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Hi Laurie,

First let me say how much I appreciate you and the FourLeg site! I rely quite heavily on it and I’ve learned so much from you.

I was wondering if you could offer your opinion on a case I saw yesterday.

Buddy is estimated to be 14 years old, MN, Shepherd/Collie mix, approximately 60 lbs (underweight). He was referred to me for acupuncture due to declining mobility concerns over the last year.

He has mild djd both coxofemoral joints and subluxation of the left on current rads. He has mild to moderate djd of both stifles with mild effusion and periarticular thickening due to chronic instability. I also discovered a grade 2 lateral luxating patella on the right. This dog has significant extensor rigidity of both hind limbs whether standing or laying down. You can use key points of control to get the limbs to flex but it’s still a bit limited. The dog cannot transition between postures and sometimes falls over. The ROM of the stifles and tarsi are quite limited with decreased flexibility. The patellar reflexes, gastrocnemius reflex, and withdrawal are all diminished. Conscious proprioception is delayed but not absent. He walks with a hopping gait on the right rear (see video) and when he stands the left rear either hovers over the ground or both rear are together or they are crossed. I was unable to demonstrate vertebral pain which surprised me. I feel like I can find vertebral pain on every case I see regardless of presentation. There were no spinal films but in the lateral pelvis the articular facets of the lumbar vertebrae look pretty bad. The radiologist made no comment.

I’m trying to decide the root of the problem. I’ve read on VIN that chronic pain can cause extensor rigidity but I’m debating about an actual neuro lesion. I don’t think I’ve seen a dog with this level of extensor rigidity before.

The dog is on meloxicam daily but owner doesn’t think there’s a difference. He started Adequan and laser at his regular vet. I’m not sure what they’re applying laser to at this point.

I performed acupuncture and instructed owner on PROM, stretching, and some massage techniques for now.

Can you share your thoughts please?
Video: https://share.icloud.com/photos/0A_9EDU ... Cw#Newbury

Kindest Regards,

LS

Hi Laura,

I’m glad you are getting so much out of the website!

Okay, so I watched the video at least 10 times trying to think, “What neuro problem would cause this?” And after about the 5th watch, I came up with - “Neuro doesn’t cause this!”
I went back and read everything you wrote and here’s my thinking!

Follow me on this:
Reflexes are diminished = either a LMNL, Degenerative Myelopathy, or they are just ‘old dog normal'
Hopping gait = Not neuro, not DM, not LMNL, not UMNL (aka lower or upper motor neuron lesion)
Placing reflexes diminished but present = quite typical for an old dog with likely DDD somewhere in the neck or back.
No vertebral pain = either no vertebral issue, or DM, or chronic as in DDD
Extension of the legs = is it really extensor rigidity or it is part of the orthopaedic mayhem going on (stifle OA, hip DJD, sublux of left hip, grade 2 LPL, reduced PROM stifle & tarsi)?
Key points of control allow some flexion: Could be either neuro or ortho - they work for both.

So, I am thinking that you have a very complex ortho case on an old dog with a bit of mild neuro-ish stuff that would by typical for a 14 year old dog - especially one with some DJD of the L/S that was visible on pelvis radiographs.
The sublux of the left hip fits with it hovering over the ground - as the leg will be ‘shorter’ due to the sublux.
The sublux plus the DJD of the hips could cause the close together stance in the rear legs (and lack of abduction).
The stifle OA would limit both hock and stifle flexion and impede normal movement.

I guess I wouldn’t call it extensor rigidity in and of itself as the description implies neuro / lack of control in stopping the rigidity. This I think is body compensations, adaptations, limitations.

So… I would focus on the ortho issues, with a nod of the head to the L/S (some acupuncture and tail pulls perhaps), but focus on the extremity joints. I think you’re on the right path with your treatment plan… not sure where you focused your time, but I’m thinking ortho is your main issue here.

Interesting case! I hope this helps!

I’ll try to upload it onto the forum as well for others to thought process through.

Cheers,

Laurie

Laurie,

You’re such a rock star! Thank you. I wanted to make it a neuro case but it just wasn’t adding up to me. I love how you broke it down and it does make sense to me.

I will continue acupuncture and really try to focus on manual therapies. This owner seems pretty committed to trying to help his friend. He sent me a text the day after treatment to say he thought the dog was moving better and he completed all the tasks I gave him to do. I will keep you updated on this case!

Thank you again for your time. I’m so grateful for your help.

L.

I unfortunately could not view the video, so am going on the verbal description but just wanted to throw out the thought that we occasionally see rigidity/hypertonia issues secondary to hyperadrenocorticotrophism induce myopathy. How are the liver enzymes looking?

The liver enzymes are abnormal. I'm not certain of the discussion the regular vet had with the client about the lab results but the owner seemed to be not concerned or disinterested in the conversation when I've initiated. I was unaware of a correlation between rigidity/hypertonia and Cushing's. The AST, ALT, and GGT are all marginally elevated but the ALKP is over 1200. The urine s.g. was 1.034 though. The dog has alopecia but the owner felt it was a thyroid problem so he put the dog on a Standard Process supplement long before I saw the dog and he feels the dog is much improved. However, the dog's hair coat is still quite abnormal. Aside from the lack of PU/PD I could believe this dog has Cushing's.

I'm going to push him to test this dog, but I have had a bit of a breakthrough. I read about vibratory therapy in treating human patients with muscle spasticity so I had the owner purchase a hand held massager. After one week of use on the rear legs the muscular tone definitely decreased. Today (after 2 weeks of vibratory therapy) the muscular tone is not only decreased but I'm able to flex the limbs much easier than before. There is still rigidity but it has improved.

I'll try to update this post as I continue to move through this case.

Thank you for all the help!