Cruciate Ligament Rupture

(Ruptured Anterior Cruciate Ligament)

If your pet has been diagnosed with cruciate ligament damage, you must recognize the importance of immediate treatment. Damage to the cruciate ligament can result in joint instability. Prompt diagnosis and repair can prevent the onset of arthritis, improve your dog's quality of life and perhaps extend its life expectancy. Awkward or restrictive movement in dogs is often the first sign of underlying orthopedic problems.

Often associated with pain, the pet owner may notice a limp, hop or the tendency to avoid use of a leg when walking. This unusual occurrence prompts a visit to the veterinarian to determine the cause of the condition. Occasionally, the irregular gait is caused by a slight injury, in which case the symptoms fade within a few days. However, ongoing irregularities signal the need for a thorough examination to determine the cause of the condition and to chart the course of treatment.

If you can identify that your dog's knee is a source of pain, suspect rupture of the anterior cruciate ligament or subluxating patellas. The anterior cruciate ligament is a very important structure in the knee (stifle) joint of the dog. This ligament helps strengthen and stabilize the knee, enabling the joint to function through its normal range of motion.

Rupture of the anterior cruciate ligament is one of the most commonly encountered orthopedic injuries seen in dogs. Large dogs, especially those with heavy musculature, display a high incidence of this condition.

Structure and Function The knee joint of the dog connects the femur (thigh bone) to the tibia and fibula. The cruciate ligaments form an X-shaped apparatus, which runs from the front of the joint to the back of the knee. This structure is critical to the stability of the joint. It prevents the two major long bones from moving too far forward or backward. This also allows for the joint to twist on its long axis without dislocating.

Recognizing Rupture Rupture of the anterior cruciate ligament can be caused by acute injury or chronic degeneration. The injury can be severe, or it may involve a partial tear.

Acute rupture is usually associated with a blunt, traumatic injury, such as an automobile accident. Dogs with these injuries are often very lame and avoid placing weight on the injured leg. The joint usually swells and is very painful when manipulated. More commonly, damage to the ligament is thought to be caused by chronic degenerative changes which result in joint instability.

These changes can lead to inflammation and damage to the articular cartilage of the joint. The cartilage begins to degenerate and erode, with changes in the surrounding bone occurring. This signals the beginning of arthritis and can lead to permanent dysfunction of the joint. Inflammatory changes are usually apparent within one week of injury.

Therefore, quick repair of the affected joints is critical to the dog's prognosis for recovery. The joint must be stabilized as soon as possible if the dog is expected to return to former activities.

Diagnosis

Your veterinarian can diagnose rupture of the anterior cruciate ligament by physical examination of the joint and with radiographs. Your veterinarian will palpate the knee using an assessment known as the "drawer sign". This will detect the abnormal forward movement of the tibia relative to the femur, which is normally held in a stable position. In acute rupture, radiographic examination can eliminate the suspicion of fractures or other injuries. With chronic ruptures, radiographs can identify degenerative or arthritic changes. Newer technology, such as Nuclear Medicine scintigraphy (bone scan) and Magnetic Resonance Imaging (MRI), can also confirm rupture or tearing of the anterior cruciate ligament.

Treatment Luckily, ruptured anterior cruciate ligaments are fixable. Many surgical techniques are available for repair of the cruciate ligament and/or stabilization of the joint. The technique selected by a veterinarian may be based on the size of the dog or the duration of the injury. Regardless of technique, the goal of surgery is to stabilize the joint and prevent the abnormal movement that results in degenerative change. Most techniques involve either repair of the ligament, replacement of the ligament (with grafted tissue or artificial material), or by augmenting a partially torn ligament.

Medical treatments with anti-inflammatory drugs, such as aspirin, may help relieve pain and inflammation. Newer drugs to combat the degenerative changes in the cartilage and help prevent arthritis are under development. These drugs may help protect cartilage from degeneration and may be useful after surgery to enhance healing. Hind leg lameness of sudden or slow appearance should alert the pet owner to possible rupture of the anterior cruciate ligament. A visit to the veterinarian for an examination can confirm the presence of this common injury.

Hip Dysplasia

Canine hip dysplasia is a developmental disorder of the hip that begins with joint laxity and progresses to arthritis over a period of several months to years. It is one of the most common skeletal diseases seen by veterinarians. The condition is very common in large breed dogs, but can be seen in any breed. Multiple genes are involved in the inheritance of hip dysplasia, and many other factors influence its development, including body type, size, growth rate, and nutrition. overfeeding, and dietary supplementation for maximal growth has been shown to increase the incidence of hip dysplasia in young, growing, large breed dogs. Conversely the development of hip dysplasia can be delayed, and its severity diminished when the growth rate of pups is restricted.

