Re: Skipping Lameness in a 3 year old Agility Sheltie

[Guest guest]

Oops,Not sure how I managed to link Bear's video - sorry Christie!Here is the correct link:http://www.youtube.com/watch?v=8CxW0LzJCMkThanks,TaraTo: VetRehab From: tararedwards@...Date: Tue, 28 Feb 2012 03:02:54 +0000Subject: Skipping Lameness in a 3 year old Agility Sheltie

Hi,

Anyone's thoughts on this case would be greatly appreciated. The dog is a 3 year old Sheltie that competes in Agility. A change in gait was noticed by the owner in mid-December. At the time, the one-step skip on the right hind was only noted during agility training when she was going at faster speeds. She has not demonstrated this skip at any other time in the house, on walks, or when going high speed in the backyard. I examined the dog last month and no lameness was noted on gait analysis. She is in very good shape with BCS 2.75/5. There was inconsistent discomfort with lower back palpation and tail elevation. She consistently had restrictions with full right hip extension. There was very mild discomfort with palpation of her iliopsoas and was often more reactive when laying in lateral for palpation. Stifles are good, patella is good, SDF tendon is good. Hip radiographs are normal. No other abnormalities were noted other than the iliopsoas - and again, it was really mild. We elected to pursue this and an ultrasound was performed and both iliopsoas muscles at their insertions imaged normally. The dog has been significantly restricted in any training and is only going for light walks. Owners are going very light ROM with only hip extension (no internal rotation or abduction) and icing over the last 2 weeks until I could see them again. Owner just sent me video and the dog is no more consistently skipping at even a walk.

Any thoughts would be greatly appreciated,

Tara , DVM, CCRT

[Guest guest]

Tara,

Thanks for posting the video, it provides so much information! Your patient's

gait at the trot is mostly and amble type gait, (pelvic limb move forward as the

thoracic limb moves forward, pelvic limb contacts ground slightly before

thoracic), there are times that the gait is almost a pace, similar to amble but

in the later feet strike ground simultaneously. Occasionally, especially after

the intermittent episodes of abnormal movement in the right pelvic limb, the

gait becomes the more common 4 beat trot. If the standard trot was your

patient's original gait then the amble maybe pathologic. I especially recognize

a change in this gait with pain and/or contracture of the iliopsoas. The amble

stretches this and the other ventral paraspinals less. Did you ultrasound the

m.psoas major in the lumbar area or just the are of iliopsoas insertion?

Regarding the intermittent abnormal movement I would suspect intermittent

dynamic medial patellar luxation. It could be recognized more frequently now

due to changes in cranial muscles of the thigh. In addition to close

examination of the iliopsoas, especially the m. psoas major in the lumbar area,

I would evaluate the m. sartorius, m. tensor fascia latae and muscle rectus

femoris.

Rick Wall, DVM

[Guest guest]

Hi Rick,

Thanks for your insight, I always enjoy your analysis of gait. So, how do I dx

a dynamic patellar luxation and why has the lameness gotten worse with a huge

reduction in activity? Playing the chicken/egg scenario....do you think the MPL

is causing biomechanical changes and thus possible iliopsoas sensitivity or the

mild iliopsoas sensitivity is causing biomechanical changes leading to possible

increased frequency of luxation? The ultrasonographer only checked insertion

points. I am waiting to hear what her chiropractor has found, according to the

owner there has been " pelvic issues " .

Tara

> Tara,

>

> Thanks for posting the video, it provides so much information! Your patient's

gait at the trot is mostly and amble type gait, (pelvic limb move forward as the

thoracic limb moves forward, pelvic limb contacts ground slightly before

thoracic), there are times that the gait is almost a pace, similar to amble but

in the later feet strike ground simultaneously. Occasionally, especially after

the intermittent episodes of abnormal movement in the right pelvic limb, the

gait becomes the more common 4 beat trot. If the standard trot was your

patient's original gait then the amble maybe pathologic. I especially recognize

a change in this gait with pain and/or contracture of the iliopsoas. The amble

stretches this and the other ventral paraspinals less. Did you ultrasound the

m.psoas major in the lumbar area or just the are of iliopsoas insertion?

>

> Regarding the intermittent abnormal movement I would suspect intermittent

dynamic medial patellar luxation. It could be recognized more frequently now

due to changes in cranial muscles of the thigh. In addition to close

examination of the iliopsoas, especially the m. psoas major in the lumbar area,

I would evaluate the m. sartorius, m. tensor fascia latae and muscle rectus

femoris.

>

> Rick Wall, DVM

>

>

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Tara,

So consider these some random thoughts strictly based on video, clinical history

and findings. I maybe totally wrong in my assessment but for discussion

purposes: I would suspect that your agility patient injured the iliopsoas first

and then acquired the dynamic MPL. Many shelties have pelvic limb varus and

internal tibial rotation predisposing to dynamic MPL. With the iliopsoas injury

a degree of coxofemoral joint dysfunction would be expected, limited extension,

as you mention. This then could effect the cranial muscles of the thigh that

assist the iliopsoas in flexion. I see much less problem with extensors of the

hip. So 1) injury to iliopsoas 2) coxofemoral dysfunction 3) muscle dysfunction

of cranial thigh muscles 4) contracture of iliopsoas and cranial thigh muscles,

especially m. sartorius 5) dynamic MPL is a consideration, especially if

conformation fits 5) although rest is often indicated in soft tissue injury I

would consider that the lack of activity and light ROM exercise have not

addressed the muscle contracture.

