Bone and Muscle Health
Patellar Luxation in Dogs
Patellar luxation occurs when the kneecap slips out of place. It can be a congenital or developmental condition, or it can occur from trauma. Pets with patellar luxations may exihibit varying degrees of lameness, and if left untreated, the condition can lead to arthritis and other orthopedic problems. Mildly affected dogs are often prescribed joint supplements and pain-relieving medications. More serious cases require surgery to remedy the condition.
Patellar luxation is a common condition of smaller dogs and, occasionally, of larger breeds. It can also occur in cats, but not as often as it does in dogs. The knees, in this case, are the site of the problem. Normally, the kneecap (or patella) sits in a groove at the bottom of the femur (the major bone of the upper leg), where the femur and the tibia (the major bone of the lower leg) meet at the knee. The patella is held in place by ligaments and muscles. Patella luxation occurs when the patella slips (luxates) out of the normal position in the groove.
Imagine if your kneecap spontaneously moved to the inside or outside of your knee (medially or laterally). What you’d inevitably feel is not so much the pain but the instability caused by the misaligned joint structure. In most cases, the abnormal positioning of the patella means your leg won’t hold you up like it should. And that’s exactly what affected pets experience.
This luxation of the kneecap may lead to significant arthritis and, in some cases, predisposes the dog to even more severe degenerative changes of this joint (such as cruciate ligament rupture or even damage to the menisci, the cartilaginous cushions inside the knee joint).
One or both hind limbs may be affected.
Signs and Identification
Not all dogs with patellar luxation are as affected to the same degree as others. Some may show no outward signs, and a veterinarian must perform a physical exam to reveal the problem, while others are chronically lame and their inability to walk normally is the obvious signal that something’s wrong. Some dogs may be diagnosed as early as 1 to 4 months of age.
Because the severity of the luxation is variable, veterinarians have developed a grading system to describe it:
- Grade I: The patella can be manually displaced but returns to its normal position spontaneously. Affected dogs are normally quite comfortable but may carry the affected limb occasionally.
- Grade II: The patella displaces all by itself but doesn’t return to its normal location immediately. Mild or intermittent lameness may be present.
- Grade III: The patella is out of the normal position most of the time and must be manually assisted in its return to normal position. Moderate to severe lameness may be present.
- Grade IV: The patella is permanently out of place, and the animal is usually very lame. These dogs may carry the affected leg or shift more weight to their forelimbs in order to maintain their balance.
This grading system is designed to describe the degree of luxation of the kneecap. It does not always correspond with the pet’s degree of lameness. In any of these cases, the pet may have figured out how to change its gait so the knee is not painful, and lameness may not be obvious.
A veterinarian may be able to diagnose patellar luxation by manually manipulating the kneecap. If the dog is very painful, sedation may be recommended for a more thorough knee examination. Radiographs (X-rays) may be necessary to further evaluate the kneecap and other structures in the knee. Because a luxating patella affects the stability of the knee joint, many dogs with this problem develop arthritis over time, which may be visible on X-rays.
Toy and small breeds are most affected. Those with bowed limbs are also at risk of inheriting this structural defect. According to the Orthopedic Foundation for Animals, the top 20 affected breeds are:
- Boykin Spaniel
- Cocker Spaniel
- Yorkshire Terrier
- Chow Chow
- Bedlington Terrier
- Australian Terrier
- Japanese Chin
- Chinese Shar-Pei
- Lhasa Apso
- Tibetan Spaniel
- Tibetan Terrier
- Labrador Retriever
- Scottish Terrier
- Shiba Inu
- Norfolk Terrier
- Shetland Sheepdog
Pets that have been diagnosed with patellar luxation but do not show clinical signs, or only exhibit occasional signs, may be monitored. Maintaining an ideal body weight and following a regular veterinarian-approved exercise program may help manage the condition. Joint supplements may be recommended, as well as pain medications for occasional episodes. Unless the condition progresses, surgical correction may not be needed.
Severely affected dogs are best treated surgically. Because any instability in the knee joint may lead to arthritis, some dogs with moderate lameness may benefit from surgery as well.
Because patellar luxation may be an inherited condition, breeders must take care to eliminate this condition from their breeding population. Responsible breeders will also ensure that affected puppies be spayed or neutered as a requirement of sale.
To maximize comfort and minimize any secondary issues related to patellar luxation (such as osteoarthritis and cruciate ligament rupture), a dog’s weight must remain in the normal range. A leaner dog tends to experience fewer complications from this condition, while one already afflicted with osteoarthritis will suffer considerably less pain at a normal weight.
In some dogs and cats, bone spurs form on the vertebrae. Sometimes those spurs might even grow to bridge the gap between two adjacent vertebrae. This condition of the spine is called spondylosis deformans. The cause is unknown, and it occurs much less frequently in the feline population, compared to the canine population. Most pets that experience the condition have no signs, but some might become lame, appear stiff, or suffer obvious back pain. In those cases, exercise restriction, weight loss, anti-inflammatory drugs, or other pain relievers can help.
Spondylosis deformans (or spondylosis, as most veterinarians refer to it) is a degenerative process of the spine in which bone spurs (osteophytes) form at the edges of the vertebrae. Sometimes, these may even coalesce into bony bridges between the vertebral segments of the spine.
The lower back is most often affected, especially the lower thoracic and lower lumbar vertebrae.
The cause of this common canine condition is unknown, but intervertebral disc disease (“slipped” discs), trauma to the spine, and congenital deformities have all been associated with it. Nonetheless, true spondylosis deformans is considered idiopathic, meaning that the cause is not known.