Diagnosis The diagnosis of hip dysplasia is based on history, physical examination, and radiographic evaluation. A typical history may include any or all of the following: difficulty or stiffness upon rising rising using front legs only and dragging rear "bunny hopping" 'gait short stride in rear legs reluctance to exercise or climb stairs rear limb lameness soreness in hips waddling rear limb gait The clinical signs commonly begin between five to eight months of age or after skeletal maturity. Some dogs don't have noticeable problems until eight to ten years of age or older. The onset of clinical signs may appear sudden or gradual. This variability is due to the individual severity of the disease as well as pain tolerance of the pet. Most dogs with CHD are most painful when the hips are extended by pulling the rear legs back behind the body. Palpation of the hips usually reveals joint laxity, although anesthesia may be required to detect it in some cases.

Radiographs are necessary to confirm the diagnosis and evaluate the severity of CHD. In young dogs or in very mild cases, joint laxity may be the only detectable abnormality. Later in the disease arthritic changes are seen. The standard radiographic position is with the dog lying on its back with both rear legs pulled straight back and parallel to each other. Most dogs with CHD are too painful to tolerate this position awake, so sedation or anesthesia is usually necessary. Proper radiographic positioning is very important to accurately evaluate the hips and to determine the best treatment.

The Orthopedic Foundation of America (OFA) has been the standard for certification of dog's hips as being free of CHD. The radiograph is taken after the dog is 2 years of age and requires the hip extended position. Unfortunately, our progress has been disappointing in reducing the frequency of CHD using OFA alone. Recently the PennHIP program has emerged as a new scientific method for the early diagnosis of CHD. It measures the passive hip joint laxity or "looseness" of the hip ball in the hip socket under sedation or anesthesia. PennHIP is more reliable and has the advantage of being accurate on puppies as young as 16 weeks of age. Treatment Medical and/or surgical treatment may be recommended for CHD, depending on the individual circumstances.

Medical management usually consists of exercise restriction, body weight management, and symptomatic pain management with analgesics and anti-inflammatory drugs. A non-weight bearing activity like swimming is the preferred type of exercise since it places minimal stress on the joints. Several surgical options are now available for treating the various stages of hip dysplasia. They include the triple pelvic osteotomy, femoral head and neck excision, and total hip replacement.

Triple Pelvic Osteotomy

The ideal candidate for this procedure is a young dog (5 months to I year of age) with clinical signs of CHD, including hip joint pain and laxity, but little or no radiographic signs of arthritis. In this procedure the acetabulum (hip socket) is rotated to a more normal position in relation to the femoral head. This seats the head more deeply into the socket. The pelvis is then stabilized in this new position with a specially designed pelvic osteotomy plate and bone screws. The procedure eliminates the joint laxity and corrects the abnormal conformation of the socket. Thus, the hip is able to develop more normally without developing arthritis. overall, with proper case selection, it appears that approximately 90% of dogs achieve good to excellent results and return to athletic endeavors. Owners have been uniformly very pleased with the results and have had no reluctance recommending the procedure to others.

If a TPO is performed on the opposite leg, it is performed 3-6 weeks later. Femoral Head and Neck Excision

When arthritis develops in a dog with hip dysplasia the damage is irreversible, so a triple pelvic osteotomy will not restore normal hip function or eliminate the pain. instead, a salvage procedure is needed that removes the source of pain. Two such procedures are the femoral head and neck excision and the total hip replacement. The femoral head and neck excision is the most commonly performed procedure. It involves removing the femoral head, which is the ball portion of the joint. The body's reaction is to form a false joint, which along with the surrounding pelvic muscles minics joint function. Although this does not return the hip to normal, it significantly relieves the pain of arthritis. making the leg more functional and comfortable. Thus, the dog usually becomes more active. The advantage of this procedure is that it is relatively simple, has few complications, can be performed at any age, is relatively inexpensive and has good results in the majority of dogs.

Best results are obtained in small and medium sized dogs. Total Hip Replacement

This procedure involves removal of both the ball and socket portions of the hip joint and replacing them with artificial implants. It is currently the best available treatment for severe hip dysplasia in large, mature dogs. Currently, the success rate is reported to be over 95%, and dogs with successful implants are able to perform almost any task performed by dogs with normal hips. Therefore, it is the treatment of choice for dogs used for working or sporting activities or when optimal hip function is desired. Candidates for total hip replacement are typically large breed dogs with irreparable disease or injury to the hip joint. The dogs must be fully grown ( minimum 9 months of age), over 40lbs, free of any infections, debilitating conditions, or neurologic disorders. Their health is fully evaluated before surgery to minimize the risk of complications. Despite extensive precautions, complications are reported in approximately 10% of the cases. Many are correctable, but some serious complications may require removal of the implants.

