Lameness

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Issues

Lameness

 

A disturbance in gait and locomotion in response to pain, anatomic disruption, or injury.

 

Pathophysiology

  • Severe, sharp pain—limited limb movement during all phases of locomotion, little to no load bearing in motion or at rest.
  • Milder, dull, or aching pain—reduced loading and ground contact time during all phases of locomotion.
  • Pain produced only during certain phases of movement—patient adjusts its motion and gait to minimize discomfort.
  • Anatomic dysfunction resulting in certain normal motions being altered or impossible.

 

SYSTEMS AFFECTED

  • Musculoskeletal
  • Nervous

 

SIGNALMENT

Any age or breed of dog.

Age, breed, and sex predilection—depend on specific disease.

 

SIGNS

General Comments

  • Unilateral forelimb—head and neck moves upward when the affected limb is placed on the ground and drops when the sound limb loads.
  • Unilateral hindlimb—pelvis drops when affected leg loads, rises when it unloads.
  • Bilateral hindlimb—forequarters carried lower to shift weight forward.
  • Always assess the patient’s neurologic status, especially with a suspected proximal lesion.

 

Historical Findings

  • Complete history—identify known trauma; alterations with weather, exercise tolerance, response to rest, effect of previous treatments.
  • Determine speed of onset of lameness.
  • Determine progression—static; slow; rapid.
  • Deterimine consistency – intermittent, constant, associations.
    • How does the patient show pain?

 

Physical Examination Findings

  • Perform a complete routine examination.
  • Observe posture—standing, getting up or lying down, sitting.
  • Observe gait—walking; trotting; climbing stairs; doing figure eights.
  • Palpate—asymmetry of muscle mass (measure and compare); bony prominences.
  • Manipulate bones and joints, beginning distally and working proximally.
  • Assess—instability; incongruency; pain; range of motion (measure); abnormal sounds.
  • Examine suspected area of involvement last—by starting with normal limbs, patient may relax, allowing comparison of normal to abnormal reactions.

 

CAUSES

Forelimb

Growing Dog (< 12 Months of Age)

  • Osteochondrosis of the shoulder
  • Shoulder luxation or subluxation—congenital
  • Osteochondrosis of the elbow
  • Ununited anconeal process
  • Fragmented medial coronoid process

 

Elbow incongruity

  • Avulsion or calcification of the flexor muscles—elbow
  • Asymmetric growth of the radius and ulna
  • Panosteitis
  • Hypertrophic osteodystrophy
  • Trauma—soft tissue; bone; joint
  • Infection—local; systemic
  • Nutritional imbalances
  • Congenital anomalies

 

Mature Dog (> 12 Months of Age)

  • Degenerative joint disease
  • Bicipital tenosynovitis
  • Calcification or mineralization of supraspinatus or infraspinatus tendon
  • Contracture of supraspinatus or infraspinatus muscle
  • Soft tissue or bone neoplasia—primary; metastatic
  • Trauma—soft tissue; bone; joint
  • Panosteitis
  • Polyarthropathies
  • Polymyositis
  • Polyneuritis

 

Hindlimb

Growing Dog (< 12 Months of Age)

  • Hip dysplasia
  • Avascular necrosis of femoral head—Legg-Calvé-Perthes disease
  • Osteochondritis of stifle
  • Patella luxation—medial or lateral
  • Osteochondritis of hock
  • Panosteitis
  • Hypertrophic osteodystrophy
  • Trauma—soft tissue; bone; joint
  • Infection—local; systemic
  • Nutritional imbalances
  • Congenital anomalies

 

Mature Dog (> 12 Months of Age)

  • Degenerative joint disease (hip dysplasia)
  • Cruciate ligament disease
  • Avulsion of long digital extensor tendon
  • Soft tissue or bone neoplasia—primary; metastatic
  • Trauma—soft tissue; bone; joint
  • Panosteitis
  • Polyarthropathies
  • Polymyositis
  • Polyneuritis

 

RISK FACTORS

Breed (size), overweight, strenuous activity

 

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

Must differentiate musculoskeletal from neurogenic and metabolic causes.

 

CBC/BIOCHEMISTRY/URINALYSIS

Muscle injury elevates creatine phosphokinase levels.

 

OTHER LABORATORY TESTS

Depends on suspected cause

 

IMAGING

Radiographs—recommend two views of region of interest.

CT, MRI, ultrasound, and nuclear scintigraphy where appropriate.

 

DIAGNOSTIC PROCEDURES

  • Cytologic examination of joint fluid—identify and differentiate intra-articular disease.
  • EMG—differentiate chronic neuromuscular from musculoskeletal disease.
  • Muscle and/or nerve biopsy—reveal and identify neuromuscular disease.

 

TREATMENT

Depends on underlying cause

 

MEDICATIONS

DRUG(S) OF CHOICE

Analgesics and NSAIDs—minimize pain; decrease inflammation; meloxicam (load 0.2 mg/kg PO, then 0.1 mg/kg daily PO—liquid), carprofen (2.2 mg/kg PO q12h), deracoxib (3–4 mg/kg PO q24h—chewable) for 7 days for postoperative pain.

 

PRECAUTIONS

NSAIDs—gastrointestinal irritation or renal/hepatic toxicity may preclude use in some patients.

 

ALTERNATIVE DRUG(S)

Chondroprotective drugs (e.g., polysulfated glycosaminoglycans, glucosamine, and chondroitin sulfate)—may be of benefit in limiting cartilage damage and improving regeneration.

 

FOLLOW-UP

PATIENT MONITORING

Depends on underlying cause

 

MISCELLANEOUS

ABBREVIATIONS

CT = computed tomography

EMG = electromyogram

MRI = magnetic resonance imaging

NSAID = nonsteroidal anti-inflammatory drug

 

Visit your veterinarian as early recognition, diagnosis, and treatment are essential.

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