JRT with a hitch in his giddy up

[Guest guest]

I am hoping for a little help. I just took a look at an 11 month old Parson's

JRT today that has been skipping and has a " hitch in his giddy up " . No other

real complaints except that he has seemed sensitive to his L hamstrings

sometimes. He is an active little bugger as JRTs are and runs and jumps around

like crazy.

On PE the only thing I could find was sensitivity at L lateral distal stifle

(EDL attachment) pain at L cranial hock palpation( but no pain on flexion and

extension) except he did not like the EDL stretch (hock extension with digit

flexion). Patellas are a little sloppy, but do not sublux. He has a typical

terrier straight build. He seems to be tippytoes on the back which I think was

worse after exam.

I will attach the youtube video of him trotting around so you can see his gait.

Questions: Does anyone know why he might have sensitivity in bilat EDL? Is this

a conformation issue possibly? Can anyone think of a compensation that this

might be stemming from? Any thoughts on skipping and hopping other than luxating

patellas? I did a thorough exam of the rest, back, hips, stifles, etc and could

find nothing wrong.

Thanks for any help!

Day, PT, CCRP

I seem to be having trouble uploading the video. If this doesn't work I will try

again tomorrow.

[Guest guest]

I'm sorry I'm still learning rehab - What do you mean by EDL?

Thanks!

Subject: JRT with a "hitch in his giddy up"To: VetRehab Date: Monday, August 20, 2012, 7:42 PM

I am hoping for a little help. I just took a look at an 11 month old Parson's JRT today that has been skipping and has a "hitch in his giddy up". No other real complaints except that he has seemed sensitive to his L hamstrings sometimes. He is an active little bugger as JRTs are and runs and jumps around like crazy.On PE the only thing I could find was sensitivity at L lateral distal stifle (EDL attachment) pain at L cranial hock palpation( but no pain on flexion and extension) except he did not like the EDL stretch (hock extension with digit flexion). Patellas are a little sloppy, but do not sublux. He has a typical terrier straight build. He seems to be tippytoes on the back which I think was worse after exam. I will attach the youtube video of him trotting around so you can see his gait.Questions: Does anyone know why he might have sensitivity in bilat EDL? Is this a conformation issue possibly? Can anyone think of a compensation that

this might be stemming from? Any thoughts on skipping and hopping other than luxating patellas? I did a thorough exam of the rest, back, hips, stifles, etc and could find nothing wrong.Thanks for any help! Day, PT, CCRPI seem to be having trouble uploading the video. If this doesn't work I will try again tomorrow.

[Guest guest]

probably Long Digital Extensor? (in Latin)

 

I'm sorry I'm still learning rehab - What do you mean by EDL?

Thanks!

Subject: JRT with a " hitch in his giddy up "

To: VetRehab Date: Monday, August 20, 2012, 7:42 PM

 

I am hoping for a little help. I just took a look at an 11 month old Parson's JRT today that has been skipping and has a " hitch in his giddy up " . No other real complaints except that he has seemed sensitive to his L hamstrings sometimes. He is an active little bugger as JRTs are and runs and jumps around like crazy.

On PE the only thing I could find was sensitivity at L lateral distal stifle (EDL attachment) pain at L cranial hock palpation( but no pain on flexion and extension) except he did not like the EDL stretch (hock extension with digit flexion). Patellas are a little sloppy, but do not sublux. He has a typical terrier straight build. He seems to be tippytoes on the back which I think was worse after exam.

I will attach the youtube video of him trotting around so you can see his gait.Questions: Does anyone know why he might have sensitivity in bilat EDL? Is this a conformation issue possibly? Can anyone think of a compensation that

this might be stemming from? Any thoughts on skipping and hopping other than luxating patellas? I did a thorough exam of the rest, back, hips, stifles, etc and could find nothing wrong.Thanks for any help! Day, PT, CCRP

I seem to be having trouble uploading the video. If this doesn't work I will try again tomorrow.

[Guest guest]

,I do not recognize a lameness but rather an intermittent alteration in gait resulting from limited stifle flexion early in the swing phase of the both pelvic limbs. I would expect that this is due to bilateral dynamic medial patellar luxation. I like to examine these patients in dorsal recumbency using the foam V-trough we use for abdominal u/s examinations. I assess the patella throughout the stifle joint ROM, especially at maximum extension. Light sedation with small doses of acepromazine can assist in identification due to relaxation of pelvic limb musculature. I assume EDL is extensor digitorum longus or long digital extensor from your description and it may at times be overloaded at the end of the stance phase if the patellar is luxated. On the video this can be seen at the end of stance phase - early swing phase when the stifle is extended and and there is exaggerated push off in the pelvic limb that raises the pelvic area higher than during a regular gait cycle.Rick Wall, DVMThe Woodlands, TX

[Guest guest]

Hi Sam,

At first look, it seems like it is from medial patella luxation however I noticed also a mild kyphosis of the lumbar spine and in the trot it was difficult to see ( I find walk easier to assess for structural things) -looks unable to stretch through his hamstrings. I was wondering on palpation what his pelvis, sacrum and lumbars are doing ( are they moving in normal range of motion? ) - even on stationary examination - are his ilial wings the same height and position? is his sacrum sitting in normal position or tilted up on one side? can he laterally flex his L7-L4 vertebra particularly on the right side?

Dr Toni Lynch BVScHons GDChiroCertAyurTLC Veterinary Rehabilitationph 0408 743 595toni.tlc@...

From: Reynolds

Sent: Thursday, August 23, 2012 4:57 AM

To: VetRehab

Subject: Re: JRT with a "hitch in his giddy up"

I'm sorry I'm still learning rehab - What do you mean by EDL?

