Bilateral 1st rib pain

[Kriszty]

Hi Laurie,
Hope you are well. Hoping for thoughts on the below case:
7yo Finnish Lapphund. Intermittently lame on one of the front legs, O not sure which or if the same front leg, over the last few months. Often worse on getting up but not always and can come on at any time. Xrayed both front legs at primary vet, nothing found.
When I examined her she was not lame. However, she had quite marked diffuse back pain, sitting down on lumbar spine palp. Bilat 1st rib pain, worse on the L. CPs intact. Mild sartorius pain RH, so so extension of hips (hip scores good). Nothing at all found on either shoulder. Neck ok. I treated the 1st ribs (gently) and she was non reactive at the end of the session. Sent O home to do gentle heatmassage and brachiocepalicus stretch. However got a vid today (actually I got 6 :/ ) showing marked LF lameness that had gone an hour later.
I was thinking due to the bilateral 1st rib and general back pain this could be back/IVDD referred nerve pain? Maybe? Don't think I've seen one present like this before though.
Thoughts would be much appreciated, thanks!

[lehughes]

Hey Kriszty,

Okay... interesting. Usually I say that when an owner tells me 'which' leg is lame but isn't sure, I just figure I've gotta look at the whole body! BUT if you see a front leg lameness in a video, then THAT I trust!

So, I'd think you have two issues. Likely one at C6 - T1 region, causing rib pain and lameness. You can still treat the rib 1... but also treat the neck with mobs and traction and laser if you have one.

The back pain could be because of back issue. And quite likely that it. Naturally, people, dogs, etc can have more than one issue. The alternate is that the back pain is there due to compensation because of a neck issue (off loading a front leg and/or some neuro compromise causing rear end weakness). I'd put money on 'two problems' versus one problem that links it all together.

Double check for Medial Shoulder Hypermobility. High correlation with Rib and shoulder. Be sure to fully extend the shoulder when you assess for abduction. Even apprehension with this test COULD indicate an issue. Dogs get very smart in protecting their joints when the condition is chronic.
You could proactively treat shoulders with 3-leg standing balance exercises. The history of lameness gone in an hour sounds a bit more 'shoulder-ish' to me. So, I'd say double check that!

Okay, that's off the top! Best of luck on round two. Sometimes you can see more on subsequent visits because you start to address all of the 'bonus' issues that confound the main problem!

Cheers,

Laurie

[Kriszty]

Thanks for your thorough reply Laurie. I was thinking might need to recheck neck as I examined it more like a vet.
Have you seen MSS in a non athlete? This is a pet dog who doesn't do much. I didn't check for hypermobility, just biceps and supraspinatus, that she was very comfy on.
Have started her on gaba and antinol rapid as well.
Kriszty

[lehughes]

Hey Kriszty,

I think MSS can occur in pet dogs... especially if the owner throw the ball for it a lot, or the dog runs / plays with others dogs often. My Borzoi had this issue (because she like to run in our field and had a few wipe outs in the tall grass not letting her turn as quickly as she wanted).

Best of luck with the next round to checks!

Cheers,

Laurie

[Kriszty]

Update just for interest for anyone reading- on u/s the dog had bilat biceps disease. Consistently no pain on palp of biceps though.

[lehughes]

Hmm...

Imaging is only useful if it matches the clinical findings...

Biceps help to stabilize the shoulder. So I would still put the primary as being potentially a MSI...

Laurie

[David Lane]

Can you be more specific than "biceps disease"? Are their architectural changes to the tendon, or just tenosynovitis? If it is tenosynovitis with no changes to either the BT or SST, that does suggest MSS. Have the elbows been cleared? Low grade elbow OA might result in no active elbow pain, but lots of secondary shoulder, neck base issues that won't fully resolve without treating the elbows as well.