Chronic Lameness Research Articles

Caudal proximal tibial deformity and cranial cruciate ligament rupture in small-breed dogs.

Eight dogs presented with chronic hindlimb lameness associated with cranial cruciate ligament rupture. Seven were small terriers. A caudal deformity of the proximal tibial shaft, originating at the proximal tibial physis, and an excessive caudal slope of the tibial plateau were present bilaterally in all dogs. The deformity was thought to be responsible for the cranial cruciate ligament failure and poor response to conservative management. Tibial plateau angles were in excess of 26 degrees in all dogs. The lameness was bilateral in three dogs. There was complete cranial cruciate ligament rupture in seven stifles and partial rupture in four. There were no meniscal injuries. Surgical correction resulted in a significant improvement (P<0.0001) in all dogs, with a mean follow-up of 12 months (range three to 24 months). There were no complications.

Orthopaedics

Practice records from November 1994 to April 2000 were searched for cats with a diagnosis of osteoarthritis (OA). Signalment, historical features and findings, treatment and response to treatment were recorded with the aim of planning prospective studies. Thirty‐one cases were found. The average age at presentation was 13·8 years (range, nine to 17 years); 67 per cent were female and 33 per cent male. Clinical signs noted included chronic changes of stiff/abnormal gait (12), difficulty/reluctance in jumping (20) and reluctance to move (five). Eleven cases had acute or chronic lameness. Seven of the records indicated that the cat had been overweight. Physical findings included thickened joints (23), pain on joint manipulation (seven) and crepitus (four).Twenty cases had been radiographed. Findings included osteophytes (14), sclerosis (10), periosteal new bone (four) and remodelling (three). Routine blood tests were performed in 15 cats and showed single abnormalities in five cases. Concurrent diseases diagnosed included hyperthyroidism, dental diseases and chronic renal failure. The final diagnosis had been based on the history, examination, diagnostic tests and response to treatment. The joints thought to have been affected by OA were as follows: bilateral elbows (12), bilateral stifles (four), bilateral elbows and stifles (four), unilateral elbow (three), bilateral hips (two), other combinations of joints (six). Seventeen cats had both meloxicam treatment and a follow‐up examination (they may have had concurrent treatments). The clinical notes recorded whether the owners considered there to have been an improvement: three showed marked improvement, 11 showed moderate improvement, one showed no improvement, one had an inconclusive response, and side effects stopped treatment in one. One cat showed a marked improvement after treatment with courses of pentosan polysulphate.

26. Homeopathic Rhus tox in the treatment of thirty cases of chronic canine lameness

26. Homeopathic Rhus tox in the treatment of thirty cases of chronic canine lameness

Use of nuclear medicine imaging: Scintigraphy in diagnosis of equine orthopedic disease

This study describes techniques, indications and findings of nuclear medicine imaging ? scintigraphy of 42 horses with acute and chronic lameness of unknown origin. Most horses showed increased uptake of 99mTc-methylene diphosphonate in the tarsal joint (linked to the osteoarthritis and distal tarsal synovitis), the distal sesamoid bones (linked to the navicular disease), proximal attaches of the musculus interoseus medius on the palmar/plantar region of the metacarpus or metatarsus (linked to the insertations desmopathie) and in the dorsal processes of thoracic vertebrae (linked to the kissing spine syndrome). The interpretation of scintigraphy appeared to be a more reliable and sensitive diagnostic method than radiography in diagnosing these equine orthopedic disease.

Proximal interphalangeal arthrodesis in 22 horses.

