Guest guest Posted November 7, 2010 Report Share Posted November 7, 2010 Hillside Veterinary Hospital 1700 Kings Road , BC V8R 2P1 doctors@... Re: Underwater Treadmill Questions We have two Fernos and have had a lot of trouble with them (one yr old). Especially the fancier model I think it is called the AquaPaws Plus. I will admit I am not the person who deals with them (either the treadmills or the reps or repair people) for the most part so you must take my opinion with a grain of salt. All I know is they seem to break a lot, get stuck and won't drain properly, make clunking sounds. And it seems to take a lot of effort to get the help we need. Also my principal dislike with these treadmills is they only open at one end so you have to turn the dog around in them and if you have a big dog with serious mobility issues this is difficult. Also the nominal " front " is solid and the dogs don't like walking towards the solid partition so we always turn the dog around and run the tread in reverse so they can walk towards the glass door and see their owners. The other Ferno we have, which inclines (but it is hard to change it from inclined to flat so we usually just leave it inclined) is worse, as it has a solid front and one solid side (the newer model has three sides glass one side solid) and many dogs will not walk in it as they seem to feel to closed in. This one does not run in reverse or at least not easily. I have not done treadmill shopping so I am not familiar with what else is out there but if you can get one with doors at both ends and all glass and even one where you can get it to incline by pushing a button rather than manhandling the treadmill then I personally would prefer that. Pamela Mueller PhD DVM Animal Therapy Center Bethlehem PA We are looking at adding a UWTM and have seen the Ferno product and the Hydro Physio. However, I see more Ferno units but hear stories about their service. My question is, what does that mean? Do they stand behind their warranty? The area I am in has a service company for when the warranty runs out. So, who are the complaints with? Ferno or the service companies? I also was told that Hydro Physio recently sold a uwtm as a demo unit. Rumored it was previously sold to a clinic and taken out due to quality issues. This same uwtm was sold again to another clinic and the same issues happened. Also told that clinic is suing Hydro over not being truthful about the unit. Anyone know the truth? Messages in this topic (6) ________________________________________________________________________ ________________________________________________________________________ 2a. Shepherd with elbow " click " Posted by: " Hillside Vet Hospital " doctors@... glynisdvm Date: Fri Oct 29, 2010 1:50 pm ((PDT)) I recently examined a new patient, a 4 year old male German Shepherd, for evaluation of a subtle R foreleg lameness which the owner feels has been present for a couple of years on & off and which seems worse after heavy exercise, particularly when he has been " rough housing " with her other dog. This dog is lean but big (43 kg) and is used for herding and bomb detection. He has never been evaluated by a veterinarian for this problem. We could not detect any lameness, so we did a gait analysis (corn starch test) which confirmed a slightly shortened stride on the R fore. I couldn't feel any abnormalities or elicit any kind of a pain response on examination of the R foreleg. There was normal ROM of all joints however he did have a repeatable audible " click " at end extension of the R elbow. I can feel a ropey structure (medial collateral ligament?) on the medial aspect of the elbow joint whose movement seems to coincide with this click. His elbows were x-rayed and sent to a radiologist for interpretation and the report came back as " subtle and minimal degenerative changes in both elbows, probably not severe enough to account for clinical signs " . (This dog also had his elbows evaluated by the OFA at 2 years of age and they were found to be clean). I have tried to research this " click " as the owner is curious and would like a diagnosis, but have not had much luck. Has anyone else ever come across this and, if so, are you able to clarify for me what is likely happening and what we should do about it? I realize that the lameness may be unrelated. Thanks to anyone who can shed some light on this for me! Sylvie Abrioux, DVM, CCRT Messages in this topic (2) ________________________________________________________________________ 2b. Re: Shepherd with elbow " click " Posted by: " shermancanapp " scanapp@... shermancanapp Date: Fri Oct 29, 2010 2:13 pm ((PDT)) Sylvie, This sounds like classic " jump down syndrome " or traumatic fragmented medial coronoid process....acute lameness, clean radiographs, medial compartment sensitivity, and intermittent click.....I would scope the elbow asap before it causes secondary cartilage erosion...bit more information below: Traumatic Fragmented Medial Coronoid Process Traumatic fragmented medial coronoid process (TFMCP) is