Chronic tendon injury L greater trochanter

[dmpaster]

Hi,

I saw a 2 1/2 year old spayed female border collie for a hopping gait with her left hind. Owner reports that she has seen her hop occasionally for the past year. The hopping increased in frequency after the dog slipped coming out of a tunnel about 6 weeks ago--that's when she presented to me for the hop. The dog is a bit shy and not easy to examine--she did offer to bite me when I palpated her left proximal sartorius, TFL and left gluteals. She also seemed not happy about palpation of her left gastroc.
I needled and lasered her and sent her home with some motor control and timing stuff--just the theraband around the abdomen when walking. I kind of lost the dog to follow up then because of COVID and curbside, but the dog did much better with just a theraband around the abdomen. Owner began doing agility again with her and the hop worsened.

X-rays of pelvis/hips/stifles were unremarkable. Owner was willing to do an MRI. I was not expecting this.
Here are the results:

FINDINGS
There is no evidence of an extradural spinal cord compressive lesion involving the caudal thoracic, lumbar, and lumbosacral spine. Iliopsoas muscles are normal. The coxofemoral joints and pelvis are normal although there is a persistent asymmetric high STIR signal surrounding the insertion sites of the left piriformis, gluteal, vastus lateralis, and obturator tendons. Fluid distention of the bursa of the left trochanteric fossa is noted.

CONCLUSIONS
Chronic injury of the insertion sites of the tendons of the left greater trochanter, trochanteric fossa, and adjacent proximal femur (gluteal, piriformis, vastus lateralis, and obturator). Otherwise normal caudal thoracic/lumbar spine, iliopsoas muscles, pelvis, left stifle and tarsal joints.

Has anyone seen something like this before? I guess I'll never know, but I want to know if the tendon injury came before the hop. Or, did she have a little hop and then injured tendons when she slipped and that just exacerbated the hop.
Could a slip account for all of these tendon injuries?

Owner has stopped doing agility with the dog and I've got to come up with a plan.
I figure we will go slowly, start with isometrics, address motor control and timing, laser, dry-needling, maybe an Assisi Loop. I don't have therapeutic ultrasound.
I need to fix the timing/hop before trying to strengthen the gluteals/vastus group, correct?

As always, any help is appreciated.
Diane

[lehughes]

Lucky you! An 'interesting and unusual' case!

So, I don't know that I've seen something exactly like this. However, I would lump it into the bursitis category. And these can be real 'buggers' to treat!!!

As such anything that targets a reduction of inflammation is fair game. I always encouraged treatment for bursitis as needing both 'inside therapy and outside therapy'. i.e. Medication and/or natural anti-inflammatory support AND modalities (Laser, US, PEMF...).

Bursa's are temperamental. So aggressive strengthening is out, and I'd limit your dry needling to the muscle bellies vs the insertions (or anything too close to the bursa). Acupuncture 'circle the dragon' technique would be fair game, and additional general points for the hip, left leg, and inflammation.

Soft tissue work (NOT ON the bursa, but on the gluteal muscles and tensor fascia lata).

And IF you can't settle down the bursa (and friends) with this, then you can consider a cortisone injection.

That's how I would approach in anyways. It was the part about the Bursa that was my Red Flag in the information you provided. I'd focus there before looking / addressing anything else!

Best of luck!

Laurie