Re: [SPAM] Stifle braces; Rear limb shaking

[Guest guest]

Hi Kathie,

In regards to the stifle instability, can you describe the instability

more in depth. If you are feeling a positive anterior drawer, the

following should help explain it. It is part of a letter I wrote to

another veterinarian that had similar concerns with TTA. Also, you may

be seeing pivot shift which definitely makes them look like they are

unstable in weight bearing.

The

post-op biomechanics

of TPLO are basically the same as TTA. Both

procedures eliminate cranial tibial thrust.

This means that when a dog is weight bearing or when you are

performing

a cranial tibial thrust maneuver even though the dog is non-weight

bearing,

there is no cranial drawer. When a dog

is not weight bearing as when they are in lateral recumbency with or

without

anesthesia and the typical test for anterior drawer (one hand above the

knee

and one below) is performed, there will be a positive anterior drawer

sign. This is passive drawer motion and

in both TPLO and TTA, there will be a positive anterior drawer in this

passive

phase, as opposed to active motion, as in weight bearing. In 2000, Tepic

and Montavon reported that the total joint

force of the stifle is nearly parallel to the patellar ligament. Cranial advancement of the tibial tuberosity

until the patellar ligament becomes perpendicular to the tibial plateau

eliminates the shearing force produced in the ACL deficient stifle in

weight

bearing or when performing the cranial tibial thrust maneuver.

Unless there is more than just a positive passive anterior drawer, I

would not think the dog needs a brace. If he does have more than just

the drawer, then he should be sent back to the surgeon to address that

instability if the owner agrees to that plan. I hope this helps.

Mark B. Parchman, DVM, DACVS, CVA

Bend Veterinary Specialists

Bend, Oregon

touheykathleen wrote:

Hi group! Hoping I can get some input on a couple of things..

I started treating an 11 yr old Irish Wolfhound mix that had left TPLO

surgery one year ago. The dog did not have any rehab and the stifle is

very unstable. The dog also has bilateral rear limb shaking that

started 6 years ago, and it only occurs in standing. Radiographs of

the spine and hips only showed mild arthritis. The shaking has not

progressed over the years but the rear limb weakness has. The

referring vet has been performing chiropractic treatment and

acupuncture. None of the vets who have seen this dog can explain the

rear limb shaking.

I've treated the dog 3 times, addressing the spine as well as the rear

limbs, performing joint mobs, tractioning and tail pulls, and working

on stability exercises, weight shifts and gait training. The owner

stated her dog was doing better until he slipped outside on wet tile a

few days ago. The referring vet and I noticed that the shaking is

significantly less, but the rear limbs are significantly weaker and he

has had several falls when toileting. His reflexes are normal and he

has not displayed any signs of pain. The only thing new was his left

pectineus and adductors were in spasm since the fall.

My questions are:

1) Has anyone used the A-TracC dynamic brace from Woundwear, Inc, or

any other stifle brace for CCL instability. From reading the posts, I

know there is differing opinions/research studies regarding bracing,

but I really feel this dog needs a brace since he is so unsteady.

2) Has anyone seen a dog with rear limb shaking only while standing?

He does not have an ataxic gait. It started when he was 4 yrs old

I appreciate any input.

Kathie Touhey, PT, CCRT pending

[Guest guest]

Kathie-

The only patient that I have ever seen with the shaking you describe

was a Great Dane that also had a torn cruciate, but had also been

diagnosed with Wobbler's. This dog had a dorsal laminectomy performed

and started rehabilitation. The dog was extremely weak, which was

probably the main reason for the shaking, but I am sure there was also a

neuro component involved, which would warrant a thorough neuro exam on

your patient (I think as previously mentioned) with attention to the

cervical region, especially in that giant breed.

The shaking had improved with rehabilitation due to strengthening, but

never resolved.

Just some thoughts...Thanks!

J. Sessum, RVT

Texas A & M University

College of Veterinary Medicine

Small Animal Rehabilitation &

Surgery Technician Supervisor

http://vmth.tamu.edu/rehab.shtml

>>> " Mark B. Parchman " 1/9/2009 1:34 PM

>>>

Hi Kathie,

In regards to the stifle instability, can you describe the instability

more in depth. If you are feeling a positive anterior drawer, the

following should help explain it. It is part of a letter I wrote to

another veterinarian that had similar concerns with TTA. Also, you may

be seeing pivot shift which definitely makes them look like they are

unstable in weight bearing.

> The post-op biomechanics of TPLO are basically the same as TTA. Both

> procedures eliminate cranial tibial thrust. This means that when a

> dog is weight bearing or when you are performing a cranial tibial

> thrust maneuver even though the dog is non-weight bearing, there is

no

> cranial drawer. When a dog is not weight bearing as when they are in

> lateral recumbency with or without anesthesia and the typical test

for

> anterior drawer (one hand above the knee and one below) is performed,

> there will be a positive anterior drawer sign. This is passive

drawer

> motion and in both TPLO and TTA, there will be a positive anterior

> drawer in this passive phase, as opposed to active motion, as in

> weight bearing. In 2000, Tepic and Montavon reported that the total

> joint force of the stifle is nearly parallel to the patellar

ligament.

> Cranial advancement of the tibial tuberosity until the patellar

> ligament becomes perpendicular to the tibial plateau eliminates the

> shearing force produced in the ACL deficient stifle in weight bearing

> or when performing the cranial tibial thrust maneuver.

>

Unless there is more than just a positive passive anterior drawer, I

would not think the dog needs a brace. If he does have more than just

the drawer, then he should be sent back to the surgeon to address that

instability if the owner agrees to that plan. I hope this helps.

Mark B. Parchman, DVM, DACVS, CVA

Bend Veterinary Specialists

Bend, Oregon

touheykathleen wrote:

>

> Hi group! Hoping I can get some input on a couple of things..

>

> I started treating an 11 yr old Irish Wolfhound mix that had left

TPLO

> surgery one year ago. The dog did not have any rehab and the stifle

is

> very unstable. The dog also has bilateral rear limb shaking that

> started 6 years ago, and it only occurs in standing. Radiographs of

> the spine and hips only showed mild arthritis. The shaking has not

> progressed over the years but the rear limb weakness has. The

> referring vet has been performing chiropractic treatment and

> acupuncture. None of the vets who have seen this dog can explain the

> rear limb shaking.

>

> I've treated the dog 3 times, addressing the spine as well as the

rear

> limbs, performing joint mobs, tractioning and tail pulls, and

working

> on stability exercises, weight shifts and gait training. The owner

> stated her dog was doing better until he slipped outside on wet tile

a

> few days ago. The referring vet and I noticed that the shaking is

> significantly less, but the rear limbs are significantly weaker and

he

> has had several falls when toileting. His reflexes are normal and he

> has not displayed any signs of pain. The only thing new was his left

> pectineus and adductors were in spasm since the fall.

>

> My questions are:

> 1) Has anyone used the A-TracC dynamic brace from Woundwear, Inc, or

> any other stifle brace for CCL instability. From reading the posts,

I

> know there is differing opinions/research studies regarding bracing,

> but I really feel this dog needs a brace since he is so unsteady.

>

> 2) Has anyone seen a dog with rear limb shaking only while standing?

> He does not have an ataxic gait. It started when he was 4 yrs old

>

> I appreciate any input.

> Kathie Touhey, PT, CCRT pending

>

>

>