Thanks!

Subject: JRT with a "hitch in his giddy up"To: VetRehab Date: Monday, August 20, 2012, 7:42 PM

I am hoping for a little help. I just took a look at an 11 month old Parson's JRT today that has been skipping and has a "hitch in his giddy up". No other real complaints except that he has seemed sensitive to his L hamstrings sometimes. He is an active little bugger as JRTs are and runs and jumps around like crazy.On PE the only thing I could find was sensitivity at L lateral distal stifle (EDL attachment) pain at L cranial hock palpation( but no pain on flexion and extension) except he did not like the EDL stretch (hock extension with digit flexion). Patellas are a little sloppy, but do not sublux. He has a typical terrier straight build. He seems to be tippytoes on the back which I think was worse after exam. I will attach the youtube video of him trotting around so you can see his gait.Questions: Does anyone know why he might have sensitivity in bilat EDL? Is this a conformation issue possibly? Can anyone think of a compensation that this might be stemming from? Any thoughts on skipping and hopping other than luxating patellas? I did a thorough exam of the rest, back, hips, stifles, etc and could find nothing wrong.Thanks for any help! Day, PT, CCRPI seem to be having trouble uploading the video. If this doesn't work I will try again tomorrow.

[Guest guest]

Dr. Toni,

Thanks for the thoughts! He was tight in his hamstrings, especially the L. I did

feel that his sacrum and pelvis were aligned normally though.

, I am sorry about the abbreviation. I use them in human medicine and

just got lazy when typing. I was referencing his extensor digitorum longus.

Rick,

Thank you for your thoughtful and experienced eye. I also thought patellar

luxation when observing the gait. I did feel that his patellas were stable when

I was examining him though. Do you see dogs that you cannot luxate the patella

without sedation, but can under sedation? And this is the cause of the altered

gait? Would you perform surgery on something like this?

I may be wrong, but I would think that if I could not manipulate his patella out

of groove with manual force with a non sedated dog, then it would probably not

be luxating during gait.

I would appreciate everyone's further thoughts,

Thanks so much!

Day

>

>

>

> Subject: JRT with a " hitch in his giddy up "

> To: VetRehab

> Date: Monday, August 20, 2012, 7:42 PM

>

>

>

> I am hoping for a little help. I just took a look at an 11 month old

Parson's JRT today that has been skipping and has a " hitch in his giddy up " . No

other real complaints except that he has seemed sensitive to his L hamstrings

sometimes. He is an active little bugger as JRTs are and runs and jumps around

like crazy.

> On PE the only thing I could find was sensitivity at L lateral distal

stifle (EDL attachment) pain at L cranial hock palpation( but no pain on flexion

and extension) except he did not like the EDL stretch (hock extension with digit

flexion). Patellas are a little sloppy, but do not sublux. He has a typical

terrier straight build. He seems to be tippytoes on the back which I think was

worse after exam.

> I will attach the youtube video of him trotting around so you can see

his gait.

> Questions: Does anyone know why he might have sensitivity in bilat

EDL? Is this a conformation issue possibly? Can anyone think of a compensation

that this might be stemming from? Any thoughts on skipping and hopping other

than luxating patellas? I did a thorough exam of the rest, back, hips, stifles,

etc and could find nothing wrong.

> Thanks for any help!

> Day, PT, CCRP

> I seem to be having trouble uploading the video. If this doesn't work

I will try again tomorrow.

>

>

>

[Guest guest]

,-----------"Do you see dogs that you cannot luxate the patella without sedation, but can under sedation?"-----------Yes, anxiety during examination can lead to muscle contraction and resistance that can limit our assessment, in my opinion. I think that during ambulation, even minor muscle dysfunction could promote the dynamic luxation, especially if conformation supports alignment issues. Contracture of the cranial thigh muscles due to the development of taut bands can not only lead to dysfunction of the cranial thigh muscles (stifle extensors) but also, agonist muscles (stifle flexors) due to decrease in reciprocal inhibition. Muscle dysfunction, joint dysfunction and possible conformation issues all work together to allow the patella to luxate at times during ambulation.---------------"Would you perform surgery on something like this?"---------------No, I would closely examine muscles of the thigh and treat dysfunction with hope of improving dynamic patellar alignment. Rick Wall, DVMThe Woodlands, TX

[Guest guest]

,

I have seen multiple dogs (large breed Labradors) that cannot be luxated while

awake but can while sedated (we use light doses of dexdomitor and burorphanol).

The population of dogs I see will luxate medially to varying degrees, I actually

call this a laxity profile ranked a-d (a being perfect and d being classical

mpl, no official way to measure it yet, I am trying to think of an objective

way) and dogs with a " c " laxity ranking are often clinically affected in their

performance of activity. A dog is given a " c " if the patella glides medially

easily and lies at or just over the medial femoral trochlear rigde in certain

positions. Often these c dogs cannot be luxated (if you can call it that) while

awake but can while sedated. I have seen these dogs remain fine throughout their

lives and others progress to grade I MPL.

And I have to say, it takes palpating hundreds of stifles to appreciate this

laxity variance I have seen. Few (including surgeons) palpate this way and admit

it is not normal and is a differet way to look for MPL.

The dynamic MPL that Dr Wall mentioned is exactly what I thought as well from

the video. :-)

-

L Hagler BS RVT CCRP CVPP CBW COCM

Certified Canine Rehabilitation Practitioner

Certified Veterinary Pain Practitioner

Certified Osteoarthritis Case Manager

Canine Body Worker

www.goldengaitcanine.com

www.ivapm.org

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