I am seeing an 11 year old male neutered lab and we are not getting results with current treatment. He is weak in the rear and has muscle atrophy + a compensatory pain pattern in the front - so far it sounds pretty typical, right? He was diagnosed by another vet with lumbar IVDD and lumbo-sacral spondylosis based on rads last December. I saw him in February and actually felt like his hips were more the issue and that the pain noted in his paraspinals was actually a compensatory pain pattern rather than the primary cause of pain. I did about 3 sessions of acupuncture and didn't see him again until early September. At this point I am seeing the following:
Stands with both rear limbs very straight, L hind toes hyperextended so you can see pads (less extreme on R hind), gait has a hypertonic/rigid look in rear where rear limb slaps down, lateral gastrocnemius overdeveloped, very sensitive to touch on RR, avoids thoraco-lumbar stretches to LR but does fine to R.
Here are some videos of his gait:
https://photos.app.goo.gl/H1oJHVHKUT2RDVCr7
I have tried treating for L-S dz and hip pain with tail and lumbar traction, therapeutic laser, PEMF, acupuncture and therapeutic exercise (primarily cookie stretches to both hips and rear feet - I was going to increase the exercises once we started to see a little improvement).
He clearly has something going on with his deep digital flexor tendon(s) - not sure what. And I can't figure out his strange gait but I know that I am missing something.
I just started really doing rehab full time, after many years of primarily doing GP and a little rehab here and there, so I would really appreciate any feedback you can give.
Thank you so much.
Stuck on a case -
Re: Stuck on a case -
Interesting videos! I know I've seen something like it before... but let me go through some thinking.
It's an interesting 'kick' of the leg, but the dog does seem to know where his legs are and doesn't have issues walking over the poles.
I almost wanted to say Fibrotic Myopathy. Could be - on the Left Hind. But the RH isn't 100% normal. So I go to neuro.
He's not ataxic. He's not scuffing. Is he slapping the feet down the way he does because a) he biomechanically can't reach forward further or normally? or b) because he is avoiding full extension of the opposite hip, and he counteracts by coming down sooner with the contralateral limb.
a) makes me think nerve root impingement / lumbosacral stenosis / lack of extensibility of the sciatic nerve.
b) makes me think severe hip OA
c) both
d) nerve sheath tumour
Now, the overdevelopment of the lateral gastrocs... I'm going to think you might actually have a tumour there. So, I've added (d) to the list above.
And as I re-read what you've done... you're treating for a, b, (& c) anyways.
Try doing 'hamstring stretch'... which is also a sciatic nerve tension test. Do is normally first - see where movement ends and the quality of the endfeel. Try it with a tail pull simultaneously. If there is greater excursion, then it fits with nerve root impingement. If the endfeel is abrupt and twangy, that is also indicative of nerve tension.
Hmm...
The toes up thing can be a lack of DDF tension (and the dorsal ligament at the DIP joints are unopposed)... but why. Not likely an injury... likely weakness. Which put us to nerves again.
Which... for it to be all toes, you go with muscle belly issue. (Could there have been an injury there?) OR tumour again.
Maybe biopsy that 'overdeveloped gastrocs'...
That's off the top of my head anyways.
Try the tests above and see if you get anything that adds up.
Keep us posted!
Laurie
It's an interesting 'kick' of the leg, but the dog does seem to know where his legs are and doesn't have issues walking over the poles.
I almost wanted to say Fibrotic Myopathy. Could be - on the Left Hind. But the RH isn't 100% normal. So I go to neuro.
He's not ataxic. He's not scuffing. Is he slapping the feet down the way he does because a) he biomechanically can't reach forward further or normally? or b) because he is avoiding full extension of the opposite hip, and he counteracts by coming down sooner with the contralateral limb.
a) makes me think nerve root impingement / lumbosacral stenosis / lack of extensibility of the sciatic nerve.
b) makes me think severe hip OA
c) both
d) nerve sheath tumour
Now, the overdevelopment of the lateral gastrocs... I'm going to think you might actually have a tumour there. So, I've added (d) to the list above.
And as I re-read what you've done... you're treating for a, b, (& c) anyways.
Try doing 'hamstring stretch'... which is also a sciatic nerve tension test. Do is normally first - see where movement ends and the quality of the endfeel. Try it with a tail pull simultaneously. If there is greater excursion, then it fits with nerve root impingement. If the endfeel is abrupt and twangy, that is also indicative of nerve tension.
Hmm...
The toes up thing can be a lack of DDF tension (and the dorsal ligament at the DIP joints are unopposed)... but why. Not likely an injury... likely weakness. Which put us to nerves again.
Which... for it to be all toes, you go with muscle belly issue. (Could there have been an injury there?) OR tumour again.
Maybe biopsy that 'overdeveloped gastrocs'...
That's off the top of my head anyways.
Try the tests above and see if you get anything that adds up.
Keep us posted!
Laurie
LAURIE EDGE-HUGHES
Re: Stuck on a case -
Laurie,
Thank you so much for your reply. I am going to see if I can get him in for some rads. It means so much just to know that I am not missing something big and obvious and I feel better now that I kept thinking about fibrotic myopathy in the back of my mind but since I have never actually had a fibrotic myopathy case I wasn't sure if I was just totally off.
I think you are right. The more I watch the gait the more neurologic it looks and so often when I am not getting any response to all the normal treatments, neoplasia is lurking in the background.
So, thanks so much for the taking the time to think about the case and respond.
Kelly
Thank you so much for your reply. I am going to see if I can get him in for some rads. It means so much just to know that I am not missing something big and obvious and I feel better now that I kept thinking about fibrotic myopathy in the back of my mind but since I have never actually had a fibrotic myopathy case I wasn't sure if I was just totally off.
I think you are right. The more I watch the gait the more neurologic it looks and so often when I am not getting any response to all the normal treatments, neoplasia is lurking in the background.
So, thanks so much for the taking the time to think about the case and respond.
Kelly
Re: Stuck on a case -
You're welcome...
I wish my thoughts on the case were 'happier'.
Best of luck!
Keep us updated if you learn more!
Cheers,
Laurie
I wish my thoughts on the case were 'happier'.
Best of luck!
Keep us updated if you learn more!
Cheers,
Laurie
LAURIE EDGE-HUGHES