Proper home care after surgery is very important to the success of the procedure. Strict confinement and close supervision is required for the first eight weeks after surgery. 80% of cases require surgery on only one side. Ultimately most dogs regain full, pain free function after total hip replacement, and live normal active lives.

disk disease, Intervertebral disk herniation

Slipped disk, disk disease, herniated disk

AffectedAnimals Dogs are most often affected; rarely cats may develop a similar disease process. Male dogs are more likely to have disk degeneration than females. Factors that increase the risk of disk degeneration include genetic predisposition, excessive weight, and lack of muscular fitness.

Breeds genetically predisposed to degenerative disk disease include those affected with chondrodystrophy or abnormal cartilage development. Affected breeds include dachshunds, beagles, cocker spaniels, pekingese, French bull dogs, basset hounds, Welsh corgis, small poodles and other mixed-chondrodystrophoid breeds. Large, older dogs without chondrodystrophy may also develop degenerative disk disease.

Overview Intervertebral disks connect the vertebrae, or bones, of the spinal column together. These disks provide flexibility and support. Degeneration of an intervertebral disk may lead to protrusion, or bulging, or it may cause herniation, or rupture. Pain and weakness or paralysis may occur, depending on the degree of damage to the spinal cord. Damage is the result of both mechanical compression of spinal tissue and secondary reactive vascular and chemical changes within the tissue. This damage to tissues results in disruption of normal spinal cord function.

Small dogs, especially those with faulty development of the cartilage, termed chondrodystrophy, are prone to sudden disk ruptures and to a rapid onset of symptoms. Large dogs are much more likely to have gradual disk protrusions with slowly progressive pain and weakness, although they can also experience rapid herniations. Dogs with symptoms of disk herniation should be evaluated immediately by a veterinarian. Diagnosis of a disk herniation is confirmed with x-rays and/or a myelogram, which is a special dye study that allows precise localization of spinal cord lesions. Depending on the severity of the case, and the overall condition of the affected dog, treatment may involve medication or surgery. Many dogs with disk ruptures recover. However, in very severe cases, in which the dog has lost the ability to feel deep-tissue pain, the paralysis may be permanent.

Clinical Signs Pain, ataxia, loss of conscious proprioception, paresis, and paralysis are common. Occasionally dogs become anorectic.

Symptoms A dog with intervertebral disk degeneration, and resulting herniation, may have general symptoms including reluctance to move, decreased appetite, and crying out in pain, or hiding from others. The affected dog may stumble when attempting to walk, or be unable to rise.

When the disk herniation occurs in the neck, or cervical spine, the animal may also show symptoms of stiff neck and muscle spasms, with occasional lameness and pain in one front limb. The dog may hold its head low. Infrequently, paralysis of all four limbs may occur.

A dog with degeneration and herniation of a thoracolumbar disk, or a disk in the mid-to-lower back, may have an arched back, in addition to the general signs. Weakness in the rear limbs may be present, and may progress to hind-limb paralysis and incontinence, or inability to control bladder and bowel function. A severely affected dog will lose all sensation to the hindquarters.

Description The spinal cord is encased by the backbone, which is composed of a series of individual vertebrae separated by disks. Together, the vertebrae and disks compose the vertebral column, which extends from the head to the tail of an animal. Disks act as cushions between the vertebrae and permit flexibility of the vertebral column. The inner core of each disk is called the nucleus pulposus, a jelly-like substance that promotes spinal flexibility. The outer covering is the annulus fibrosis, which is normally a tough, fibrous structure.

As disks degenerate, the nucleus pulposus loses its gelatinous consistency and the annulus fibrosis weakens. This condition eventually permits a disk to protrude or herniate into the spinal canal, compressing the spinal cord and interfering with its functions. The injury to the spinal cord is progressively worsened by vascular and chemical changes. These changes occur in the tissue and cells of the spinal cord and begin immediately after, and in response to, spinal cord damage by the herniated disk. The result is altered blood flow producing areas with reduced oxygen, and the release of toxins and excessive amounts of neurotransmitters. These chemicals lead to cell damage and death. There are two kinds of invertebral disk degeneration. Hansen Type I disk degeneration typically occurs in small dogs that have a particular type of skeletal development, termed chondrodystrophy, where cartilage, including spinal cartilage, develops abnormally. Hansen Type I degeneration can cause abrupt disk rupture, with sudden onset of pain and paralysis as nuclear material explodes into the spinal cord. Clinical signs of this type of disk degeneration usually develop in middle-aged dogs. Hansen Type II disk degeneration occurs in older, large, and non-chondrodystrophoid breeds. In these cases there is a gradual protrusion of the nucleus pulposus, and a slow progression of pain and weakness. Because of the anatomical characteristics of the vertebral column, the most likely sites of disk rupture are the neck, or cervical region, and in the mid-to-lower back, or thoracolumbar region. Disk disease in the neck typically results in neck pain, lack of coordination, and, less frequently, weakness of all four limbs. Occasionally there is lameness and pain in one front limb, and, in rare cases, complete paralysis of all four limbs. The clinical signs of thoracolumbar disk herniation depend on the amount of disk material involved, and the force with which the herniation occurs. Signs can range from back pain alone to complete paralysis and loss of sensation in the hindquarters.