The purpose of this study was to evaluate a new method of internal fixation technique for pastern arthrodesis. Pastern arthrodeses are performed commonly in horses with chronic osteoarthritis of the pastern joint or, in cases of acute traumatic injury to the pastern, in which the weightbearing bony column must be restored. Chronic osteoarthritis of the pastern is a frequent cause of lameness in the equine athlete and is evidenced by chronic lameness localised to the pastern joint, and supported radiographically by periosteal proliferation and loss of joint space. Nonsurgical and surgical treatments have both been described in the literature. Complications following pastern arthrodesis have been reported on several occasions and appear to focus on excessive periarticular exostoses and increased time in a cast due to prolonged time to bony fusion. The hospital records of horses presenting for pastern arthrodesis to the Rood and Riddle Equine Hospital in Lexington, Kentucky, were reviewed and 22 met criteria for inclusion in the study. Horses with chronic osteoarthritis of the proximal interphalangeal joint or horses with an acute traumatic injury to the pastern undergoing pastern arthrodesis with one of the following techniques were included in the study. Horses with severe comminution of the middle phalanx were excluded. Three 5.5 mm cortical bone screws placed in lag fashion alone or in combination with a 4 or 3 hole dynamic compression plate affixed with 4.5 mm cortical bone screws were compared. A lower limb fibreglass cast was applied in all cases. Period in cast, time to return to intended use, complications encountered and outcome were evaluated. Seven of the 8 hindlimbs treated with the combination technique became sound. Three out of 6 of the front limbs treated with the combination technique became sound. Four of the 5 horses with hindlimbs, and one of the 2 with front limbs, treated with screws only returned to their intended use. The type of internal fixation did not appear to influence the overall number of horses returning to the intended level of performance. The period spent in cast and the time to return to soundness were decreased in horses operated on using the combination technique. We concluded that, in the immediate postoperative period, the combination of the parallel screw technique with a dorsally-applied dynamic compression plate provides the most stable and secure fixation, minimising motion, expediting bone remodelling and therefore favouring rapid fusion of that joint.

Radial carpal bone fracture in dogs.

In a retrospective study, 11 radial carpal bone (RCB) fractures in nine dogs were studied. Chronic lameness was reported in all dogs. Reduced range of motion and soft-tissue swelling of the carpal joints were clinical signs seen most frequently. Three common fracture patterns were identified: oblique fracture with a large medial fragment, sagittal fracture with a small medial fragment, and comminuted fracture. Radial carpal bone sclerosis and carpal osteoarthritis were identified in all dogs. Pancarpal arthrodesis was used to manage 55% of the RCB fractures in this report. Although RCB fracture is not associated with obvious trauma, the fracture mechanism is unknown.

Fragmented palmar metacarpophalangeal sesamoids in dogs: a long-term evaluation

SummaryLong-term clinical and radiographicresponse to surgical and conservativemanagement of 22 dogs with fragmentedsesamoids was evaluated. Mean follow-up was 3.6 years (range = 3 monthsto 11.0 years).Initial (retrospective) and follow-up(prospective) radiographs of the affectedpalmar sesamoids and associatedmetacarpophalangeal joints were evaluatedusing a graded scoring system. A lameness evaluation and physicalexamination were performed at followupin a blinded manner. In addition,owners were asked to complete a questionnaireregarding their pet’s thoraciclimb lameness.There was not any difference betweengroups (sesamoidectomy, conservativemanagement, incidental finding)in age at onset, duration of lamenessprior to therapy, body weight at treatment, time to follow-up, number ofaffected joints, nor owner perceptionsof whether they thought the lamenessimproved, resolved, or recurred, andwhether or not they were pleased withthe outcome.Sesamoid fragmentation treated bysesamoidectomy resulted in significantlygreater progression of radiographicchanges that were consistentwith degenerative joint disease.Chronic lameness resolved or improvedto the point of owner satisfactionwith conservative therapy in most cases. Continued lameness, or recurrent,although improved lameness associatedwith heavy activity, occurred followingsurgical extirpation of the affectedsesamoids in many cases. Given thesefindings, a more conservative approachto the treatment of chronic lamenessassociated with sesamoid fragmentationmay be warranted.Long-term clinical and radiographic response to surgical and conservative management of 22 dogs with fragmented sesamoids was evaluated. Mean follow-up was 3.6 years. Sesamoid fragmentation treated by sesamoidectomy resulted in significantly greater progression of radiographic changes that were consistent with degenerative joint disease. Chronic lameness resolved or improved to the point of owner satisfaction with conservative therapy in most cases. Continued or recurrent lameness was common following sesamoidectomy. Conservative therapy should be attempted prior to sesamoidectomy for dogs with chronic lameness associated with palmar metacarpophalangeal sesamoid fragmentation.

