Hello my esteemed colleagues. I have a frustrating case that I’d love some fresh perspective on….
Blaze, 1 yr old MN Aussie:
· Dec 2017: Fractured P2 of the 4th digit on the right pes; conservative management
· Jan 22, 2018: presented to our surgeon –
o 4th digit palpably thickened, but no pain on palpation/manipulation of the digit; dog continues to offweight the R PL/intermittent lameness – esp when descending stairs. He placed the limb for 2-3 steps, then held it up again; similar intermittent pattern when transitioning surfaces outside
o Not restricted by owner
o Per DVM: strict rest x 4 weeks; consider amputation
· Apr 5, 2018 – owner finally returned for recheck with surgeon, who consulted me on the case
o Strict rest was (mostly) enforced; but intermittent lameness persists on R PL, though slightly improved
o Short-strided on R PL/offweights in standing persists
o Suspect iliopsoas issue
o Unremarkable ortho (including 4th digit) and neuro exam otherwise
o Recommend PT
o PT: SIJ dysfunction – R cranial pelvic rotation; corrected this over the next few visits; focused on soft tissue (ST lig primarily), SIJ, sacrum, mm – Sartorius (did some dry needling here) and hams/epaxials
As of June (haven’t seen him since; but followed up with owner 2 weeks ago) the dog was fully ambulatory, with no lameness/ SIJ resolved– but we’re still seeing that intermittent NWB going down stairs and with transitions in the yard – ie – grass to stone, etc.
Thoughts here?
Thanks guys!
-C
Puzzling Case
Re: Puzzling Case
So, I’ll weigh in with thoughts.
I’d look more at soft tissue restrictions, given that he presumably had the SIJ dysfunction for so long, and while he was growing. So, I'd try long slow myofascial holds to work on iliopsoas, abdominal fascia ventrally, forelimb and rearlimb stretches ipliateral and contralaterals, and side bending away from the affected side, and/or lying over a bolster.
Evaluate Femoral nerve / dural glide.
Doesn’t quite sound right for when the lameness comes on, but throw a finger on the sesamoid bones.
Double check the SIJ and L7.
Look at gluteal muscle & abdominal timing with 3 leg standing / leg slide
And in the back of my head, I am reminded of a case of a mini poodle who was only lame in tall grass. I found and fixed pelvis, but didn’t fix it completely. She also had pectineus & deep gluteal pain and pain on compression of the hip. I sent her back for x-rays. She ended up having Legg Perthes. So I throw that out there to keep in the back of your mind as well.
Test with hip joint compressions.
Best of luck!
Cheers,
Laurie
I’d look more at soft tissue restrictions, given that he presumably had the SIJ dysfunction for so long, and while he was growing. So, I'd try long slow myofascial holds to work on iliopsoas, abdominal fascia ventrally, forelimb and rearlimb stretches ipliateral and contralaterals, and side bending away from the affected side, and/or lying over a bolster.
Evaluate Femoral nerve / dural glide.
Doesn’t quite sound right for when the lameness comes on, but throw a finger on the sesamoid bones.
Double check the SIJ and L7.
Look at gluteal muscle & abdominal timing with 3 leg standing / leg slide
And in the back of my head, I am reminded of a case of a mini poodle who was only lame in tall grass. I found and fixed pelvis, but didn’t fix it completely. She also had pectineus & deep gluteal pain and pain on compression of the hip. I sent her back for x-rays. She ended up having Legg Perthes. So I throw that out there to keep in the back of your mind as well.
Test with hip joint compressions.
Best of luck!
Cheers,
Laurie
LAURIE EDGE-HUGHES
Re: Puzzling Case
Shoot I can actually think of a second case with almost the same presentation that was LCP. So now I say, double check the hip!
Laurie
Laurie
LAURIE EDGE-HUGHES