Hi,
I hope you can help me with a patient of mine. German Shepherd male, 3 years. Pelvis and hind limb angles are not too bad for a german shepherd dog. Sorry about the long reading!
The dog was presented to me for the first time in February 2017. At the time he had been intermittent lame on the left hind leg for a couple of weeks , worse after resting. During gait assessment the dog didn`t show any lameness, however showed a reduced mobility of his caudal lumbars/lumbosacral junction. This was confirmed under clinical examination. There was moderate pain upon palpation of L6+L7. Lumbosacral junction showed normal extension, however no hyperextension. The dog showed no muscle atrophy, all joints of left hind limb were without remarks. No obvious neurological deficits but I didn`t proceed with a full neurological examination. Xrays showed narrowed intervertebral space to L6-L7 and L7-sacrum. It was hard to get a symmetrical positioning for the hip xrays but we concluded with a mild degree of hip dysplasia. The dog was prescribed rest and nsaids for two weeks. The owner was supposed to keep in touch but didn`t.
I then saw the dog again in the end of August 2017. The dog now showed lameness in his right hind leg. He sometimes had trouble jumping into the car and had had a couple of accidents with urinal incontinence. A bit exaggerated swing phase of the right hind limb. The dog tended to place his right hind limb in median direction, under his abdomen. The lumbar spinal pain upon palpation was worse and the grade of extention to the lumbosacral junction reduced. No neurological deficits.
The dog was sent to an MRI, which showed minimal lumbosacral degenerative disc disease without evidence of spinal cord or nerve root compression, mild sclerosis of the facet joints of L4-L6 as well as a questionable coxofemoral synovitis and minimal bilateral osteophyte formation to the acetabulae. The radiologist suggests the hip changes as the main reason for the symotoms. I more believe in changes to the spinal column, although the changes are quite small and don`t cause any neurological symptoms (yet). And the combination of it all, of course.
What do you think about the cause? Should I just start up standard rehabilitation treatment or am I missing something here?
German Shepherd showing minor neurological changes
Re: German Shepherd showing minor neurological changes
Hi Hanne!
What an interesting case! So I think you are on the right track.
I'd want you to also assess the neck (especially C7) and the SIJ's, and put Degenerative Myelopathy into your list of differentials.
And once you have ruled out or ruled in those other areas, you can treat them (i.e. neck mobs, traction, and modalities to the caudal cervical spine or SIJ mobilizations, etc.) if present, or proceed as you are thinking for L-S issues.
In this scenario (i.e. if L-S), I would focus my therapies on the 'root' of the problem. So lots of back mobilizations, maybe some SIJ stuff... just because it can affect L-S quite dramatically, Traction, & tail pulls, acupuncture, laser, shockwave, if you don't have / do acupuncture then I'd use TENS or e-stim down at 2 - 5pps along the caudal lumber region bilaterally. If you don't have laser, but do have US, it will be better than nothing. Do some fascial work over the area, and you could so some massage -but it would only be minimally effective for a pinched nerve. Oh! And watch also the Dural mobilization videos and do the Sciatic Nerve dural glides.
If nothing works and the dog continues to deteriorate, then you are putting the diagnosis of Degenerative Myelopathy further up your list of differentials. And if you & the owner really want to know, then you can send away for the DM test - www.offa.org.
Best of luck!
Laurie
What an interesting case! So I think you are on the right track.
I'd want you to also assess the neck (especially C7) and the SIJ's, and put Degenerative Myelopathy into your list of differentials.
And once you have ruled out or ruled in those other areas, you can treat them (i.e. neck mobs, traction, and modalities to the caudal cervical spine or SIJ mobilizations, etc.) if present, or proceed as you are thinking for L-S issues.
In this scenario (i.e. if L-S), I would focus my therapies on the 'root' of the problem. So lots of back mobilizations, maybe some SIJ stuff... just because it can affect L-S quite dramatically, Traction, & tail pulls, acupuncture, laser, shockwave, if you don't have / do acupuncture then I'd use TENS or e-stim down at 2 - 5pps along the caudal lumber region bilaterally. If you don't have laser, but do have US, it will be better than nothing. Do some fascial work over the area, and you could so some massage -but it would only be minimally effective for a pinched nerve. Oh! And watch also the Dural mobilization videos and do the Sciatic Nerve dural glides.
If nothing works and the dog continues to deteriorate, then you are putting the diagnosis of Degenerative Myelopathy further up your list of differentials. And if you & the owner really want to know, then you can send away for the DM test - www.offa.org.
Best of luck!
Laurie
LAURIE EDGE-HUGHES