Border Collie and mysterious limp

[lehughes]

The other case is NOAH (3 y.o. Border Collie, 13Kgs)

Her first visit was on february. She was a great sports dog (agility, canicross and discdog).

- Medical History: On January she stopped agility because of a RHL patella subluxation. No OA signs on radiographs. Vet told them to have rest for a while and gave Noah some chondroprotectors.
- Home environment: 10 stairs to get home. Non slippery surface

She used to go for a walk and running 3 times per day but because she've lost stability owner rathers not to run with her at the moment. She used to train almost everyday (depending on owner's job). She was getting better with rehabilitation until May.

On May 10th owner said she was getting worst since 15 days ago. We rechecked Noah and recorded an slow motion video where we saw a shorter RHL step. At right iliopsoas palpation she had pain + Grade 1 RHL patella subluxation.
While waiting for the next rehab session we tell the owner to come few times a week, whenever he can to put laser on iliopsoas trying to help the recovery.

On June 27th we knew Noah had lameness on RFL few days ago ang Vet found two spikes on that paw but today she's fully recovered from that.
Owner told us that one day went with her to the mountain and suddenly Noah started to cry so hard and he had to carry her to the car because she was limping from RHL and biting this leg. We re-test everything and she's pain at right iliopsoas and PWB RHL. Owner at home does stretchings and exercises. We put ultrasound, did exercises to try to improve her propioception , PROM, manual therapy and laser. Noah is day by day more fearful because of firecrackers season here in Barcelona and owner is day by day more negative, worried and exhausted.
Few days ago he called us to let us know Noah , on sidestepping she avoids completely left to right sidestep.

We are worried that the owner is gonna give up and whenever Noah is a bit recovered , something happens and comes back worst. We are worried may be overlooking something....Can you help us, please?

A, R, & I

[lehughes]

And next is Noah,

So the strange this is biting at the leg - patella doesn’t create a pain worthy of ‘sudden biting’, nor does iliopsoas. That piece of information alone makes me think nerve… and given that he’s a border collie, I’d really look at the lumbosacral junction. A grade one patella shouldn’t cause this degree of issue either! So I think that is a secondary issue. Lumbosacral pain / pinch / DDD / Stenosis can cause a facilitation of the iliopsoas muscle (which is painful to palpation).

Has the back been x-rayed? (CT or MRI?)

I’d try treating the L-S with a presumptive Dx of lumbosacral disc disease and see what happens. I’d use mobilizations (flexion in particular), laser, acupuncture, traction, shockwave if available. Slowly I’d introduce activities that include stretching out the back while working the abdominals (i.e. front and rear feet between blocks - slowly moved further apart, while stimulating/poking at the abdominals to get them to contract at the same time.) I’d try the dog on anti-inflammatories and Gabapentin as well.

Give it a try! Best of luck!

Laurie

[David Lane]

At the risk of taking this post onto a different tangent...

I disagree that you don't (uncommonly to rarely) see biting at the leg with iliopsoas cases. The femoral nerve, which provides sensory information to the medial thigh, runs through the belly of psoas major. For cases where the muscle belly (not just the tendon) are sore, I have had owners report that the dog bites high on the leg up in the flank fold region. Treatment of the psoas issue resolves that clinical sign.

Of course, I can't prove that there isn't a concurrent IVDD issue as none of the cases I saw with this presentation progressed to MRI, but I can make the argument that psoas muscle spasm is enough to induce paresthesia of the upper limb.

If in this case, and if the biting occurred down low on the limb in regions innervated by the sciatic, then I agree with Laurie's comments. However, if the biting was high on the thigh, I am not willing to let the psoas go without blame.

David Lane DVM
ACVSMR

[lehughes]

Great observations David!
Thank you for sharing!

Laurie