote resorption or healing would be in order... so if you have it, throw US into the mix as well. I might try out some myofascial techniques to slowly stretch / stress the tissues and stimulate healing. Hard to specifically stretch popliteus.

Beyond that, I would wonder about strengthening... Hamstrings??? I guess I think WHY would the popliteus tendon be affected? If overuse, then I think strengthen his allies - hamstrings. However, why would popliteus be overused? It's not likely... more likely a direct trauma. So back to the passive therapies.

My gut says to throw in some neurodynamic stuff for sciatic nerve as well.
Could do acupuncture / acupressure / laser acupuncture anywhere around the stifle - UB40 in particular, but also anything that traces the sciatic nerve. There I am back at sciatic nerve.

I'm going to throw this up onto the FourLeg Forum and see if there are any hits on it - in particular in regards to PRP. (I think PRP is a bit over-offered in vet med and is being touted as a bit of a panacea. Not sure it has a place in a case like this... but I'm okay with being wrong on that if others have had success in such cases!)

My thoughts anyways!

Laurie

[lehughes]

Wow ....thanks Laurie! All helpful! I figured PRP if all else tried as it won’t do any harm (even if there are no results.....human would do anything for her pup so money not a problem).
A.

[lehughes]

Sure... I can see that. I'd try the physio first and have PRP as a back up. Makes sense in that order.

L

[lehughes]

Yes....at this point I’m treating the secondary right SIJ & psoas issues. Wasn’t sure what to do the the left stifle

Such a young pup. Don’t like the osteophytes!!

A.

[lehughes]

It's so weird really!!!

[David Lane]

Tendinitis or tendinopathy? Do you have a copy of the radiologist's description of the findings? Was their fluid in the area? Tissue disruption? Osteophytic change or enthesiophytic? How do the tendons of origin of the gastroc look?

Depending on the answer to the above questions for me would determine if I went the way LEH suggested, or consider regen medicine instead (or in addition to).

[Arlana]

Hi David,
The ultrasound findings are:
Moderate enthesiophytosis is noted at the left popliteus tendon. The left popliteus tendon itself is thickened, measuring up to 0.19 cm with loss of fiber pattern. The adjacent left collateral ligament is mildly displaced outward by the thickened left popliteus tendon, however the left collateral ligament is considered within normal limits for thickness and fiber pattern (overall thickness estimated at 0.1 cm).
There is no evidence of left stifle joint effusion or capsular thickening. The rest of the left stifle joint, including the left patellar ligament, fat pad, visible portions of the menisci and left medial collateral ligament are considered unremarkable.
Conclusion: Findings are suggestive of left popliteus tendinitis with moderate to severe osteophytosis at its origin. The is no conclusive evidence of left collateral desmitis or long digital extensor tendinitis. The rest of the left stifle join is considered unremarkable.

[Arlana]

By the way David, you are seeing this young little GSP early June. Owner has made an appointment and driving from the Okanagan to consult with you

[David Lane]

Thanks. I figger'd this was the same case. We had a preliminary phone consult before she made the drive and discussed the pro's/con's of ESWT, regen med etc.