Weirdness, lameness, atrophy...

[lehughes]

Hi Laurie

I hope I am not overstepping here but my own dog has become quite the puzzle for myself and several other doctors.

She is a 5 yr FS Boxer mix that injured her left hindlimb playing ball at a boarding kennel approximately 1 yr ago. She was partial weight bearing grade 2-3/5 on the left hind but extremely painful. Radiographs did not show much. She improved with rest and NSAIDs but never returned to normal. A few months later she flared again repeated radiographs and there was a small lytic lesion in the wing of her left ilium. CT = avulsion fracture associated with the sartorius or TFL. Very small - unable to surgically repair. She is still grade 1/5 lame consistently on the left and now also on the right. She also had mild narrowing of her LS. She has had spinal manipulation, She does exercises daily (cavaletti poles, sit to stands, circles, spinal stretches) but she still continues to be lame. She will lay with both limbs fully extended behind her regularly when sleeping. Her only issue is when I flex her hip and extend her stifle. Now she is developing atrophy in the region of her biceps femoris bilaterally and there is some internal rotation of both stifles when she walks. No stifle effusion, no cranial drawer or tibial thrust. Still sits with both stifles flexed.

A surgeon has looked at her - no answer other than maybe cruciates but definitely atypical, a radiologist says iliopsoas which makes no sense b/c she fully extends both hips no problem. I am thinking LS or obturator or femoral neuropathy due to bone fragment on the left compensation on the right and atrophy due to disuse but I am not willing to bet on it.

Any ideas? I can send you videos of her walking / sitting etc if you are interested and think it would help. I wish I could just bring her to Canada to see you - I am certain you would have her figured out in a second.

Thanks for any advice you can offer - she is seriously frustrating and it's sad to restrict her from the things she loves but if I walk her more than 1/8 -1/4 mile she will limp (gr 2/5) on the left.

L.

[lehughes]

Hi L,

Sorry for my tardy reply! I am just in the process of trying to get caught up with my e-mails!

So, firstly, I think you have two things going on - the strain / avulsion of Sartorius and…?
I’m thinking that because of the CT findings and pain to stretch sartorius - those two things correlate well. Treat by continuing to stretch - slow towards pain. And I’d use modalities as available at the iliac crest, as well as any manual massage or myofascial techniques.

Your part 2 could be something at the lumbosacral junction as per the atrophy of biceps femoris and the narrowing on imaging and the progression to bilateral signs and symptoms.
Differentials:
L-S disc disease
L-S stenosis (this actually fits with the limping after a certain distance. Increase blood flow = decreased canal space = pressure on nerves = more limp or signs of problems).
Degenerative Myelopathy b/c she’s a boxer, and because other issues (i.e. the sartorius injury) can seem to set off the start of DM

So treat L-S disc or stenosis with things like traction, mobilizations, acupuncture, modalities. If contemplating stenosis, then take lots of rests when walking - preferably allow her to sit and flex the spine for a while before progressing again.
Order the DM test from OFA just to cover that base.

My thoughts on the subject anyways. I know it’s hard to be objective when it’s your own dog. Hopefully these thoughts will be helpful!

Cheers,

Laurie