a condition in the elbow joint of dogs that appears to occur commonly in performance and working dogs. Unlike the classic condition of fragmented medial coronoid process (FMCP) affecting the elbow joints of skeletally immature large to giant breed dogs, jump down syndrome (TFMCP) appears to have no age or size limitations. Cause The cause and pathogenesis of TFMCP are poorly understood. It is possible that abnormal repetitive loading, such as landing from a jump, hitting contacts or a flyball box, and so on, may lead to microfractures of the bone underneath the cartilage (subchondral fractures). Additionally, increased repetitive loading can arise from contraction of the biceps/ brachialis muscle complex. When the biceps/brachialis contracts, a force is generated that rotates the medial coronoid into the radius. These microcracks disturb the mechanical properties of bone, and if not repaired properly through normal body mechanisms, fatigue fractures develop. Additionally, loss of osteocytes (bone cells), indicated by decreased osteocyte densities, has been strongly associated with the presence of microdamage after fatigue loading. These studies imply that excess load may lead to fatigue microdamage of the subchondral trabecular bone and eventual fracture, which we believe may play an important role in the pathogenesis of TFMCP. Dogs may be further predisposed to this condition if they have elbow dysplasia. Dogs with elbow dysplasia had asymmetric growth of the radius and ulna during development, resulting in elbow joint incongruity. Elbow incongruity such as radioulnar step defects, humeroulnar incongruence/conflict, and varus deformity of the humerus causes abnormal contact patterns in the elbow, specifically at the coronoid trochlear articulation, which is theorized to increase the load on the medial coronoid process (MCP). Regardless of the etiology, if left untreated as a continual lameness, secondary osteoarthritis may progress as noted by damage to the cartilage such as softening, fibrillation, fissuring, and erosions as well as additional subchondral bone microcracks and fragmentation. The free fragments contribute to frictional abrasion ( " kissing lesions " ) of the opposing surface including the medial aspect of the humeral condyle and radial head. Diagnosis History and Clinical Signs Dogs with TFMCP may present with a history ranging from a subtle intermittent offloading of the forelimb to significant unilateral or bilateral forelimb lameness. This lameness is typically exacerbated with exercise and heavy activity. The onset of lameness is insidious. As lameness persists, it may increase in severity. Affected dogs often place the carpus in an exaggerated valgus position (turned out) when sitting or standing, and circle the foreleg outward and move the elbow away from the midline (circumduct the antebrachium and abduct the elbow) during the swing phase of the stride. The history of dogs with TFMCP typically includes a lack of response to rest and non-steroidal anti-inflammatory drugs (NSAIDs). Many dogs with TFMCP are mistakenly treated for shoulder pathology because the attending veterinarian elicits a pain response when the shoulder is extended. The authors believe the pain response actually arises from the elbow because when the veterinarian performs an extension maneuver of the shoulder, the elbow is usually simultaneously extended. Extension of the shoulder and elbow causes tension in the biceps/brachialis muscle complex. Tension in the biceps/brachialis exerts pressure on the medial coronoid and overlying inflamed joint capsule causing the pain response. Orthopedic Examination On physical examination discomfort is usually noted on direct palpation of the medial compartment of the elbow joint, specifically the medial coronoid process. Discomfort may also be noted on hyperflexion of the elbow. Most dogs with TFMCP are reluctant to allow for full endrange flexion. In chronic cases, full flexion may not be obtained. Crepitus may be noted when placing the elbow through range of motion. Some investigators suggest that the carpus should be placed in a flexed, externally rotated position while the elbow is extended. Joint effusion may be detected as a fluctuant swelling beneath the lateral or medial epicondyle of the humerus. Depending on the chronicity, atrophy may be noted in the affected forelimb. Advanced Diagnostics In addition to history, gait analysis, physical examination, orthopedic and neurologic examinations, further diagnostic tests used to differentiate causes of elbow pathology currently consist of hematology, biochemical profile, urinalysis, arthrocentesis, imaging modalities, and arthroscopy. Unfortunately, radiographs have been shown to be of little value because of difficulty identifying the fragment or line of separation using standard radiography. In some chronic cases, however, radiographs may reveal secondary evidence of bony remodeling consistent with osteoarthritis. These changes may include sclerosis within the ulnar notch, and