Hello,
I was recently referred a case of an 8 yr old FS Collie. She had her first TPLO June 8th, 2016. Recovered well, then tore the other one and had surgery on August 10th, 2016. Just after her 4 week recheck (where everything was fine) she was found in the kitchen unable to get up. Her referring vet examined her and decided it was most likely neurological and put her on a tapering dose of prednisone. He referred her to me 3 weeks after this incident noting she was getting better, but not fully improved.
On my exam she is very weak in the rear, unable to rise unassisted, but can walk once up. She sits in a bear-sit posture. She has delayed proprioception bilateral, but not absent. She is painful near T11-L1 and possibly painful at L-S, but I wasn't convinced as her SI was also displaced and painful bilaterally.
She is EXTREMELY cow-hocked. The rDVM said she was like this before the incident, but this is just the most extreme I have seen (her tarsii are nearly rubbing together when she walks). I am wondering if it is being exacerbated by the rear weakness. Also, the left (most recent TPLO) foot is turning out when she is in the stance phase. It strikes the ground, pivots and returns. Both feet when standing are pointing out laterally.
Her stifles appear to be healing well and both sides have great extension and flexion, some mild-moderate psoas pain. Kypthotic posture.
Owner is not ready to jump on referral yet, and the rDVM is waiting on rads till her 8 week TPLO check to do it all then.
I am thinking this is disc at T-L junction and maybe she slipped in the kitchen when the owner wasn't there. She doesn't appear to be in much pain, however, I didn't se her at he time of the incident.
My question is with the extreme cow-hocked stance what should I be looking for in terms of compensation and/or areas that would be good to focus on for strengthening. Have you ever seen a case that extreme in dog without other issues causing it? Should I be thinking this posture is more related to the neuro issue?
Sorry, this seems like a sort of vague question, but I feel like I am working up several different issues and I a not sure where to focus my attention.
Sorry to be long winded. I really appreciate your feedback.
Thank you,
E.W.
Neuro with TPLO and Cow Hocks... where to focus?
Neuro with TPLO and Cow Hocks... where to focus?
LAURIE EDGE-HUGHES
Re: Neuro with TPLO and Cow Hocks... where to focus?
Hi E,
Okay, so it does sound like you have multiple things going on with this case.
The external rotation and ‘wobble’ of the TPLO legs in stance is common in legs that have not been adequately strengthened. Perhaps exacerbated by the fact that the conformation was a little ‘cow hocked’ before that anyways. Strengthening there will be a priority in addition to localizing & treating the neurologic issue.
It does seem that you have neurologic issues. So your best way to localize the neurologic lesion is testing, 1) to see do you have Hyper-reflexia (then your problem is higher in the spine - PS be sure to also check the neck) or hypo-reflexia, which would be more of an indicator of Lumbosacral disc disease. 2) Check for a crossed extensor. Presence of a crossed extensor reflex tells you that the problem is T-L region or neck (or in between there) and absence tells you nothing (in this case). 3) Be very specific about doing a lateral pressure on the spinous process of L7 and L6. Look for pain here.
SIJ is your red-herring. If painful / asymmetric, it could cause biomechanical disadvantages at the lumbosacral junction, but it’s not the root of the neurologic issues you describe. You’ll want to treat it, but you still need to ascertain the root.
So, all in all if you focus on the neuro (I always say the neuro trumps ortho when deciding where to focus), and in doing so you will secondarily engage in some strengthening of the rear simultaneously. When I treat neuro I say you firstly address the root of the problem - neck, T-L, L-S, and then work on function secondly. The same holds true in this case.
I hope this helps a bit. I’ll post it to the forum as well - so others might chime in too!
Cheers,
Laurie
Okay, so it does sound like you have multiple things going on with this case.
The external rotation and ‘wobble’ of the TPLO legs in stance is common in legs that have not been adequately strengthened. Perhaps exacerbated by the fact that the conformation was a little ‘cow hocked’ before that anyways. Strengthening there will be a priority in addition to localizing & treating the neurologic issue.
It does seem that you have neurologic issues. So your best way to localize the neurologic lesion is testing, 1) to see do you have Hyper-reflexia (then your problem is higher in the spine - PS be sure to also check the neck) or hypo-reflexia, which would be more of an indicator of Lumbosacral disc disease. 2) Check for a crossed extensor. Presence of a crossed extensor reflex tells you that the problem is T-L region or neck (or in between there) and absence tells you nothing (in this case). 3) Be very specific about doing a lateral pressure on the spinous process of L7 and L6. Look for pain here.
SIJ is your red-herring. If painful / asymmetric, it could cause biomechanical disadvantages at the lumbosacral junction, but it’s not the root of the neurologic issues you describe. You’ll want to treat it, but you still need to ascertain the root.
So, all in all if you focus on the neuro (I always say the neuro trumps ortho when deciding where to focus), and in doing so you will secondarily engage in some strengthening of the rear simultaneously. When I treat neuro I say you firstly address the root of the problem - neck, T-L, L-S, and then work on function secondly. The same holds true in this case.
I hope this helps a bit. I’ll post it to the forum as well - so others might chime in too!
Cheers,
Laurie
LAURIE EDGE-HUGHES