Middle-aged to older animals and bigger-breed dogs are predisposed. Though dogs are more likely candidates for this condition, cats can suffer from it, too.
Symptoms and Identification
In most cases, the condition sounds more painful than it actually is. In fact, most dogs and cats who experience spondylosis deformans are asymptomatic, meaning that they appear to have no signs. (In animal medicine, however, it’s important to note that our human perception of pain may inadequately represent the true state of our pets’ feelings.)
In pets that do show signs, lameness (limping), back pain, stiffness, and loss of muscle mass over the affected areas are the most common, especially after exercise. Spondylosis deformans rarely leads to neurological signs, and in most cases, it is because something else is causing compression on the nerves.
In any case, spondylosis deformans is almost always diagnosed with radiographs (x-rays). A CT scan and/or myelogram (a dye-based study of the spinal canal) are often used to diagnose spinal cord compression if it’s suspected, but again, it is usually not caused by the spondylosis itself.
Some studies suggest that Boxers are the most common breed affected, with other large-breed dogs (such as German Shepherds and Airedale Terriers) following. Nonetheless, this area of study is not without controversy. Veterinary radiologists posit that smaller breeds, such as Cocker Spaniels and Dachshunds, may be as likely to suffer spondylosis deformans.
The treatment of spondylosis deformans depends on the degree of back pain, lameness, stiffness, or loss of muscle mass the patient experiences. Exercise restriction, weight loss, and pet-specific anti-inflammatory medications (either NSAIDs or corticosteroids) are typical treatments.
Genetic predisposition to spondylosis deformans is suspected in some breeds, though this has not been established. Modes of prevention, therefore, are speculative.
Arthritis in Dogs
Arthritis can be caused by injury, infection, the body’s own immune system, or developmental/hereditary abnormalities, and the treatments –– ranging from weight loss to medication to surgery –– are equally varied. But the most common form of arthritis is a degenerative process related to advancing age. But growing older doesn’t have to equal arthritis for your dog, and if you notice that your pet seems stiff when he walks or otherwise has trouble moving around, don’t assume it’s normal.
Arthritis is an abnormal, destructive joint process that can reduce a dog’s mobility and elicit pain. It is more typically seen in older dogs but is more than capable of affecting even very young dogs. By far the most common form of arthritis is referred to in scientific circles as “osteoarthritis” or “degenerative joint disease.” Normally, joints form smooth connections between bones. Osteoarthritis involves the thinning of joint cartilage (a protective cushioning between bones), buildup of fluid within the joint, and the formation of bony growths within the joint. Over time, this process leads to reduced joint mobility and pain.
Osteoarthritis can affect any joint in the body, including the hips, knees, elbows, shoulders, neck, and back. Shockingly, osteoarthritis affects one out of every five dogs, yet the condition is often under-recognized by owners who assume the symptoms of arthritis are an inevitable part of their dogs’ normal aging process. (Not necessarily so!)
Other less common disease processes involving inflammation within the joint also go by the name “arthritis.” These can be caused by a variety of infectious organisms (like Lyme disease), immune-mediated diseases, or certain congenital conditions. These versions of arthritis will not be treated here.
Signs and Identification
Signs of arthritis include the following:
- Stiffness after exercise
- Wasting away of muscle
- Limited movement
- Joint swelling
- Trouble getting up, lying down, walking, climbing stairs, or jumping
- A grating sound in a joint (“crepitus’)
Recognizing arthritis in dogs can be difficult in many cases because the condition can progress slowly and dogs don’t complain about their aching joints. Also, because some owners assume that signs of arthritis are “normal” in older animals and/or fail to recognize the subtle signs of pain our stoic dogs offer us.
Radiography (X-rays) can reveal bony growths and some joint abnormalities. Some very specific radiographic studies can even predict the possibility of osteoarthritis in the future (PennHIP, for example, which is an X-ray technique used successfully to help identify future problems as a result of hip dysplasia).
Arthritis can affect dogs of any breed. It is common in large to giant breeds and breeds predisposed to hip dysplasia, elbow dysplasia, and other common hereditary diseases that affect the joints.
Osteoarthritis is not considered a curable condition. For most pets, it is a chronic illness that can be managed through a combination of therapies. Treatment options will differ depending on the cause of the arthritis and the severity of the pet’s condition. These options are likely to change over time as the condition progresses. The following recommendations are typically offered by veterinarians:
- Getting/keeping a dog slim throughout his or her lifetime can help immeasurably by decreasing the load on his or her joints over time.
- Feeding a dog the right amount of high-quality food should help with weight control.
- Carefully monitored exercise on soft surfaces can assist affected dogs.
- Because arthritis may be aggravated by cold and damp environments, keeping dogs warm and dry is always helpful. Padded dog beds (orthopedic foam or water-bedding) can help, too.
- Warm compresses can soothe affected joints.
- Massage can increase a dog’s flexibility, circulation, and sense of well-being. Professional animal massage therapists are available.
- Medication, including dog-approved, non-steroidal, anti-inflammatory drugs (commonly called NSAIDs), may help relieve pain and inflammation. But you should never give your dog a drug without your veterinarian’s recommendation.
- Corticosteroids can be used to suppress inflammation, but they are usually used for short periods due to their side effects.
- Disease-modifying osteoarthritis drugs (DMOADs) can be an important part of managing osteoarthritis.
- Glucosamine, chondroitin, and some other nutraceuticals have been used to help manage arthritis in dogs and other animals.
