Hi!
I have a case that makes me say "Huh". I'm sure you've had your share.
Ruby is an 11-year-old 56# FS Shepherd-ish dog. She was adopted at 7 years with lameness or walking difficulty that the owner can not define better for me. Fast forward to this summer (owner say difficulties have slowly progressed) when Ruby was brought to me paraplegic in the rear legs (flaccid, but can move them when supported in a standing position and moved forward) and stiff front legs (that will pattern again if supported, but very stilted gait like she is trying to resist moving forward).
Lab work is unremarkable. DM test is a carrier. Severe muscle atrophy all over, but no obvious pain except with elbow palpation and PROM on the Left. I took sedated x-rays and found bilateral elbow OA, minimal lumbar spondylosis, hips are good, no LS spondylosis, mild bilateral stifle effusion, but minimal OA signs, and shoulders and hocks looked good - confirmed with a radiologist.
I finally got the owner to take her to a vet that does acu/chiro that I trust a lot. And I've gotten her in the UWTM a couple of times in the Canine Rehab sling system. We are just working on getting her stand in the water and slowly decreasing support. I talked with my rehab tech about doing PROM in the water in a walking gait with each limb individually, but she is having troubles with the stiff front legs getting Ruby to relax. Even with toe pinching Ruby remains stiff and resists flexing.
I've worked with the owners showing them how to do stretching of the shoulder, elbow, hips, etc., and encouraged them to do massage and warm packs before stretching. Do you have other ideas for this kid?
Thanks for your time.
CC
Strange neuro case
Re: Strange neuro case
Okay… so my first thought is NECK. When you have front leg involvement, when those front legs are stiff / stilted… I think neck.
So, of all the areas that you mention were radiographed, I see no mention of neck. I see that shoulders were looked at - any comment on neck?
So, if not mechanically neurologic (i.e. Wobblers), then what else is there? Tick-borne pathology? Past distemper (I’ve seen this…)? Protozoal?
Okay… so perhaps a neurologist can come up with other differentials. I’ve seen lots of weird stuff… but not enough to know all of the differentials.
However, if getting to the root isn’t what the owner wants… then you go with function. So, I’d still do neck traction and laser the neck (based on the fact that you have 4 limbs affected). Then, any kind of movement practice is fair game. Would the owner consider a quad cart as a way engage in active exercise on a regular basis?
Try the standing sling on land, with the estim trick under the pad of a paw to see if you can get a flexor withdrawal that way. To break tone, try shaking the limb, rotating the limb, or just flexing the toes and carpus… and go from there.
If this is cervical & mechanical… then I have tended to see rear legs come back and normalize in tone and strength before the front legs. In which case you focus on the neck even more and work the rear end to strengthen as the front end tone starts to normalize on its own.
I don’t know if this helps or not… but it’s what’s coming to mind!
Cheers,
Laurie
So, of all the areas that you mention were radiographed, I see no mention of neck. I see that shoulders were looked at - any comment on neck?
So, if not mechanically neurologic (i.e. Wobblers), then what else is there? Tick-borne pathology? Past distemper (I’ve seen this…)? Protozoal?
Okay… so perhaps a neurologist can come up with other differentials. I’ve seen lots of weird stuff… but not enough to know all of the differentials.
However, if getting to the root isn’t what the owner wants… then you go with function. So, I’d still do neck traction and laser the neck (based on the fact that you have 4 limbs affected). Then, any kind of movement practice is fair game. Would the owner consider a quad cart as a way engage in active exercise on a regular basis?
Try the standing sling on land, with the estim trick under the pad of a paw to see if you can get a flexor withdrawal that way. To break tone, try shaking the limb, rotating the limb, or just flexing the toes and carpus… and go from there.
If this is cervical & mechanical… then I have tended to see rear legs come back and normalize in tone and strength before the front legs. In which case you focus on the neck even more and work the rear end to strengthen as the front end tone starts to normalize on its own.
I don’t know if this helps or not… but it’s what’s coming to mind!
Cheers,
Laurie
LAURIE EDGE-HUGHES