Diagnosis A provisional diagnosis of degenerative disk disease is based on the symptoms, history, the breed and age of the dog, and the findings of a neurological examination. The diagnosis is confirmed and the exact site of the disk rupture determined by spinal x-rays. Commonly, a myelogram is performed to fully visualize the affected disk, especially if surgery is elected. A myelogram is a spinal x-ray where radiopaque contrast or dye has first been injected around the spinal cord. Rarely, diagnosis may require advanced imaging, as with MRI or CT.

Prognosis Dogs with degeneration of a cervical disk have good prognoses. Many dogs will improve with medical management alone, although there is a 33 percent chance of recurrence of the problem. Additionally, the neck pain tends to respond more slowly, and may be more difficult to control with medical management. Decompression and fenestration yield better results in a higher percentage of dogs than medical treatment alone. When a cervical disk rupture results in a dog not being able to walk, the degree of recovery depends on the location of the disk rupture and duration of immobility before surgery is performed.

Dogs with degeneration of the thoracolumbar disk have prognoses that depend on whether the dog is able to feel deep-tissue pain. Even dogs that are severely weak or paralyzed have a good chance of recovery, as long as they can feel deep-tissue pain, and undergo surgical decompression within 48 hours of symptom onset. Dogs may respond to medical management alone, but without surgery, recurrence is likely. Following recovery from disk herniation, dogs may experience problems at another site. The reported incidence of additional herniation varies from seven to 15 percent in various studies.

Transmission or Cause Degeneration of a vertebral disk may result in eventual protrusion, or herniation, of the disk into the spinal canal with impingement of the spinal cord. In dogs with chondrodystrophy, genetic predisposition to disintegration of a disk combines with the normal forces of weight bearing and motion about the joints of the spinal column to cause vertebral disk degeneration and herniation. Large, older dogs without chondrodystrophy develop disk degeneration and herniation from long-standing stresses on the spine alone.

Treatment Dogs with symptoms of disk disease should be seen by a veterinarian without delay. It is important to keep them quiet and still. Confinement in a cage or crate until examination is recommended. The dog should not be encouraged to walk or jump, as this may make the situation dramatically worse by causing more disk material to herniate. The sudden onset of weakness or paralysis calls for emergency treatment. The goal of treatment is to reduce spinal cord swelling, inflammation, and compression as quickly as possible, so that normal spinal function will return. Disk herniation may be managed either medically or surgically, depending on the findings of a neurological examination and the overall condition of the dog.

Medical treatment consists of strict cage rest for three to four weeks. Medication to reduce pain and inflammation may be used with care when the patient is under direct veterinary supervision. Eliminating an animal’s pain entirely encourages it to become overactive, and this will increase spinal cord injury. Medical management is indicated for initial episodes of pain, pain combined with mild lack of coordination, dogs with other medical conditions that preclude surgery, and dogs that have lost the ability to feel deep-tissue pain for more that 48 hours. Many dogs that have maintained the ability to feel deep-tissue pain will improve with medical treatment alone. In these cases, however, recurrence is likely, and some residual neurological deficits may remain.

Surgery should be considered when there have been repeated episodes of mild signs, when a dog that is being treated medically deteriorates, when there is progressive neurological dysfunction, or when there is moderate to severe weakness or paralysis. Surgical techniques may involve fenestration, decompression, or both. Fenestration is a surgical technique in which the disk space is opened and the nucleus pulposus is removed without entering the spinal canal. Fenestration alone may be beneficial in cases in which there have been repeated episodes of pain without any other signs, or when there is a second episode of pain and mild weakness.

Surgical decompression is a technique in which a portion of the vertebra at the disk rupture site is removed, thus reducing the compression of the spinal cord and allowing removal of the ruptured disk from the spinal canal. Decompression is indicated when there is moderate to severe weakness or paralysis. Dogs that are paralyzed and have no deep-tissue pain sensation should ideally undergo decompressive surgery within two hours. If a dog has lost deep-tissue pain sense for greater than 48 hours, the likelihood that surgery will be beneficial is extremely small and surgery is not recommended. Methods of decompression include ventral slot, in which the spinal cord is approached through the bone from the bottom. This is generally done only with cervical disk disease. Hemilaminectomy, in which the spinal cord is approached from the right or left side, is usually performed with thoracolumbar disk disease. Dorsal laminectomy, in which the spinal cord is approached from the top, is performed in some cases of cervical, thoracolumbar, and lumbar disk disease. Adequate nursing care both for post-operative patients and for weak or paralyzed dogs that are being managed medically is critical to their overall recovery.