- Acupuncture isn’t just for people. It’s painless and has been shown to offer some relief for animals.
- Surgery may be a good choice in certain cases of canine arthritis –– for example, some dogs with hip dysplasia are candidates for surgical correction.
- A low-stress environment, plenty of affection, and supportive care can help improve any dog’s quality of life.
Regular, moderate exercise and a high-quality diet can help reduce the likelihood of developing arthritis by managing body weight and keeping a dog’s musculoskeletal system in good shape.
Identifying at-risk dogs early so that any special care –– such as surgery or drug therapy –– can be taken is undeniably helpful.
Hip Dysplasia in Pets
The most common symptom of this genetic disease is limping, but dogs with hip dysplasia might also walk funny, have a hard time jumping or rising, or lose muscle bulk in their thighs. Pain-relieving drugs, joint supplements, and maintaining a proper weight help manage the condition, which causes crippling arthritis, but, unfortunately, a true solution for many can come only through surgery.
In the world of small animal veterinary medicine, hip dysplasia is considered the mother of all orthopedic diseases for being so common, so crippling, and yet so frustratingly insidious. It’s very common in large dogs, relatively common in smaller dogs, and even seen in cats.
Hip dysplasia is painful and can be expensive to treat. It’s also preventable. But this last point is a complex matter — especially when you consider that hip dysplasia is acquired primarily through hereditary means.
This genetically predetermined disease that causes mild to severe changes to the inner workings of the hip joint happens when an animal (usually a large breed dog) inherits a series of genes specific to how this joint’s components (made up of the bones of the femur and pelvis) fit together. More specifically, it has to do with how the femoral head (the ball portion of the femur) and acetabulum (the pelvis’s hip socket) align to achieve the kind of smooth movement a pet requires for a lifetime of weight bearing and normal wear and tear. One or both hips may be involved.
Signs and Identification
The problem with hip dysplasia is that it’s not always obvious that your pet has it. Because its severity is variable due to the way this disease is inherited, some pets will show signs as early as 4 months old, while others surprise us with symptoms that appear only when they reach middle age or even later.
If untreated, arthritis (often referred to as osteoarthritis) is the result in all cases. Because the bones of the joint don’t line up just right, the joint cartilage is subjected to abnormal wear and tear. Over time, cartilage damage occurs, resulting in pain and arthritis.
Limping is the most apparent sign but, as if to confuse us further, is not always present. Loss of muscle mass in one or both thighs, reluctance to jump, a funny way of walking, or slowness in rising can also signal the presence of this hip disease.
A diagnosis of hip dysplasia is made based on clinical signs, physical examination, and radiographs (x-rays). Two systems have also been developed for screening and/or diagnosing dogs with hip dysplasia. Responsible breeders use at least one of these systems before including a dog in their breeding program:
- The OFA System: The Orthopedic Foundation for Animals (OFA) oversees a multibreed hip registry database. The OFA’s system, which has been in use since 1966, has developed a standardized evaluation system and radiographic test to help breeders and owners assess the hip health of prospective parents as well as any puppies they may produce. Dogs must be 24 months of age or older to be included in the registry.
- The PennHIP System: The PennHIP system, which was developed at the University of Pennsylvania School of Veterinary Medicine, has been in use since 1993. It uses a series of three radiographs to assess a “distraction index” — or DI — for each dog. The greater the DI, the higher the chances that the dog has or will develop hip dysplasia. The PennHIP analysis can be performed in puppies as young as 4 months of age.
Giant, large, and dwarfed, smaller breed dogs are most often affected, but mixed breed dogs and cats are not immune. According to the OFA, Bulldogs have a high prevalence of hip dysplasia with 72.6 percent of Bulldogs studied being affected. Of the Pugs studied, 64.3 percent were affected.
Several studies in veterinary journals have highlighted how common hip dysplasia is across different dog breeds. The OFA’s website also provides a full ranking of dog breeds and the percentage of the group that suffers from hip dysplasia according to OFA statistics. However, a study published in the Journal of the American Veterinary Medical Association in 2005 suggests that OFA statistics may underrepresent other affected breeds such as Rottweilers and Golden Retrievers.
Many owners are in denial about their pets’ hip status, especially when pain is not yet obvious to them. That’s because dogs don’t always display pain the same way humans do. Whining and complaining is just not in their nature. But veterinarians will know it’s there even before limping and other more obvious signs are present.
By 2 years of age, 95 percent of animals that have genes for hip dysplasia will show evidence on X-rays. But the severity of the dysplasia as seen on a normal X-ray doesn’t always indicate the degree of pain or lameness (limping). It also doesn’t tell us when a pet will begin to show signs of the disease.
A proper diet that helps maintain an ideal weight, combined with a veterinarian-approved, regular exercise plan, can help slow the progression of hip dysplasia for some dogs. In less severe cases, medical management can also include providing pain medications as needed under veterinary supervision as well as administering oral or injectable joint supplements or medications. “Comfort care,” such as keeping dogs out of cold weather and performing massage or physical therapy, can also help keep affected dogs comfortable and slow progression of the disease for as long as possible.
In severe cases, surgery may be indicated. Surgical options include hip replacement surgery, reconstructing the hip joint, or removing the abnormal part of the joint and allowing the surrounding structures to form a “false joint” over time. Your veterinarian will discuss the best methods of management with you and whether surgery is an option for your dog.
The onus for prevention is primarily on the breeders of dogs. If you intend to purchase or adopt dogs of a breed potentially affected by hip dysplasia, OFA or PennHIP certification of the parents’ acceptable hip quality is recommended.
