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I have a national team hopeful 3yo BC with bilateral tenosynovitis (mild on the left, mild to moderate on the right based on radiographic and ultrasound imaging). Owner picked up on a transient limp for 3-4 strides when the patient first exits the crate after agility practice. No reason to think MSI, but cannot rule out without getting in there with a scope. Certainly no instability detected under sedation, and not the typical ultrasound results that point me in that direction. Patient is scheduled to undergo PRP IA and concurrent ESWT/laser plus rehab.

Question: What would be your timeline for escalating activity on a patient with no demonstrable macroscopic connective tissue injury, and is asymptomatic unless competing in agility or a equally demanding activity? Specifically, how would your protocol vary relative to that of someone with a known grade 2 connective tissue injury?

Sincerely,

DL

Hmmm…

So, I’d treat it like an MSI. I’d give exercises (cookies between the chest with rear legs elevated), stretches (extension), and shoulder ‘wobbles’ (med-lat glides) as home program. Also 3-leg balancing variations.

Okay, now for your questions:

Escalating activity. I’d add a component / new task every week if it’s challenging. And reintroduce simpler tasks every 3 - 4 days.
So it’s hard to say for sure what I’d do because I’d need to know the current activity level. How much is the owner doing with the dog now? Is this when the 3-4 strides of limp occur - or was that in the past?
If you are progressing simple tasks, then I give the owner instructions on progressing only if nothing worsens. If I ask them to progress with something more challenging, then I’d like to ‘feel’ the dog before saying they can progress again (or if they have to dial it back.)

Okay. So, really it depends on the current training level and testing what flares and what can be done successfully. I’d likely first set out with similar instructions in these two groups to begin with. (i.e. try 2 easy jumps, and a tunnel. or 2 jumps and an A-frame.) I don’t want tight wrap arounds for a while in the Grade 2 dog, and I’d also wait on trying weaves as well. Hmmm… so with the bicipital tenosynovitis. Hmmm. I’m thinking as I type. Really, it would be quite similar. I tried to think of why I’d feel safer that I’d not flare anything up - but I don’t! So, I’m changing my answer to ‘same’. Because those bicipital tenosynovitises can be a real bugger to treat as well.

So, what are your thoughts?

L