The dogs should be kept clean and dry, and provided with a well-padded surface to prevent the development of bedsores. Urinary bladder function must be carefully monitored and maintained to prevent over-distension and secondary bacterial infection. Most patients are hospitalized until they regain control of bowel and bladder. Strict exercise restriction for three to four weeks is critical. Physical therapy is important for post-operative patients, in order to maintain muscle tone and flexibility.

Prevention Dogs should be fed properly and regularly exercised since excessive weight and lack of muscular fitness are among factors that lead to disk degeneration. Dogs with a history of intervertebral disk disease may be restricted from stairs or situations that add to stress on the spine, such as jumping onto furniture or into the car, or down from heights.

Osteochondrosis, osteochondritis dissecans (OCD)

OCD, osteochondrosis, osteochondritis dissecans, shoulder/elbow/stifle dysplasia, joint mice

Affected AnimalsDogs, pigs, horses, cattle, chickens, and turkeys.

Overview Osteochondrosis is a disease that affects cartilage formation; the cartilage, due to an abnormal thickening, is unable to receive a normal supply of nutrients from the joint fluid, causing it to become weaker and more susceptible to damage. Cartilage provides a protective gliding layer between the bones in a joint, and when it is injured and lesions form, the dog will experience pain, lameness, and arthritis. Lesions may occur on one or both sides of the body.

1.Scapula

2.Humerus

3.Humeral Head

4.Floating Cartilage and Bone

5.Detachment Site

In all animals, osteochondrosis can affect many different joints, but in the dog, the most common sites of disease are the shoulder, elbow, stifle or knee joint, and tarsus or hock. Generally, osteochondrosis occurs in young, large to giant breeds, although it is also seen in mixed breeds. The most commonly affected breeds include the German shepherd, golden and Labrador retriever, rottweiler, Great Dane, Bernese mountain dog, and Saint Bernard.

Clinical Signs Lameness, pain, crepitus, and swelling of the affected joint(s).

SymptomsLameness and pain.

Description Osteochondrosis, or OCD, is a disease of cartilage formation that results in weakened cartilage. Because cartilage is the contact layer between bones forming a joint, joint pain, lameness, and progressive arthritis result when the cartilage is damaged. A form of the disease called osteochondritis dissecans (OCD) occurs when a weakened layer of cartilage forms a flap that becomes elevated because of joint fluid dissecting between it and the surrounding cartilage and bone. Mineralization can occur when the flap breaks off and floats around in the joint. This complication, called a joint mouse, can result in a "pebble-in-the-shoe" feeling of irritation for the dog, as well as intermittent or persistent lameness. Osteochondrosis can affect any joint, but generally, there are four commonly affected joints in the dog:

Shoulder osteochondrosis, or shoulder OCD, causes a lesion to develop on the head of the humerus, which is the bone in the upper front leg. Although this condition occurs while the dog is growing, some animals will not show signs of disease until they have matured fully and more advanced disease is present. However, the majority of animals show lameness early on, between the ages of five and 10 months. In 25 to 75 percent of the cases, both shoulders are affected. The lameness is usually one-sided and tends to improve with rest. With exercise, though, the lameness recurs. Pain is seen on extension of the shoulder. The amount of arthritis present depends on the size and duration of the lesion. Because osteochondrosis is often bilateral, it is necessary to take x-rays of both shoulders to evaluate the extent of the disease.

Primarily occurring in large to giant breed dogs, elbow osteochondrosis is one of three diseases that are grouped under the term elbow dysplasia. The other diseases, ununited anconeal process and fragmented medial coronoid process, are described under separate encyclopedia headings. With elbow osteochondrosis, the lesion is usually seen on the inside of the humerus. Most dogs with elbow osteochondrosis are presented for lameness at less than one year of age. As with the shoulder form of the disease, some animals may not be seen until they are much older, after the onset of significant arthritis. The lameness may be intermittent or persistent, tending to improve with rest and worsen with activity. Because it can be difficult to differentiate between elbow and shoulder osteochondrosis, x-rays of both joints may need to be taken. Even with x-rays, though, it can be difficult to detect a lesion in the elbow. Exploratory surgery may be needed in some cases before arrival at a definitive diagnosis.