Myotonia is a condition that results in constant contraction or delayed relaxation of voluntary muscles. It may be congenital, meaning that it is present before or at birth, or it can be an acquired condition later in life. A handful of dog breeds are known to be affected, and the condition is rare in cats. Pets with myotonia have a stiff gait and trouble getting up. They might have difficulty swallowing. Although there is no specific treatment for the disease, there is a drug that can reduce some signs in pets, but many pets with this condition are euthanized.
The congenital form of this disease, more aptly termed myotonia congenita, is caused by a defect in the muscle membrane. Chloride channels within the membrane (which allow complex electrical impulses to pass from nerves to muscles) do not function properly, resulting in constant contraction or delayed relaxation of voluntary muscles (like that of most of the skeletal system).
In some cases, myotonia has been found to be acquired; that is, dogs with certain conditions may also experience chloride channel disturbances by virtue of their primary disease. Cushing’s disease has been associated with myotonia in dogs, and some infectious or immune-mediated conditions may also result in similar signs.
Symptoms and Identification
Dogs with myotonia exhibit a stiff gait, have trouble rising, and may have an abnormal bark and difficulty swallowing. Young dogs start to show signs as early as a few weeks old, although the acquired form may occur at any age.
A DNA test pioneered by the University of Pennsylvania is currently available to screen for both carriers and diseased Miniature Schnauzers. Muscle biopsy and electromyography (or EMG, a study of electrical impulses in the muscles) have also been shown to be helpful in diagnosing the problem.
Chow Chows and Miniature Schnauzers have been documented as affected breeds.
Procainamide, a drug usually used to treat heart arrhythmias, has been found to reduce the signs in many affected dogs. Apart from this approach, nothing is known to be effective, including (to date) treatment of the underlying disease in those who have acquired (noncongenital) forms of myotonia. Few dogs will ever be free of symptoms altogether and many are euthanized.
Prevention of congenital myotonia is achieved primarily through testing of affected breeds and removing carriers or affected patients from the breeding pool through spay and neuter. A campaign is currently underway by the University of Pennsylvania to test all Miniature Schnauzers intended for breeding to completely eliminate the problem in this breed.
Lumbosacral Stenosis in Dogs
Lumbosacral stenosis is a painful condition caused by a narrowing of the spinal column that results from either degeneration over time or a birth defect, which, in turn, puts pressure on the spinal cord. The condition is difficult to diagnose, especially in older dogs, because the common symptoms, which include limping, difficulty rising, a limp tail, and incontinence, mimic other diseases of old age. However, once a diagnosis is made, surgery is the typical treatment, and it is generally successful.
Lumbosacral stenosis is a painful condition of dogs that affects the spinal cord and the nerves around the area where the spinal column meets the pelvis (low down in the back, where the lumbar spine meets the sacrum at the level of the pelvis). In this multifaceted condition of dogs, the hind limbs, tail, bladder, and rectum may be separately or uniformly affected, depending on the severity of the lumbosacral stenosis.
This disease can be the result of a degenerative or congenital narrowing of the spinal column.
In degenerative cases, it can happen because of vertebral malformations, chronic changes to the discs that cushion the vertebrae, changes in the ligaments, trauma, or tumors. In fact, anything that causes instability between the vertebrae in this area can result in lumbosacral stenosis.
For the congenital form, a vertebral malformation typically cases pressure on the spinal cord and the nerves that exit it at this point and beyond (toward the tail). Pressure on the spinal column is what leads to clinical signs.
Symptoms and Identification
Older dogs who limp or are slow to rise and who suffer from incontinence of the bladder or bowels (or both) should be suspected of having the degenerative form of the condition.
Younger dogs with this condition (as young as puppies) are the most likely candidates for the congenital form.
In most cases, it’s a hard condition to identify. That’s because more commonly affected older dogs of large breeds typically already exhibit signs of arthritis that affect the hind end function and may already be incontinent due to a variety of other old-age processes. Younger dogs, by contrast, are easier to identify as a result of their normally pristine spinal cord status.
The collection of these symptoms (sometimes just the involvement of a few) may raise a veterinarian’s suspicions of lumbosacral stenosis. But even then, the problem can be a challenge to diagnose in older dogs that suffer similar symptoms from other degenerative diseases. It’s easy to get caught up in the other diseases and miss the bigger picture.
In either case — degenerative or congenital — X-rays, myelogram, CT scan, and/or MRI are the way to go. Your veterinarian may refer you to board-certified veterinary surgeons and/or neurologists to handle these advanced diagnostic details.
The congenital form of this condition is generally seen in smaller to medium-sized dogs. The acquired form is more common in large breeds, such as German Shepherds, Boxers, and Rottweilers.
Treatment depends on how severely the dog is affected.
In mild cases, veterinarians defer to pain-relief drugs (NSAIDs) and exercise restriction. When it comes to surgical treatments, pain relievers are also employed, but veterinarians hope the drugs are necessary only in the short term.
Severe cases usually require surgical treatment to free up space for the cord to “decompress,” so the swelling and its painful or functional symptoms can be relieved. Some dogs may not, however, completely recover normal neurologic function. Rapid treatment (once the process is identified) is deemed more effective in these cases.
Prevention of degenerative lumbosacral stenosis is difficult but can be achieved by limiting weight gain (this curbs the impact of disc disease and osteoarthritis).
Dogs don’t play tennis, but that doesn’t mean they can’t have achy elbows. Elbow dysplasia — and eventually arthritis — happens simply because the elbow joint isn’t made right. Signs include pain and limping. Dogs can take supplements to support joint health and drugs to help ease pain and inflammation, but corrective surgery is often recommended.