Synovial osteochondromatosis in the elbow joint of a Bengal tiger (Panthera tigris tigris)

SummaryA 10-year-old Bengal tiger with a history of chronic thoracic limb lameness was presented for clinical evaluation. Radiographs of the elbows revealed extensive osteophyte formation in both joints and three ovoid mineralised densities in the right joint. Joint fluid analysis was consistent with a degenerative joint process. The joints were partially explored arthroscopically. A medial arthrotomy of the right joint allowed collection of synovial membrane samples which, when examined histopathologically, revealed the presence of cartilaginous nodules with central endochondral ossification within the synovial membrane. A diagnosis of synovial osteochondromatosis was made. This case is compared to other cases described in veterinary and human medical literature.Clinical, radiological, and histopathological description of synovial osteochondromatosis in the elbow joint of a Bengal tiger.

Diagnostic findings and prognosis following arthroscopic treatment of subtle osteochondral lesions in the shoulder joint of horses: 15 cases (1996-1999).

To determine clinical, scintigraphic, radiographic, and arthroscopic findings and results of treatment in horses with lameness attributable to subtle osteochondral lesions of the shoulder joint. Retrospective study. 15 horses. Medical records were reviewed, and results of physical examination, scintigraphy, radiography, arthroscopy, and treatment were recorded. Severity of lameness ranged from grade 1 to 4. Response to shoulder flexion or extension was variable. Twelve horses had a narrow upright foot. Intra-articular anesthesia of the shoulder joint localized the cause of the lameness to the shoulder joint in 9 of 10 horses. Scintigraphic abnormalities were detected in 4 of 6 horses. Radiographic lesions were subtle and included glenoid sclerosis, focal glenoid lysis, small glenoid cysts, and alterations in the humeral head contour. Arthroscopic evaluation confirmed clefts in the glenoid cartilage, glenoid cysts, a humeral head cyst, fibrillation of the humeral head cartilage, cartilage fragmentation, or a nondisplaced fracture of the humeral head. After treatment, 12 horses returned to their previous level of performance, 1 was sound for light riding, 1 remained lame, and 1 was euthanatized because of chronic lameness. Results suggest that a combination of physical examination, scintigraphy, and radiography is necessary to diagnose subtle osteochondral lesions of the shoulder joint in horses. Arthroscopy can be used to confirm the diagnosis and treat cartilage and subchondral bone lesions. Young and middle-aged horses with subtle osteochondral lesions of the shoulder joints have a good prognosis for return to performance following arthroscopic treatment.

Radial shock wave therapy® for chronic lameness

Radial shock wave therapy® for chronic lameness

Removal of large fragments of the extensor process of the distal phalanx via arthrotomy in horses: 14 cases (1992-1998).

To evaluate the outcome of horses with large fragments of the extensor process of the distal phalanx that were removed by use of arthrotomy. Retrospective study. 14 horses with large fragments of the extensor process of the distal phalanx. Medical records for horses with large fragments of the extensor process that were removed by use of arthrotomy were reviewed. Data retrieved from medical records included signalment, use of horse, affected limb, lameness history, lameness examination findings, radiographic findings, surgical technique, and outcome. Follow-up evaluation was obtained by telephone interview. Most affected horses were < 5 years old and had a history of chronic lameness. Lameness grade ranged from 1/5 to 4/5. Fragments involved 20 to 45% of the dorsopalmar articular surface of the distal phalanx. Eight of 14 horses had a successful outcome. Outcome was not associated with age, duration or severity of lameness, or fragment size. Despite involvement of a large portion of the articular surface and use of arthrotomy, joint instability and permanent soft tissue injury was not a problem in most horses. Outcome may be improved by selection of horses with lameness of < 2 years' duration and careful management after surgery. A fair prognosis may be anticipated for removal of large fragments of the extensor process via arthrotomy.

Mineralization of the supraspinatus tendon in dogs: a long-term follow-up.