I always seem to upset others when I talk about sedating but you need a relaxed

patient to evaluate for the possibility of dynamic MPL. In a sheltie I would

use 0.025-0.05mg/kg acepromazine SQ and wait about 30 minutes. This does

absolutely nothing to suppress a pain response but can enable relaxation and in

some patient that are anxious when performing lameness workup it will relax them

and make the lameness more apparent. The dose can be titrated to desired

effect. Place the patient in dorsal recumbency, I use a the foam V-trough used

in diagnostic u/s. Evaluate mobility of the patella and the state of the

cranial muscles of the thigh. You could also use this relaxation to better

assess the m. psoas major. I would suggest repeated MSKUS looking at the psoas

major in the lumbar area. A difference in size of the muscle maybe appreciated

and possibly changes in echogenicity. If you have a really good transducer

10mHz and up you might even appreciate a trigger point.

Rick Wall, DVM

[Guest guest]

Thanks Rick,

I agree, nothing has been done yet for actual treatments to address soft tissue

dysfunction. I gave the owners minimal instructions until our schedules allowed

another meeting. She has been updating me over the last 3 weeks and I was

concerned about the increased skipping frequency despite lack of activity and

with the negative iliopsoas ultrasound, thought that I had to reinvent a theory!

I appreciate your ideas and your 1-5 steps make sense. She will be in again on

Friday for an assessment so hopefully, something more concrete can be found than

what was present 3 weeks ago. If not, back to the drawing board:)

Tara

> Tara,

>

> So consider these some random thoughts strictly based on video, clinical

history and findings. I maybe totally wrong in my assessment but for discussion

purposes: I would suspect that your agility patient injured the iliopsoas first

and then acquired the dynamic MPL. Many shelties have pelvic limb varus and

internal tibial rotation predisposing to dynamic MPL. With the iliopsoas injury

a degree of coxofemoral joint dysfunction would be expected, limited extension,

as you mention. This then could effect the cranial muscles of the thigh that

assist the iliopsoas in flexion. I see much less problem with extensors of the

hip. So 1) injury to iliopsoas 2) coxofemoral dysfunction 3) muscle dysfunction

of cranial thigh muscles 4) contracture of iliopsoas and cranial thigh muscles,

especially m. sartorius 5) dynamic MPL is a consideration, especially if

conformation fits 5) although rest is often indicated in soft tissue injury I

would consider that the lack of activity and light ROM exercise have not

addressed the muscle contracture.

>

> I always seem to upset others when I talk about sedating but you need a

relaxed patient to evaluate for the possibility of dynamic MPL. In a sheltie I

would use 0.025-0.05mg/kg acepromazine SQ and wait about 30 minutes. This does

absolutely nothing to suppress a pain response but can enable relaxation and in

some patient that are anxious when performing lameness workup it will relax them

and make the lameness more apparent. The dose can be titrated to desired

effect. Place the patient in dorsal recumbency, I use a the foam V-trough used

in diagnostic u/s. Evaluate mobility of the patella and the state of the

cranial muscles of the thigh. You could also use this relaxation to better

assess the m. psoas major. I would suggest repeated MSKUS looking at the psoas

major in the lumbar area. A difference in size of the muscle maybe appreciated

and possibly changes in echogenicity. If you have a really good transducer

10mHz and up you might even appreciate a trigger point.

>

> Rick Wall, DVM

>

>

>

>

>

> ------------------------------------

>

>

[Guest guest]

Tara, the video appeared to be a black lab, not a sheltie. Or am i missing

something? At any rate, did you check the sacrum and SIJ?

Liz

>

> Hi,

> Anyone's thoughts on this case would be greatly appreciated. The dog is a 3

year old Sheltie that competes in Agility. A change in gait was noticed by the

owner in mid-December. At the time, the one-step skip on the right hind was

only noted during agility training when she was going at faster speeds. She has

not demonstrated this skip at any other time in the house, on walks, or when

going high speed in the backyard. I examined the dog last month and no lameness

was noted on gait analysis. She is in very good shape with BCS 2.75/5. There

was inconsistent discomfort with lower back palpation and tail elevation. She

consistently had restrictions with full right hip extension. There was very

mild discomfort with palpation of her iliopsoas and was often more reactive when

laying in lateral for palpation. Stifles are good, patella is good, SDF tendon

is good. Hip radiographs are normal. No other abnormalities were noted other

than the iliopsoas - and again, it was really mild. We elected to pursue this

and an ultrasound was performed and both iliopsoas muscles at their insertions

imaged normally. The dog has been significantly restricted in any training and

is only going for light walks. Owners are going very light ROM with only hip

extension (no internal rotation or abduction) and icing over the last 2 weeks

until I could see them again. Owner just sent me video and the dog is no more

consistently skipping at even a walk.

>

>

>

> Any thoughts would be greatly appreciated,

> Tara , DVM, CCRT

>