Elbow dysplasia occurs when the bones and cartilage that make up the elbow joint don’t come together properly, leading eventually to painful movement in the forelimb.
The elbow is made up of the humerus (the long bone of the upper forelimb), which communicates at the elbow joint with the radius and ulna (the two bones that compose the lower forelimb) below it. All these bones and their associated cartilage need to develop properly and fit together just right for the elbow to withstand a lifetime of wear and tear. When they don’t, elbow dysplasia occurs.
Four abnormalities specific to the elbow are considered forms of elbow dysplasia, although other abnormalities can also be involved in the disease:
- Un-united anconeal process: A section of bone on the ulna, called the anconeal process, doesn’t unite properly with the rest of the ulna during bone growth.
- Fragmented medial coronoid process: A small piece of bone on the inside of the elbow joint develops abnormally and breaks away from the ulna bone, causing damage within the elbow joint.
- Osteochondritis dessicans: A piece of cartilage becomes partially or fully detached from its normal place inside the elbow joint.
- Elbow incongruity: Improper alignment and formation of the elbow joint
These variations of elbow dysplasia have in common one additional thing: They invariably lead to pain and elbow arthritis.
Though improper nutrition during puppyhood and trauma to the elbow can contribute to elbow dysplasia, this disease is most commonly the result of genetic factors that lead to less than optimal joint conformation.
Signs and Identification
Dogs affected with elbow dysplasia may show signs of mild to moderate pain and lameness in the forelimbs as early as 4 months old, but some will show no signs of the disease until later in life. Both elbows are typically involved, but one may be much more grievously affected.
Diagnosis of elbow dysplasia is typically arrived at through X-rays confirming visible changes to the joint. But a history of front-limb lameness in a young dog or thickening of the elbow that a veterinarian can detect during physical examination usually raises the alarm. Magnetic resonance imaging (MRI) and computed tomography (CT) scans of the area can also be very helpful to identify the exact version of elbow dysplasia present. Surgical exploration (usually through arthroscopy but also through open-joint surgery) is also considered a method for determining the extent of the joint’s damage and initiating surgical correction.
Large-breed dogs are most affected, but smaller dogs can also be affected, including Pugs, Basenjis, and Shiba Inus. Below are the top 10 breeds affected, courtesy of the Orthopedic Foundation for Animals (OFA).
- Chow Chow
- Bernese Mountain Dog
- Black Russian Terrier
- Chinese Shar-Pei
- Fila Brasileiro
- Dogue de Bordeaux
- American Bulldog
The treatment of these cases varies according to the exact form the disease has taken and the stage at which it presents. If possible, surgically removing loose flaps of cartilage and smoothing out the cartilage in the joint are undertaken. However, this is best achieved in the disease’s earliest stages. After arthritis has set in, it becomes increasingly difficult and less beneficial to do surgery.
Some veterinarians perform the surgery themselves; others may refer this procedure to a veterinary surgeon or orthopedic specialist. Some veterinarians can perform surgery using arthroscopic surgical equipment (surgically introducing a fiberobtic scope into the joint). Open joint surgery is also an option.
Non-surgical options for management include pain-relieving drugs, such as pet-approved anti-inflammatory drugs and pain medications. Long-term use of nutraceuticals (like glucosamine/chondroitin and fatty acids) has also been found to be of some assistance, as well as weight management and physical therapy/controlled exercise.
Elbow dysplasia is considered an inherited disease. Affected dogs should not be used for breeding.
Dog Limping – How to Get Your Dog Back on His Feet
A number of things –– infections, injuries, or arthritis –– can sideline your dog, leaving him with a limp. Here’s how to figure out what’s wrong and get him the help he needs.
If you see that your dog is having trouble walking –– even if it doesn’t seem like that big a deal –– you should make an appointment with your veterinarian, who can determine the problem and offer targeted recommendations to help put the spring back in your dog’s step.
When you bring your pet in, your veterinarian will likely evaluate him with a thorough physical examination and may perform lab tests and X-rays to get to the root of the problem. Common causes of limping (also known as lameness) include infections such as Lyme disease, fractures, soft tissue (ligament, tendon, or muscle) injuries, and arthritis.
No matter the cause of the lameness, it’s very important that you follow your veterinarian’s recommendations for rehabilitation and recovery, as sometimes these instructions may help your dog recover fully and even avoid surgery. And if your dog does require surgery, careful rehabilitation can ward off additional problems. That’s essential, since a fracture or joint replacement site that becomes reinjured or infected can leave few treatment options for your dog.
Sprains, Strains, and Torn Ligaments
For minor injuries, such as a slight muscle pull, your veterinarian may limit your dog’s exercise and activity. Exercise restrictions usually include keeping your dog in a small space –– for example, a crate –– and taking him or her for only short walks on a leash. Closely following these instructions can sometimes keep minor injuries from requiring expensive treatment or even surgery. Your veterinarian may also prescribe anti-inflammatory medications to help ease your dog’s pain. You should only give your pet medications that are prescribed by your veterinarian.
Traumatic Injury and Joint Replacement
Complicated injuries require a more involved recovery period. Typically, full recovery from a complex fracture repair or hip replacement surgery takes at least two to three months, and some dogs need six months of careful monitoring and rehabilitation before they are completely recovered.