Mineralization of the supraspinatus tendon was diagnosed in 24 large-breed dogs as a probable cause for a chronic unilateral forelimb lameness. Owners of 12 dogs responded to a questionnaire survey evaluating the treatment that their dog had received which consisted of either surgical removal of the mineralization after failure of conservative treatment (operated group; n=9) or rest and nonsteroidal anti-inflammatory drugs (NSAIDs) (nonoperated group; n=3). In eight out of the 12 dogs, the mineralization was also present in the asymptomatic forelimb. Based on owner evaluation, the degree of lameness had decreased distinctly in both groups. Six dogs (four operated and two nonoperated) were reevaluated at Michigan State University Veterinary Teaching Hospital (MSU-VTH) and were without lameness except for one dog in the operated group. The mineralizations had reformed in all dogs in the operated group after a mean follow-up time of 5.1 years.

Repair of Chronic Complete Traumatic Rupture of the Common Calcaneal Tendon in a Dog, Using a Fascia Lata Graft

SummaryA 3-month-old male Cocker Spaniel was presented with the complaint of chronic right hind leg lameness. The owner described superficial trauma at the area of the hock, which was noticed immediately after delivery. History, habitus, physical examination, and radiography suggested rupture of the common calcaneal tendon. This report describes the successful repair of complete rupture of the common calcaneal tendon, with loss of tendon length, using a fascia lata free graft.The following case report describes the successful repair of a chronic complete traumatic rupture of all components of the Achilles tendon with loss of tendon length, in a 3-month-old puppy, using a tensor fascia lata free graft. Due to the young age of the animal no internal fixation was used to protect the graft, and external coaptation was used instead. Achilles tendon rupture is a relatively common injury in humans and many methods of repair are reported for acute and chronic ruptures. The medical and veterinary literature is reviewed with regard to the pathogenesis and treatment of Achilles tendon rupture.

Lameness associated with the bicipital bursa in an Arab stallion

Severe, chronic lameness in the left forelimb of a five-year-old Arab stallion was localised to the bicipital bursa by local anaesthesia and gamma scintigraphy. Radiographic and ultrasonographic examinations of the...

Bacterial septic arthritis in 19 dogs.

To provide information on the clinical features, diagnosis and treatment of bacterial septic arthritis in dogs. A retrospective study examining case records of all dogs diagnosed with bacterial septic arthritis at Murdoch University Veterinary Hospital between 1988 and 1997. Nineteen dogs were diagnosed with bacterial septic arthritis, which most commonly occurred after surgery involving the stifle joint. Haematogenous infection occurred in only five dogs. Diagnosis was based on clinical signs, joint fluid analysis, radiography, microbiology and/or response to treatment. Chronic lameness was the most common problem at presentation. Analysis of joint fluid invariably revealed large number of nucleated cells, which consisted primarily of neutrophils. In all but one case the neutrophils were nondegenerate. Culture of joint fluid was frequently successful. Staphylococcus spp were the most common bacteria isolated. Treatment involved antimicrobial drugs only in five dogs. Other dogs received antimicrobial drugs in combination with surgical procedures such as joint lavage and removal of nonabsorbable suture material (eight), arthrodesis (two) or amputation (one). Two dogs were euthanased. Most dogs responded well to treatment and were free of signs of septic arthritis at follow-up. Bacterial septic arthritis may often be mild and manifest as chronic lameness. Analysis of joint fluid will detect an inflammatory arthropathy but the presence of toxic neutrophils should not be relied on as an indicator of sepsis. Culture of infected joint fluid is likely to be successful if antimicrobials are not given prior to collection and if the sample is inoculated into enrichment broth. Treatment should involve antimicrobial drugs, open-joint lavage and removal of joint prostheses if the infection is associated with previous surgery.