Stifle osteochondrosis, which occurs in the knee joint, affects the same breeds and types of dogs that develop shoulder and elbow osteochondrosis, but it is much less common. Dogs with this disease usually show a slow onset of lameness that worsens with activity. The lesion will occur on the femur, the large bone in the thigh—usually on the outer part of the bone. The degree of arthritis depends on the size and duration of the lesion. Tarsal or hock osteochondrosis occurs in large dogs, most commonly the Labrador retriever and rottweiler. Hind-limb lameness and a straight-hocked stance are the most common signs. The joint will appear thick and will be painful on manipulation. With this form of the disease, arthritis tends to develop more rapidly and become more severe.

Diagnosis The veterinarian may presume a diagnosis of osteochondrosis if the dog shows signs of disease and is a commonly affected breed. A definitive diagnosis requires analysis of x-rays.

Prognosis The prognosis for shoulder osteochondrosis is excellent. Dogs with this disease often become normal after surgery, unless the lesion has been long-standing and arthritis has set in. The prognosis for elbow osteochondrosis is good but becomes guarded if significant arthritis is present. The prognosis for stifle osteochondrosis is good unless the lesion is very large or significant arthritis is present. The prognosis for tarsal or hock osteochondrosis is guarded because most of the dogs with this form of the disease already have significant arthritis. If the arthritis is severe, surgery may be no more effective than medical management.

Transmission or Cause The cause of osteochondrosis is unknown, but because the disease is primarily seen in large and giant breed dogs, a genetic component is suspected. Other factors, such as a high calorie diet, and diets that promote rapid growth, are also thought to be significant.

Treatment The treatment of osteochondrosis is surgical. A chondroplasty procedure, in which the cartilage is reshaped, involves opening up the affected joint to expose the lesion, removing the abnormal cartilage, and exposing the deeper blood vessels. Scar cartilage will fill in the defect, decreasing or eliminating the pain caused by the lesion. Medical management of osteochondrosis consists of weight loss and non-steroidal anti-inflammatory medications, such as aspirin, carprofen, or etodolac.

Prevention Prevention generally includes avoiding calorie-dense diets in large to giant breed dogs. Puppies should be fed adult diets or giant breed growth formulations, and vitamin over-supplementation should be avoided. Maintaining a lean body condition also seems to decrease the risk of osteochondrosis.

Canine Panosteitis, eosinophilic panosteitis

Panosteitis, growing pains

Affected AnimalsDogs.

Overview Rapidly growing dogs may experience pain that arises from the long bones in the limbs. These "growing pains" are known clinically as panosteitis, a disease affecting young dogs between the ages of five to 12 months. Lameness that shifts from leg to leg is a common symptom of panosteitis. Nausea and fever may occur as well. Although the pain associated with panosteitis can be acute, this discomfort—along with the other symptoms—almost always goes away once the dog has matured. Large breeds, particularly the German shepherd, are most commonly affected by panosteitis, which also is reported fairly frequently in the golden and Labrador retriever, Great Dane, Scottish terrier, and Doberman pinscher breeds.

Clinical Signs Long bone pain, shifting leg lameness, fever, anorexia, lethargy.

Symptoms Lameness that may shift from limb to limb, pain, fever, and loss of appetite.

Description Affecting young, rapidly growing dogs of larger breeds, panosteitis is a disease that causes inflammation in the marrow cavities of long bones such as the humerus, radius, ulna, femur, and tibia. This inflammation leads to pain and the production of reactive bone that results in lameness and sometimes fever.

1.Pelvis

2.Lesions of Panosteitis

3.Femur

Because it can affect different bones at different times, frequently the lameness will "shift" from limb to limb. These cycles of lameness may last from two to three weeks for each affected bone. Often, there will be periods of apparent normalcy between the periods of lameness. Fortunately, although very painful, the disease usually disappears when the dog reaches maturity.

Diagnosis The veterinarian may presume a diagnosis if the dog shows signs of the disease and is a commonly affected large breed. A definitive diagnosis requires x-rays. However, x-rays taken early in the course of the disease may not always demonstrate the lesions; thus it may be necessary to repeat x-rays on the dog two weeks later. In repeat x-rays, the characteristic changes often will be present.

Prognosis Prognosis is excellent, as most dogs recover with no permanent effects. Occasionally, panosteitis will flare up in mature dogs, but this is quite unusual. Some dogs can, however, be in extreme pain and it may be difficult to keep them comfortable while the disease is active.

Transmission or Cause The cause of panosteitis is unknown. There is speculation that it may be viral, and distemper has been implicated as a potential cause, but this relationship has yet to be proven conclusively. Other possible causes include nutritional derangements, immunologic disease, metabolic disease, and other viruses.

Treatment Panosteitis is treated symptomatically. Rest, exercise restriction, and pain medication are prescribed. Pain medication is usually a non-steroidal anti-inflammatory drug, or NSAID, such as aspirin, etodolac, or carprofen. Rarely, severely affected dogs may need more potent pain relief such as narcotic drugs.