If your dog has a broken bone in his leg, it may be immobilized in a molded splint or cast for four to six weeks or possibly longer. If your dog must undergo complex joint surgery, your veterinarian may prescribe complete cage rest (see box), followed by another four weeks of exercise restriction. After that, your veterinarian will offer advice on gradually increasing your dog’s activity level.
In some cases, your veterinarian may also prescribe physical therapy, including massage and hydrotherapy, to help your dog heal.
Post-Surgery Care at Home
When you leave the hospital, your veterinarian will likely prescribe medications for you to give your dog. You’ll also need to check the cast or surgical site daily and keep your dog from scratching or chewing at the sutures or bandage. If he does, an Elizabethan collar –– also known as an “e” collar –– may be necessary.
Also smart: Monitor your dog’s behavior, appetite, and water intake. If you notice anything unusual –– for example, he seems strangely tired or agitated –– contact your veterinarian.
If you notice any of the following signs, get in touch with your veterinarian immediately:
- Swelling of the limb or surgical site
- Skin rash or pressure sores (red, blistered, or raw areas)
- Unusual smell or leakage from the surgical site
When taking your dog out for bathroom breaks, keep him on a leash at all times.
Follow any instructions you get about avoiding stairs and slippery floors, and ask whether you should attach the leash to a collar versus a harness. Also ask about the best way to lift or support your dog when necessary; your veterinarian may recommend using a towel to support your dog as he walks outside to relieve himself.
No matter the cause of your dog’s lameness, it’s critical to keep all recommended follow-up appointments, so that your veterinarian can monitor your pet’s progress. If sutures were used, your veterinarian may need to remove them. If a cast was placed, you vet will want to check it periodically and eventually remove it. He may also order X-rays or other tests to see how well the injury is healing.
Extra Tip: Cage Rest
Sometimes, veterinarians recommend “cage rest”: keeping your dog in an appropriately sized crate to restrict activity. This can be difficult for both you and your pet. If your veterinarian has advised you to keep your dog in a crate, it’s vitally important to do so, even if your pet is unhappy or seems to be healing. To make this trying time easier for your pooch by keeping him occupied with plenty of toys and an occasional low-calorie treat. You may also want to turn on a radio or television for company when no one is home or pamper him with daily grooming, which can be a welcome distraction. If your dog craves company, consider placing the cage in a high-traffic area where he can watch the household’s activity. But if he’s shy or nervous, it may be a better idea to keep the crate in a quiet room.
- Joint arthroscopy is a diagnostic and/or therapeutic technique that allows the veterinarian to look inside your pet’s joints through a very small skin incision.
- A pet’s joints can be examined for signs of degeneration or trauma. In some cases therapeutic procedures can be performed. Recovery time from arthroscopic versus “open” joint surgery is generally easier and shorter.
- The procedure is minimally invasive, but the pet must be under anesthesia.
What Is Joint Arthroscopy?
An arthroscope is a specially designed instrument that allows a veterinarian to look inside joints using a tiny, sterile, illuminated fiber optic camera. Arthroscopy is a minimally invasive procedure that can be used to examine joint structures for signs of degeneration and trauma without having to perform open surgery on a joint. It can be used for both diagnostic and therapeutic purposes. For example, if a veterinarian is examining your pet’s joint for signs of degeneration, he or she can remove painful cartilage fragments or bone chips as part of the procedure.
How Is It Performed?
Because joint arthroscopy requires anesthesia, your veterinarian may recommend pre-anesthetic blood work and other pre-anesthetic testing before performing joint arthroscopy for your pet.
Before performing joint arthroscopy, the patient is placed under anesthesia. All hair is removed from the skin over the joint (to avoid introducing hair particles into the joint), and the skin is cleaned thoroughly with a surgical scrub solution to kill bacteria and other germs. The area around the joint is covered with sterile surgical drapes to reduce the risk of accidentally introducing bacteria into the joint. Finally, the veterinarian scrubs his or her hands before dressing in a sterile surgical gown and sterile gloves.
One or two tiny incisions are made through the skin and into the joint to allow access for the sterile camera and instruments. A sterile saline solution is then typically pumped into the area to inflate the joint. This helps the veterinarian visualize the area. Once the scope is inserted, the veterinarian can examine the joint with the illuminated camera. Special lenses allow areas of interest to be magnified and images captured (photographed) for later review. Small surgical instruments can also be inserted through the incision to allow the veterinarian to perform therapeutic procedures.
What Is It Used For?
Arthroscopy is useful because it can allow a veterinarian to directly visualize areas that cannot be examined completely using X-rays or ultrasound. Diagnostic and therapeutic arthroscopy can be performed in virtually any joint, including the elbow, hip, shoulder, and knee. Medical conditions that can be diagnosed using arthroscopy include:
- Elbow dysplasia
- Hip dysplasia
- Cruciate ligament injuries
- Other ligament injuries
Arthroscopy can be used to help determine if a patient is a good candidate for certain orthopedic procedures. It can help your veterinarian assess the amount of joint degeneration and help determine which surgical option for treatment may be the most appropriate.
Benefits of Arthroscopy
The recovery time for pets after an arthroscopic procedure has been performed is generally brief compared to recovery time for pets that have undergone open-joint surgery. Rather than a large incision, arthroscopy requires only one or two small incisions to be made in the skin. Many pets experience minimal discomfort after the procedure. Arthroscopy also causes less disruption of fragile tissues surrounding the joint and as a result there is a reduced chance of swelling. An additional benefit is that diagnostic or therapeutic arthroscopy may negate the need for a more invasive surgery if a problem can be accurately diagnosed and treated.
