Patellar Luxation Case
Posted: Sun Nov 14, 2021 8:01 pm
Hello Laurie,
I was wondering if you could help me out with a case. I’m a vet and this is my third case since being certified. Already I seem to be specializing in lateral luxations, my first case was a grade one Frisbee dog and I have been following your exercises for medial lunation-I’m assuming the treatment is the same for lateral. The case that is really challenging me is Punkin a 23 kg slightly pudgy SF 6 year old Huskey mix. She was a rescued as a young dog and has always been lame on her right rear leg, which had never been worked up until last spring as the lameness was becoming more pronounced. She was brought to a boarded surgeon who examined her and reviewed her radiographs. Her assessment, was the femur was abnormally shortened most likely due to a fracture at 2 locations when Punkin was a puppy which healed incorrectly. Her patella is permanently luxated laterally. She does not have a cruciate drawer. The rads showed moderate arthritis of the stifle and there was some possibility of there being less bone density in her distal femur. The greater trochanter appeared stunted and rotated. The surgeon did not consider surgery a viable option.
On her assessment with me, she had a normal top line, was weight bearing on the affected leg but with some decreased strength. During the swing phase her stifle turns outward and when she flexes her stifle it turns inward with a slight pause before she extends, I’m assuming that the patella is catching. She obviously has a shortened stride on that leg. I was unable to measure the flexion of her stifle as it was too uncomfortable for her. The girth was about even with her contralateral limb but I’m guessing with the shortened leg its not all the informative. I could not find any trigger points but then again I’m a vet, I did find some discomfort when palpating her pirifomes region. Carprofen and rest appear to provide some relief but not completely.
So my thoughts are at least initially are to control pain, tweaking nutraceuticals, lasering, acupuncture, tPEMF massage, compressions and traction and perhaps some e-stim. I don’t have anything fancy ie ultrasound or UWTM. For exercises I was going to start simple and gentle, low caveletti’s, brief single leg stance, weaves, perturbations with front legs on unstable surface, tummy tucks.
Any other thoughts, should I try and move the patella into place and do the exercises. Other helpful exercises-I don’t want to make her more painful. If the exercises make sense, how should I advance them? Obviously, I can’t perform miracles but would like Pumpkin to continue to use that leg with a minimum amount of pain.
Your help is greatly appreciated, as is your web site, I have learned so much, but then have so much to learn. And I wonder how you get your dogs to be so cooperative.
Thank you
CC
I was wondering if you could help me out with a case. I’m a vet and this is my third case since being certified. Already I seem to be specializing in lateral luxations, my first case was a grade one Frisbee dog and I have been following your exercises for medial lunation-I’m assuming the treatment is the same for lateral. The case that is really challenging me is Punkin a 23 kg slightly pudgy SF 6 year old Huskey mix. She was a rescued as a young dog and has always been lame on her right rear leg, which had never been worked up until last spring as the lameness was becoming more pronounced. She was brought to a boarded surgeon who examined her and reviewed her radiographs. Her assessment, was the femur was abnormally shortened most likely due to a fracture at 2 locations when Punkin was a puppy which healed incorrectly. Her patella is permanently luxated laterally. She does not have a cruciate drawer. The rads showed moderate arthritis of the stifle and there was some possibility of there being less bone density in her distal femur. The greater trochanter appeared stunted and rotated. The surgeon did not consider surgery a viable option.
On her assessment with me, she had a normal top line, was weight bearing on the affected leg but with some decreased strength. During the swing phase her stifle turns outward and when she flexes her stifle it turns inward with a slight pause before she extends, I’m assuming that the patella is catching. She obviously has a shortened stride on that leg. I was unable to measure the flexion of her stifle as it was too uncomfortable for her. The girth was about even with her contralateral limb but I’m guessing with the shortened leg its not all the informative. I could not find any trigger points but then again I’m a vet, I did find some discomfort when palpating her pirifomes region. Carprofen and rest appear to provide some relief but not completely.
So my thoughts are at least initially are to control pain, tweaking nutraceuticals, lasering, acupuncture, tPEMF massage, compressions and traction and perhaps some e-stim. I don’t have anything fancy ie ultrasound or UWTM. For exercises I was going to start simple and gentle, low caveletti’s, brief single leg stance, weaves, perturbations with front legs on unstable surface, tummy tucks.
Any other thoughts, should I try and move the patella into place and do the exercises. Other helpful exercises-I don’t want to make her more painful. If the exercises make sense, how should I advance them? Obviously, I can’t perform miracles but would like Pumpkin to continue to use that leg with a minimum amount of pain.
Your help is greatly appreciated, as is your web site, I have learned so much, but then have so much to learn. And I wonder how you get your dogs to be so cooperative.
Thank you
CC