Prevention There is no specific method of prevention; however, many veterinarians believe the disease is made worse by calorie-dense diets and over-supplementation with calcium and phosphorus. Thus, a diet change to an adult formula, or a large breed growth formula, is recommended. The dog should be fed an amount that does not promote obesity or overly rapid growth. Calcium and vitamin supplements should also be avoided.

Medial & Lateral Patellar Luxation

Patellar (knee cap) luxation, a frequent occurrence in dogs manifests in different types of luxation and varying grades of severity. Understanding the causes and effects of this problem, allows dog owners to make educated decisions about the care of pets.

Help is available for dogs affected by patellar luxation. Good diagnostic and surgical practices have produced a 90-95% success rate for achieving active and pain free use of the patient's affected limbs. Early detection of patellar luxation is critical for providing a good quality of life. In addition to the pain and suffering caused by the knee abnormalities, approximately 95% of dogs with patellar luxation have a related structural abnormality.

If these conditions are treated when the dog is young, progressive deformities can be avoided. Routine veterinary examinations should include evaluation of the joints with particular attention paid to those dog breeds known to be predisposed to orthopedic abnormalities. Medial Patellar Luxation is the most common stifle problem seen.

Toy and miniature breeds have 4-8 times the incidence of this disease than other dogs. Medial patellar luxation is most often a congenital (inherited) problem which occurs early in life (4-6 months of age). Usually trauma is not associated with medial luxation, but anatomical deformities result in the luxation.

In middle to older aged pets, 15-20% of the cases presented exhibit concurrent rupture of the cranial cruciate ligament of the stifle joint. Clinical signs of medial luxation of the patella depend on the degree and duration of deformity, and if one or both joints are involved. Neonates and young puppies may be seen with abnormal hind leg carriage and function (grades 3-4).

Young to mature dogs with a grade 2-3 will have an abnormal or intermittently abnormal gait. These will usually only be presented for examination when the gait visually worsens. Older dogs with a grade 1-2 luxation exhibit sudden signs of lameness due to breakdown of the soft tissue in the joint resulting from trauma or degenerative joint disease. Many dogs with medial patellar luxation will not show pain on palpation. The treatment for this dislocation is aimed at reducing the anatomic defects causing the secondary luxation as well as repair of the patella. Trauma-induced Medial Luxation Lateral Patellar Luxation is typically seen in small dogs.

Symptoms are slow to develop, exhibiting problems in the dog later in life (5-8 years). Usually these are grade 1-2 luxations, which have a greater function in degree of disability, but still may result in a breakdown of soft tissue response. Clinical signs may develop rapidly, usually associated with minor trauma or strenuous activity.

A "knock-knee" or seal-like stance often characterizes the condition, and pets with sudden luxation occurring in both legs, may not be able to stand, simulating a neurologic disease. Lateral Luxation in Large Dogs is often seen in the breeds that are affected by hip dysplasia, including Rottweilers, Golden Retrievers. Labrador Retrievers, Chow Chows, and German Shepherd Dogs.

Research has shown that congenital hip dysplasia deformities may cause this condition. Lateral patellar luxation can cause deformation of the femoral head, due to the rapid growth seen in large breeds. Genetic (and possibly nutritional) factors are keys to the development of this condition. Clinical signs occur around 5-6 months of age with a thickening of tissues of the stifle joint, a "knock-knee" and/or a cow hocked stance with the toes pointed out. In cases with associated hip dysplasia, the correction of both abnormalities is necessary to prevent progressive deformities.

Classifications Preliminary classification of the degree of patellar luxation is important in evaluation of the patient. These grades (1 being the least severe, to 4 being the most severe) are based on the pets' stance, movement (gait) and how easily the veterinarian can manipulate the patella.

• Grade 1: Occasional carrying of the leg is seen, often described as skipping or hopping, which may be transient, often returning to normal by itself. Your veterinarian may easily luxate the patella manually and return it to its normal position. Pain may be evident only when the knee cap is luxated.
• Grade 2: The frequency of luxation increases, becoming more or less permanent. The pet will usually carry its leg, but will occasionally bear weight on it. When palpated by the veterinarian, a dry, crackling sensation (crepitation) may occur in the joint. A grade 2 luxation can increase in severity, and if not surgically treated, can develop into degenerative joint changes.
• Grade 3: Permanent dislocation that occurs though weight bearing may still be possible, however the stance will appear somewhat crouching or bowlegged. Surgical intervention should not be delayed, especially if this is found in a young, growing dog. Rapid growth of abnormalities results in progressive deformities.
• Grade 4: Permanent luxation, with the affected limb always being carried, creates a bowlegged / crouching stance. Early surgery is strongly recommended at this state for bony deformities of the femur and tibia. Treatment In early to mild stages, soft tissue reconstruction may be sufficient to correct the problem. Complications such as increasing degrees of luxation, duration and multiple joint involvement require a variety of bone reconstruction techniques, with soft tissue repair often being necessary. Luxating patellas can be surgically corrected to allow a dog to lead a pain free, productive life.