Despite the fact that arthroscopy is a minimally invasive procedure and your pet may experience little to no discomfort afterwards, it is very important to carefully follow your veterinarian’s instructions regarding recovery, including any limitations placed on activity.
Osteochondrosis: Osteochondritis Dissecans (OCD) of the Knee, Ankle, and Spine in Dogs
In many joints, the surfaces of bones are lined with cartilage to allow the bones to glide smoothly during movement. Sometimes that cartilage is defective, and that’s where osteochondritis dissecans (OCD) comes in. The disease, characterized by a lifting or separation of the cartilage, can affect the knee, ankle, and spine of dogs. It is almost always diagnosed in large and giant breeds less than 1 year of age. Limping in one or both back legs is the first sign of trouble in the case of OCD of the knee, ankle, or spinal versions of the disease. Treatment almost always involves surgery.
Osteochondrosis is a developmental disease where portions of the cartilage do not mature at the same rate as the surrounding cartilage. As a result, the cartilage can become thickened in these areas and prone to injury. (Refer to osteochondrosis of the shoulder and elbow for more detailed information.) Any type of force, such as one bone hitting another when a dog leaps, can cause these areas of cartilage to crack and lift away from the bone. When this occurs, the condition is referred to as osteochondritis dissecans.
In OCD of the knee, ankle, and spine, small cracks in the cartilage lead to a lifting or separation of the cartilage, often resulting in a partially or fully detached flap of cartilage in the joint, thereby compromising the ultra-smooth, gliding movements we expect from our dogs’ joints.
Pain from the rubbing caused by the presence of this abnormal cartilage is the inevitable result. The joints of the knee and ankle are most commonly affected, though lesions like this have been seen in other joints as well — most notably at the lumbosacral joint in the spine.
Although OCD has been seen in cats and small dogs, it is almost always diagnosed in young large- and giant-breed dogs (4 to 8 months is most typical).
Symptoms and Identification
Limping in one or both hind limbs is the most common sign. Affected dogs may not always appear terribly painful — though some undeniably are. They may only have trouble upon rising or appear stiff when they walk. A characteristic “slinky” gait has been described for some hind limb OCD dogs.
Diagnosis is best achieved through X-rays, though some dogs may require CT (computed tomography) scans or even surgery (arthroscopy or arthrotomy) for a more accurate diagnosis.
Osteochondrosis of these joints is seen in a wide variety of dogs, though most often in large- and giant-breed dogs.
- In the ankle or hock (the most commonly affected joint after the shoulder and elbow), Rottweilers and Labrador Retrievers account for more than 70 percent of cases.
- For the knee form, Great Danes, Labrador Retrievers, Golden Retrievers, Newfoundlands, and German Shepherds are the most commonly affected.
- In the lumbosacral version, German Shepherds, Boxers, and Rottweilers are overrepresented, as are males of these breeds (by a four to one margin over females).
If cartilage lesions are recognized early, at 4 to 6 months of age, before cartilage flaps have formed, it’s possible that the lesions may heal with conservative management. In these cases, dogs may do well on pain medications (like NSAIDs), exercise restriction (until the signs completely subside), nutraceuticals (such as glucosamine), and appropriate weight and nutritional management.
Once a cartilage flap has formed, however, it will not heal, and surgery may be necessary to remove the abnormal cartilage. Still, surgery is not always completely curative in these cases. Knee sufferers, in particular, tend to experience more complications than others, especially if the disease is diagnosed later (past 12 months of age).
Surgery happens either through arthroscopy (a small camera and instruments are inserted into the joint through tiny incisions) or a variety of open-joint techniques (arthrotomy) for all affected joints.
There are many factors that may lead to osteochondrosis and OCD, including genetics, rapid growth, excessive dietary calcium, and trauma. One way to prevent OCD is through genetic management. In other words, affected dogs should be spayed and neutered so as not to risk passing down the genetic traits that may lead to this condition.
Additionally, owners should understand that slower growth rates might reduce the risk of OCD. That’s one reason many veterinarians recommend lower-calorie diets for large-breed, growing dogs. Eschewing calcium supplements is advisable. Because hard cement or wood walking surfaces may lead to trauma, softer surfaces, such as carpeting, is also a good idea for puppies of susceptible breeds.
Some veterinarians may also recommend nutritional supplements that target the joint (such as glucosamine) to help support normal cartilage and attempt to ward off the development of osteoarthritis.
10 Ways to Help an Arthritic Dog
When your dog is in pain, you want to help him feel better — fast. Luckily, there are quite a few things you can do to relieve the aches that are an everyday occurrence for dogs with arthritis:
- Take your dog in for regular checkups so that your veterinarian can monitor your pet’s arthritis and make necessary adjustments to the treatment plan.
- Getting or keeping your dog slim can help by decreasing the load on his joints. Your best bet: feeding your dog the right amount of high-quality food.
- Controlled exercise is a must, but make sure you carefully monitor your dog while she plays, walks, or runs. If possible, find a soft surface for activity. Your veterinarian can offer more suggestions for getting your dog moving regularly.
- As much as possible, keep your dog warm and dry, since cold and damp conditions can aggravate arthritis. Consider investing in a padded dog bed and apply warm compresses to painful joints.
- Ask your veterinarian for a recommendation to a professional animal massage therapist, as massage can increase your dog’s flexibility, circulation, and sense of well-being.
- Pain medication, including nonsteroidal anti-inflammatory drugs (commonly called NSAIDs), may help relieve pain, and disease-modifying osteoarthritis drugs (DMOADs) can also play an important role. Talk to your veterinarian before giving your dog any medication.
