Elvis is a 13 year old MN Havanese. He has a history of various orthopedic issues. In 2014 he had a left extracapsular repair for a ruptured cruciate ligament. His meniscus was intact at that time. In April of 2017 he has a right extracapsular repair. He does not have luxating patellas. On 6/22/17 he was examined and right forelimb lameness was noted. He was diagnosed with bilateral elbow dysplasia R>L.
On Jan 31st of 2018 Elvis was evaluated at a neurologist for a sudden change in gait over the last 2-3 weeks. This is a summary of what the neurologist noted:
1/31/2018: seen for gait change. 2-3 week h/o of hesitant to walk. HLs buckle underneath
him or sits down. HLs slide and cross and uncoordinated. RHL worse. Will occasionally fish
tail when walking and intermittently back is arched. Not worse in am and doesn't warm out of it. FLs unchanged - crossing & lame RF for ~2 years d/t elbow dysplasia. No obvious pain and
normal urination and defecation. Bilateral stifle thickening, normal musculature.
Elvis was put on gabapentin 100 mg TID. He did have an MRI – but I do not have the written report.
We evaluated Elvis on 7/17/18 – here is a list of what we found on exam:
Problem List/Impairments:
1. Gr 3/4 RF lameness - adducts and crossing and knuckles intermittently
2. equivocal CP on RF
3. Dysmetric HLs (RR > LR)
4. BL thickening of stifles with crepitus
5. muscle atophy R > L
6. BL carpal hyperextension
7. BL decreased elbow extension
8. BL decreased shoulder extension (R >> L)
9. decreased tarsal extension - RH
10. decreased stifle extension - RH
11. BL decreased CF extension
12. BL increased CF flexion secondary to muscle atrophy
Here are his measurements:
Thigh Girth Right: 18.7 cm Left: 19.5 cm
JOINT MOTION MEASURED
R L
Shoulder Flexion 48.2 52.9
Shoulder Extension 136.2 150.1
Elbow Flexion 38.6 43.9
Elbow Extension 142.9 148.6
Carpus Flexion 27.3 27.2
Carpus Extension 206.6 211.5
JOINT MOTION MEASURED
R L
Hip Flexion 38.6 38.3
Hip Extension 150.3 152.5
Stifle Flexion 45 44.6
Stifle Extension 145.8 164.5
Tarsus Flexion 44.6 37.4
Tarsus Extension 158.3 165.3
Basically, his hindlegs are hyperextended, he cannot stand normally, he can only sit if he sits up like a meerkat and if we try to place him to stand properly as soon as we bend his stifles he face plants into the ground and he cannot extend his neck.
We want to know the best way to help this little guy – he still “walks” by propelling himself over the ground without really touching his front legs on the ground. I have attached a couple of You tube links for you to see.
Any input would be greatly appreciated!
https://www.youtube.com/watch?v=1iUx9wKLKmc
https://www.youtube.com/watch?v=0BrdrgPbmM8
Interesting Case - All input appreciated
Re: Interesting Case - All input appreciated
SO I realize the links to YouTube will not automatically go when you click on the link. Please copy and paste into a separate browser window and they will work perfectly. Thanks! Any input is greatly appreciated. We are having him see another neurologist but would welcome suggestions.
Re: Interesting Case - All input appreciated
Interesting indeed!
So a couple of things pop out.
1) This isn't an orthopaedic case... or rather the musculoskeletal system isn't causing the weirdness you are seeing. The orthopaedic issues are 'bonus' in my head!
2) From a neurological perspective, I have two 'guesses' based on funny little dogs I've seen in the past. a) Syringomyelia. How he 'sits' is what jumps out at me there. b) Atlanto-Axial subluxation. The face planting and rear end tippy toeing lead me to this guess.
Both of which, I believe, if mild cases, might not show up until an animal ages and the nervous system deteriorates (in regards to SM) or the muscle tone / bulk diminishes, thus allowing for more cord compression at the AA joint... or a face plant made that area, which was hanging on by a thread just come a bit looser. So, there's no manual test for the SM. But you could do the tests for the AA joint (since I know you've taken the Advanced Spine course - more than once even!!!) So test for Integrity of the Dens, for Alar Ligaments, & for the Transverse Ligament of the Dens.
At least it's somewhere next to look!
Keep us posted!!!
Laurie
So a couple of things pop out.
1) This isn't an orthopaedic case... or rather the musculoskeletal system isn't causing the weirdness you are seeing. The orthopaedic issues are 'bonus' in my head!
2) From a neurological perspective, I have two 'guesses' based on funny little dogs I've seen in the past. a) Syringomyelia. How he 'sits' is what jumps out at me there. b) Atlanto-Axial subluxation. The face planting and rear end tippy toeing lead me to this guess.
Both of which, I believe, if mild cases, might not show up until an animal ages and the nervous system deteriorates (in regards to SM) or the muscle tone / bulk diminishes, thus allowing for more cord compression at the AA joint... or a face plant made that area, which was hanging on by a thread just come a bit looser. So, there's no manual test for the SM. But you could do the tests for the AA joint (since I know you've taken the Advanced Spine course - more than once even!!!) So test for Integrity of the Dens, for Alar Ligaments, & for the Transverse Ligament of the Dens.
At least it's somewhere next to look!
Keep us posted!!!
Laurie
LAURIE EDGE-HUGHES