gastrocnemius avulsion

[jenrehab]

Hi Everyone: Murphy is a 10 yr old black lab who became LHL lame 5 months ago. I saw the dog last week and found that the dog was very painful over the lateral fabella. Stifle was stable. I took rads and found the lateral fabella to be mottled and reactive. Sent rads to radiologists who believes this to be a lateral gastrocnemius origin avulsion. This makes sense to me and I'll have to have the dog back to really palpate the entire lateral gastrocnemius to confirm.
But in the meanwhile, I'd like to prepare for rehab mgmt of this condition.
I've never managed a gastrocnemius avulsion before and given the chronicity of this issue, I am sure that surgery is no longer a viable option.
Thoughts?
PS: dog also has bilat hip dysplasia/OA and mild L7-S1 stenosis - but seems to be coping with these issues at this time.
Thanks
Jennifer Stelfox, DVM, CCRT

[lehughes]

Hey Jennifer,

My first reaction was "Right on! That's cool!" If possible, I'd love if you'd post a picture of the radiograph!!

Okay, then next, for rehab, don't overcomplicate it.

Goals:
Pain Management (gastrocs region AND hips AND L7/S1)
Limb use followed by Strengthening
Manage secondary issues / compensations (spine/pelvis, soft tissue tightness in iliopsoas/sartorius from offloading & you may need to retrain end range extension at the stifle)
Educating the owner regarding modified activity (i.e. shorter leash walks)

Any issues affecting the tarsus? Any drop of the hock that might necessitate a brace?

It's a 10 year old Lab... you can totally make him feel better and move better with just some simple stuff. I think some laser, some strengthening of the rear leg(s), some mobilizations, massage, myofascial work, and some owner education, and you'll find that you're a miracle worker in short order!!

I hope this helps!

Cheers,

Laurie

[jenrehab]

Hi Laurie
That is a great idea of managing the soft tissue compensation issues of the iliopsoas and the sartorius. I am attaching the xrays.
As for strengthening the lateral gastrocnemius muscle, I can think of: putting the dog's front legs up on a fairly elevated surface and having the dog reach forward to get a cookie to really make him activate the gastrocnemius and extend the tarsus - this would also work on stifle extension too.

[jenrehab]

Oops, pressed send a little too fast.
Other strengthening exercises could include: 1) dog putting front legs up on owner's chest and walking forward should the hips allow this (might be too hard given his age and the hip OA). 2) backwards walking.
Do you have any other strengthening exercises you would recommend?
Here are the xrays. Let me know what you think and thanks so much for your advice.
Jennifer

[lehughes]

Hey Jennifer,

Yep, the exercises you've put forth would be good.
I'd also include slow sit to stands, and/or going into a sit... but before he get's there ask for a stand.
You're right, I think the front feet up on the owner might be too much for OA hips.

Thanks for posting the radiographs!

Laurie