- Glucosamine and chondroitin supplements can be used to help improve joint mobility and support better joint functioning for dogs with arthritis.
- Acupuncture isn’t just for people. This painless technique has shown some success in animals suffering from arthritis.
- If your dog’s arthritis is advanced, surgery may be an option. Ask your veterinarian about the pros and cons of surgery and what you can expect.
- Be sure to take steps to adjust his environment at home. Some things that can help an arthritic dog include: providing soft supportive bedding for his achy joints, using ramps to help a dog get in and out of a car or up to a bed, and putting down carpeting and secure rugs to help him get traction as he walks.
Remember: A low-stress environment, plenty of affection, and supportive care can help your dog feel so much better.
Rehabilitative Medicine (Rehab) for Dogs With Osteoarthritis
- A rehabilitative medicine program can dramatically increase strength and mobility, improving overall quality of life for dogs with osteoarthritis.
- Pain is often the main hindrance to initiating a rehabilitation program. If a dog responds to pain management quickly, rehab can begin as soon as possible and can continue based on the dog’s abilities.
- In many cases, improvement can be seen within days. Regular exercise should continue long term but must be carefully controlled to prevent injury.
What Is Rehabilitative Medicine?
Traditionally, treatment for arthritis in dogs (more commonly called osteoarthritis) has focused on using medications to relieve joint pain and inflammation. Many veterinarians also incorporate joint supplements, weight control, and other management tools to give arthritic dogs more help. However, medications can’t improve a dog’s strength or fitness level, which directly affects mobility. Rehabilitative medicine, also known by the term rehab, can help meet this therapeutic need. Properly undertaken, a rehabilitative medicine program can dramatically increase strength and mobility, improving overall quality of life for dogs with osteoarthritis. Some consider rehabilitative medicine a tool that is reserved for dogs recovering from orthopedic surgery or injury. However, because the principles of rehabilitative medicine are fairly universal, this therapy can also be very useful for managing dogs with osteoarthritis.
The overall goals of rehab are to improve comfort, joint motion, and strength. During the early stages of osteoarthritis, pain relief is a primary goal, and rehabilitative practices can help accomplish that. As osteoarthritis progresses, the body undergoes other changes including reduced joint motion, loss of muscle mass, and decreased muscle strength. A well-structured rehab program can combat these complications as well.
What Are the Techniques and Equipment Used in Rehabilitative Medicine?
Pain is often the main hindrance to initiating a rehabilitation program. If a dog is in pain, even passive stretching and massage are uncomfortable. In contrast, if a dog responds to pain management quickly, rehab can begin as soon as possible and can continue based on the dog’s abilities. Pain medications, joint supplements, and other products can continue as needed to keep the dog comfortable, control inflammation, and promote a continued willingness to exercise.
The techniques and equipment needed for rehabilitative therapy vary depending on the needs of the patient but can include the following:
- Stretching. Stretching exercises are an important part of any rehab program. Your veterinarian can show you how to do this properly. Moist heat can be used first to warm the muscles. Once the target muscles are warm, manual stretching can begin. In some cases, a hinged brace can be used to control range of motion for weak joints as they are flexed and extended to improve mobility.
- Controlled exercise. Depending on a patient’s abilities, ramps, controlled leash walking, and agility courses can all be used as part of a rehab program. The key is to control the exercise and range of joint motion to decrease the likelihood of injury. If building ramps and purchasing agility course equipment is not convenient, pet owners can often achieve favorable results using controlled leash walks. The goal is to provide the dog with low-impact exercise (no leaping or jumping) to build muscle strength and tone without injuring the joints.
- Underwater treadmill and swimming. Although generally only available in a clinic setting, an underwater treadmill is a very useful piece of equipment for patients undergoing rehab therapy. An underwater treadmill consists of a tank filled to a certain level with water (usually just below the dog’s hip area), with a treadmill at the bottom. Compared with walking on land, the underwater treadmill is easier on the joints and decreases the risk of injury. Compared with swimming, another popular method of rehabilitation, the motion of walking is advantageous because the action of walking is more predictable, and the patient’s speed can be easily controlled. In contrast, it is difficult to control speed for a dog that is swimming. Swimmers are also likely to flex their backs while swimming, making range of joint motion more difficult to control. Also, dogs walk with all four legs but tend to swim primarily with the front legs, so walking is a better exercise for dogs with rear limb problems.
- Swimming does have benefits for dogs with osteoarthritis — it strengthens the forelimbs and develops core strength (chest and abdomen); this can be helpful for a dog that has lost overall strength because of chronic joint disease. However, the underwater treadmill is likely a better option for its ability to protect the joints, control range of joint motion, control level of exertion, and provide an overall conditioning and strengthening activity.
What Are the Therapeutic Outcomes With Rehabilitative Medicine?
Your veterinarian may recommend and structure a rehab program for your pet or may refer you to a rehab specialist to get you started. Once a dog begins a rehabilitative medicine program, results are generally observed quickly. Pain relief can be the most rapid result. If a dog is having an arthritis flare-up, ice can be used with pain medication to provide quick relief. Improved limb use can be observed within days to weeks of initiating a program. However, progress depends on the degree of disuse that was present initially. A more chronically affected dog can be expected to take a longer time to respond. Improvements in overall strength can also be observed during the first few weeks of therapy.
Once initial improvements are made, the goal is to continue the program, modifying and increasing as necessary, to maintain the patient at a level where strength and mobility remain favorable. Ideally, regular exercise should continue long term but must be carefully controlled to prevent injury.