Patella Luxation
The luxation of the patella (kneecap) is generally associated with deformities and malalignment of the femur and tibia in small breed dogs. The degree of luxation is graded from grade 1 – least severe, to grade 5 – most severe. Surgery is generally recommended for anything grade 2 and above.
Clinical signs of patella luxation include:
- Skipping lameness for one or two strides
- Frequent on and off lameness
- Complete non weight bearing
If left untreated, the patella can wear down the subchondral bone on either side of the trochlear grove in which is lives in, which can expose nerve endings and be incredibly painful. Secondary conditions may also arise such as quadriceps and hamstring tightness and contracture from constant pressure from holding the limb up.
In 15-20% of luxating patella cases, cranial cruciate rupture in is also present if left untreated. This can occur in the knee of which the patella is luxating, or the contralateral limb due to increase pressure from the change in gait and lameness.
All three of these conditions will present with a forelimb lameness and between the ages of 4 and 9 months of age. Swelling and pain will be present, as well as pain on flexion or extension of the elbow. Your pet may already have muscle atrophy of that limb. It can appear in both forelimbs or unilaterally.
Radiographs can look for certain changes of the elbow, but often an FCP lesion will not be able to be seen and can commonly be mistaken for an OCD lesion. Further diagnostics such a CT scan or arthroscope will be needed to properly diagnose and treat the condition.
Treatment for FCP and UAP is usually removal of the fractured process or defective cartilage via arthrotomy. The prognosis is good providing we have caught it before there are advanced signs of osteoarthritis.
An Ununited Anconeal Process is a failure of the anconeal process to fuse with the olecranon by 5 months of age. This causes instability, which presents with a decrease range of motion, joint swelling and inflammation. Treatment includes surgical removal of the fractured and possible osteotomy to relieve joint incongruency, where the radius and ulna do not grow at the same time and the joints do not fit together properly.
In all cases, rehabilitation is used to prevent the slowing of progression of osteoarthritis, maintaining range of motion in the elbows, preventing secondary compensatory issues such as biceps tendinopathy or shortening of the biceps or triceps muscles.
Hip Dysplasia
An abnormal development of the hip joint occurs primarily in medium and large breed dogs. It can be caused by many factors that include genetic predisposition, rapid growth rate and diet.
Dogs with a genetic predisposition, their hips are normal at birth but develop instability in the early stages of disease at 4-12 months of age.
Clinical signs include difficulty rising, decreased activity level, a ‘bunny hopping’ gait and lameness after exercise.
We are very lucky here to be able to diagnose dogs with hip dysplasia at a young age by being able to perform Penn Hip Radiographs. Upon standard hip x-rays, the hips may seem normal, but you will not be able to tell the degree of laxity this way. Penn Hips
With varying degrees of hip dysplasia, remodelling of the hip joint and differences in laxity we can see degenerative changes on radiographs as early as 1year old.
There are several preventative options for a dog that has hip dysplasia. Surgical options are designed to change the joint alignment and improve joint stability and therefore slow the progression of osteoarthritis and joint degeneration.
There are also conservative preventative options such as stem cell therapy, platelet rich plasma injections, shockwave therapy used in conjunction with a tailored rehab program to target the gluteal and thigh muscles to provide better stability to the joint and decrease laxity.
OCD can effect multiple joints of the doing including:
- Hocks
- Elbows
- Stifles
- Elbows
An Xray is the diagnostic imaging required. Rarely, but in some instances, more advanced imaging is needed to see the defect in the subchondral bone. Treatment of this condition requires surgery to remove the piece of bone or cartilage, followed by rehab to decrease initial inflammation and pain post-surgery, maintain range of motion and build back muscle mass to support the joint. In most cases, the long term prognosis for the condition is great.
Spinal Disease
Spinal disease covers a range of conditions such as:
- Intravertebral disc disease (pre and post surgery)
- Spondylosis
- Facet Joint arthritis
- Degenerative Lumbosacral stenosis
- Fibrocartilaginous embolism (FCE)
- Neoplasia
- Discospondylyitis
- Degenerative Myelopathy
- Peripheral nerve injuries
- Wobblers syndrome (cervical disc disease)
- Fibrocartilaginous embolism (FCE)
Diagnosis of your pets condition is imperative to putting together a rehabilitation program and providing you with a prognosis. Diagnostics of spinal conditions often can begin with Our aim in rehabbing the neurological / spinal patient is to decrease pain, improve neurological function and neural pathways, prevent secondary compensatory issues and return the patient to being independent once again. Patients with these conditions are at risk of developing complications including shortening of ligaments and tendons, muscle atrophy, pressure sores and urinary tract infections, depending on the stage of their disease.
Spinal conditions and often very painful, adequate pain relief and using modalities such as laser therapy to help combat inflammation and pain as well as promote healing at a cellular level is used for a successful outcome. Rehabilitation programs are used to treat several targeted areas such as
- Increasing core strength to build paraspinals which support the spine.
- Stretching exercises to ensure the spine remains flexible.
- Neurological exercises to regain or maintain proprioception and limb awareness.
- Weight shifting exercises to build strength.