The key to successful treatment lies in early diagnosis and therapy.

Pelvic Fractures

The pelvis is the medical term for the hip. Each rear leg is attached to the body by a "ball and socket" joining the pelvis and the femur ("thigh bone"). Many automobile injuries result in fractures of the pelvis, commonly referred to as a "fractured hip" or "crushed hip." Since the pelvis is the point of attachment of the rear legs, instability of this part of the body’s bone structure can result in any degree of signs from slight lameness to total inability to stand or walk. Since the rectum and bladder lay within the pelvis, injury to the hip can also cause bloody urine and/or constipation. In many cases, a pelvic fracture is one of the easiest and least expensive to treat. Since the muscles surrounding the hip form a "natural body cast," the majority of these fractures will heal with rest and a "tincture of time."

The following recommendations will make your pet’s recovery much improved:

• Provide a cushioned surface for the pet. Foam rubber works well.
• Keep the pet clean and dry.
• Assist the pet in its body eliminations by taking it outside several times daily. Sometimes it helps to support the body by placing a folded towel under the abdomen and then holding each end above the body to give the pet enough support so it can stand.
• Provide adequate nutrition and water. Many pets will not eat for several days after this type injury.
• Tempt the pet with its favorite foods.
• Make sure vaccinations are up to date, especially Rabies Vaccination.
• Give the dispensed medication to aid in softening stools to prevent constipation.
• Give the pain medication as directed. Give the anti-inflammatory medication as directed.
• Give the dispensed antibiotic to prevent infection.
• Caution others, especially children, that the pet will be very sore and may bite if handled roughly.
• Turn the pet gently from side to side several times daily. Use caution to avoid being bitten. Notify the clinic if the pet appears to worsen in any way or if you have any questions.
• Most pelvic injuries heal enough for the pet to begin to walk in 2 weeks, although it will take several months for full recovery to occur.

Laryngeal Paralysis in Dogs

Laryngeal paralysis is a relatively common disorder causing difficulty with breathing. It typically occurs in middle age and older, larger breed dogs, but it can be seen in small breed dogs and occasionally in cats. It can occasionally be seen as a congenital disease in young Bouvier dogs, Dalmatians, and Siberian huskies. Laryngeal paralysis refers to paralysis of the muscles that open up the upper airway (specifically, these muscles pull the two vocal folds in the larynx apart from each other, thereby increasing the size of the opening into the trachea and lungs). Most of the time, the specific cause of the muscle paralysis is not known.

Occasionally, laryngeal paralysis is only one sign of a systemic neurological disorder, but most of the time it is a problem that occurs by itself. Clinical signs of laryngeal paralysis are related to failure of normal movement of the vocal folds. Since the vocal folds cannot be pulled apart from each other when breathing, the opening of the airway is smaller than usual. This means that the dog is not able to get as much air into his or her lungs as is needed. Common clinical signs include progressively noisier breathing, intolerance to exercise, and sometimes a voice change. More severe signs include coughing/gagging, vomiting, and sometimes a near inability to breathe.

Laryngeal paralysis can be an emergency situation if the dog is unable to breathe. Definitive treatment for laryngeal paralysis involves surgery. If a dog is in a crisis situation - where it cannot breathe and is essentially choking - emergency intervention is essential. A dog in this situation is typically sedated to decrease anxiety, and an endotracheal tube might be placed so that oxygen can be administered. Often, sedation is sufficient to calm the dog down enough to allow improved breathing. There are several types of surgery available for laryngeal paralysis. All of them are designed to increase the size of the opening of the airway to allow easier passage of air. The most successful surgery, and the one most frequently performed, is called ARYTENOID LATERALIZATION, or laryngeal tieback.

This surgery involves opening the larynx from the side of the neck to expose the piece of cartilage to which the vocal fold attaches. Typically, this is done on the left side of the neck. The cartilage is freed from its attachment and pulled back and to the side and sutured in this position. Doing this will pull the left vocal fold off to the side which increases the size of the opening to the airway. Only one vocal fold usually needs to be tied back. Most dogs respond very nicely to this surgery.

The surgery does not necessarily make the dog perfectly normal and act like a puppy again, but it is very good at improving their ability to breathe and is excellent at preventing the breathing crises which can occur with laryngeal paralysis. After the surgery, most dogs are sent home for a couple of weeks of rest. Mild coughing is common after the surgery, but should resolve within a week or two. Improved breathing is usually seen almost immediately after surgery and usually lasts for the life of the dog.