Bone Plate Removal in Dogs and Cats

SummaryThe medical records and radiographs of 255 consecutive bone plate applications were reviewed. Thirteen percent of the bone plates were removed. Removal of bone plates was most often performed for carpal, tibial, femoral and humeral constructs. Only 9.4% of plates were applied to the tibia and the tarsus, but 27% of plate removals were performed for these skeletal regions.The most common reason for plate removal was construct instability. Factors often associated with unstable constructs included multiple limb injuries, fracture comminution, empty screw holes, engagement of an inadequate number of cortices proximal or distal to the fracture and failure to use cancellous bone autograft. Other reasons for plate removal included infection, soft tissue irritation, and chronic lameness.A series of 255 consecutive bone plate applications were reviewed. Thirteen percent of bone plates were removed. Construct instability was the most common reason for plate removal. Bone plates were also removed because of soft tissue irritation, infection, and chronic lameness. Plate removal was most often performed for tibial and tarsal constructs.

Shoulder joint luxation in large animals: 14 cases (1976-1997)

Objective To determine clinical and radiographic findings in and treatment and outcome of large animals with shoulder joint luxations. Design Retrospective study. Animals 5 horses, 3 goats, 1 calf, 1 sheep, 1 Himalayan tahr, 1 pot-bellied pig, 1 reindeer, and 1 white-tailed deer. Procedure Medical records and radiographs were reviewed to determine signalment, history, physical examination findings, type of luxation, treatment, and outcome. Owners and referring veterinarians were contacted for follow-up information. Results Goats, sexually intact males, and animals &lt; 1 year old were overrepresented, compared with the general hospital population during the study period. Closed reduction was attempted in 3 animals and was successful in 1. Open reduction and internal stabilization was attempted in 4 animals, including 1 in which closed reduction was unsuccessful. Long-term stabilization of the joint was achieved in 3 animals, but overall results were poor because of osteoarthritis and chronic lameness. Three animals were not treated, and 5 were euthanatized because of a poor prognosis. Clinical Implications Large animals with shoulder joint luxation and concurrent fractures had a poorer prognosis than did those with shoulder joint luxation alone. (J Am Vet Med Assoc 1998;213:1608–1611)

Bone scintigraphy in the diagnosis of sacroiliac injury in twelve horses.

Nuclear bone scintigraphy was used to diagnose sacroiliac injury in 12 horses presented for nonspecific rear limb lameness. The most common history was decreased performance and/or a mild chronic rear limb lameness which could not be localised by routine lameness examination. The scintigraphic patterns of the 12 affected horses were compared to 5 normal horses and 10 horses with lameness not related to the pelvic region. Subjective and quantitative evaluation of the bone scans clearly separated the 12 affected horses from the 5 normal horses and the 10 horses with lameness from causes other than the sacroiliac joint disease. The 12 affected horses had a scintigraphic pattern of moderate to marked increased uptake of the radiopharmaceutical within the sacroiliac joint region on the side of lameness. In contrast, the 5 normal horses and 10 horses scanned for other causes of lameness, had a symmetric, or only slightly asymmetric pattern of radioisotope uptake. Although nonspecific for the type of injury, nuclear bone scintigraphy is considered sensitive for the detection of sacroiliac injuries in horses.

Decision making in the diagnosis and management of bone spavin in horses

BONE spavin is one of the more common causes of chronic hindlimb lameness in mature horses. Achieving a definitive diagnosis and identifying the best method of treatment are perceived as...

Diagnosis of shoulder instability in dogs and cats: a retrospective study.

The glenohumeral joint is a remarkable articulation providing the greatest range of motion of any joint in the body. Glenohumeral stability results from several mechanisms, including those that do not require expenditure of energy by muscle ("passive mechanisms") and those that do ("active mechanisms"). Glenohumeral instability has been recognized in 47 shoulders of 45 dogs and one cat. Cases are presented because of chronic foreleg lameness. Shoulder joint pain is obviated by the orthopedic examination. Only 57% of the involved shoulders presented with degenerative joint disease. Signs of instability are recognized under anesthesia using a craniocaudal or mediolateral drawer sign or both. This report describes the radiographic and arthroscopic findings of shoulder instability. Arthroscopy of the shoulder joint allows identification of all intra-articular pathologies. Shoulder instability, not fully recognized in the past, appears to be the most common cause of shoulder lameness in the dog.