dog with possible severe SIJ dysfunction

[k9rehab700]

“Lolita” Greenstein is an 8 year 2 month old canine mix that weighs 60 pounds. She presented first to the surgical service at Blue Pearl Veterinary Partners (BPVP) (referral/specialty hospital) on Feb 5, 2016 for evaluation of a chronic intermittent left HL lameness that began Dec. 2014. She had been placed on Rimadyl and Tramadol by her veterinarian “as needed” and some improvement was initially noted with meds. Radiographs at her veterinarian revealed no abnormalities. She is also on Prozac.

The ortho exam at Blue Pearl: ambulatory x 4 with moderate weight bearing lameness of the left pelvic limb. No appreciable bone or joint crepitus, swelling or instability. No pain on spinal palpation. Mild to moderate muscle atrophy of the left pelvic limb. Radiographs of LH limb, pelvis and spine were unremarkable. LH muscle atrophy of unknown cause, possibly neurogenic and recommended MRI. Owner declined MRI. Noted that Lolita is very reactive to palpation of feet but that under sedation no obvious instability or crepitus noted. Blue Pearl added in Gabapentin at 200mg po BID (was on the Rimadyl and Tramadol at that time)

March 7, 2016: owner conversation with Blue Pearl surgeon saying that she was giving the Gabapentin, 100mg Rimadyl once daily and 50mg Tramadol once daily and was keeping her comfortable with occasional manifestations of pain. BPVP recommended gradually tapering off meds.

April 26, 2016: Lolita presented to Canine Rehab of NY. She was essentially NWB lame on the left hindlimb with very significant muscle atrophy. She was ambulatory with no discernible orthopedic problems. She exhibited pain when getting up from lying down. Discussed concern that Lolita exhibiting neurogenic atrophy with significant pain and on initial exam that my concern is SIJ dysfunction. Took several videos of Lolita walking.

Force plate measurements that day: Thigh Circumference
LF RF RH: 39.7cm
32 27 LH: 34.6cm

LH RH
00 41

April 26, 2016
Lolita came in and owner said that she is much more painful. She had tapered all meds except the Gabapentin (which is at a 7mg/kg dose).
Lolita will walk on the LH limb (very lame) but is non-weight bearing at a stance. She is definitely painful but is also dramatic which makes assessment a little difficult. However the following findings were repeatable:
painful on palpation of piriformis on the left
painful on palpation of pectineus left and right but more on the left
painful on palpation of the left dorsosacral ligament
severe left hamstring atrophy
yelps when standing up or laying down
pelvis appears and palpates as a cranial displacement on the left

initiated some “generic” mobilizations for the SIJ and started on the non painful side. Difficult to asses how painful the mobs are and I was only attempting Grade 1-2 mobilizations. Scripted out Acetominophen 300mg with codeine 30mg per tablet at 1 tablet twice daily.

https://youtu.be/J222dG_BkkQ

IMG_5232 copy.JPG (137.41 KiB) Viewed 3192 times

picture of her LH atrophy

Advice please on if this sounds like SIJ dysfunction or other rule outs? Are treatment options different because it is SO chronic? Thank you!!

[lehughes]

Hey there,

So I'll cross my fingers for you that a severe SIJ dysfunction could do this...
Alternately,

I'll throw a list of differentials to think of / test:
Nerve sheath tumour
Sciatic nerve compression / traction (check L7 & SIJ)
Torn muscle? Saw a horse once with a full tear of TFL - it couldn't abduct the leg and it crossed under him like this dog.
Weird, but also palpate the symphysis pubis... I don't know for what, but just thinking of how weird the dog walks - see if there is tenderness or abnormalities
Try doing a 'hamstring stretch' (but look at motion on left vs right) and take note of end feel. If less on left, then have someone do a tail pull as you repeat and see if you gain more range this way (which would indicate a pinched nerve root - likely L7).

That's where I'd start anyways. Feel free to give me another shout as you learn & assess a few more things!

Good luck!

Laurie