remodeling along the anconeal process and MCP. Advanced diagnostic imaging modalities such as CT scans, MRI, nuclear scans, and arthroscopy may allow confirmation of the condition. Arthroscopic evaluation of the elbow joint allows direct observation of all major intra-articular structures with magnification, " dynamic " evaluation of tissues during elbow range-of-motion tests, and " palpation " of intra-articular tissues using arthroscopic instrumentation. Arthroscopic exploration of the elbow provides a definitive diagnosis of TFMCP when a fragment or cartilage fissure. In a small percentage of cases, advanced imaging (nuclear scan, CT, MRI) indicates fragmentation of the coronoid but arthroscopic observation does not reveal a fissure or fragment. In such cases, the fissures (microcracks) are believed to be within the coronoid bone beneath the cartilage surface. Treatment Treatment of TFMCP is multimodal and includes a combination of medical and surgical management as well as rehabilitation therapy. Through a multimodal approach it is possible to relieve pain and maintain limb function, as well as to return the dog to a normal level of activity and competition. Arthroscopy is an excellent modality for diagnosing TFMCP as well as a minimally invasive means of treatment. Arthroscopic removal of the fragments is recommended not only to remove the inciting cause of lameness but also to help prevent/slow the progression of osteoarthritis. Arthroscopic treatment may include a combination of techniques such as fragment removal, debridement of diseased tissues, creation of vascular access by abrasion arthroplasty, forage, microfracture, and subtotal coronoid ostectomy depending on the progression and severity of disease. Arthroscopy is not only a great diagnostic modality, allowing for superior visualization of structures within the joint, but also has less soft tissue trauma, shorter surgery and hospitalization times, decreased risk of infection, and shorter recovery times compared to the traditional surgical approach of fully opening the joint (arthrotomy). Following arthroscopic treatment, dogs are typically prescribed NSAIDs for 14 days to help decrease inflammation and discomfort. Polysulfated glycosaminoglycans (PSGAG) an injectible joint protective agent, is also recommended following arthroscopic treatment and is administered intramuscularly twice a week for up to four weeks. PSGAGs has been shown to decrease the amount of degradative enzymes (that stimulate inflammation and cartilage erosion) as well as promote repair and regeneration of cartilage. In addition, an oral joint protective agent such as glucosamine, chondroitin sulfate, and avocado/soybean unsaponifiables (ASU), is recommended as a daily supplement for life. The anti-inflammatory properties and pain-reducing effects of these supplements have been well-documented. There is also evidence that they may have a cartilageprotective effect. As with any rehabilitation therapy program, elbow rehabilitation following elbow arthroscopy should follow a sequential and progressive multiphased approach. The ultimate goal of elbow rehabilitation is to return the patient to their previous functional level as quickly and safely as possible. However, each case is uniquely different, and several factors; including duration of injury/lameness prior to surgery, secondary osteoarthritc conditions, surgical intervention performed, all influence the rate at which the patient proceeds through the healing process. The elbow is predisposed to flexion contractures due to the intimate congruency of the joint articulations, the tightness of the joint capsule, and the tendency of the anterior capsule to develop adhesions following injury. The biceps/brachialis complex also attaches to the capsule and crosses the elbow joint before becoming a tendinous structure and inserting on the ulnar tuberosity. Injury to the elbow may cause excessive scar tissue formation of the brachialis muscle as well as functional splinting of the elbow. Reestablishing full elbow extension is the primary goal of early ROM activities to minimize the occurrence of elbow flexion contractures. Additional goals of this stage are to protect healing tissue, decrease pain and inflammation, restore weight bearing and retard muscular atrophy. The rehabilitation therapist must not overstress healing tissues during this phase. It is important that the owner restrict the dog's activity to short leash walking only with no running, jumping and rough play. Hope this helps.......please let me know if you need help finding a surgeon in your area that scopes.... Happy Halloween!!! Sherman Sherman O. Canapp Jr., DVM, MS, CCRT Diplomate ACVS Diplomate ACVSMR Veterinary Orthopedic & Sports Medicine Group 10975 Guilford Road polis Junction, MD 20701 Phone: Fax: http://www.vosm.com > > > > I recently examined a new patient, a 4 year old male German Shepherd, for > evaluation of a subtle R foreleg lameness which the owner feels has been > present for a couple of years on & off and which seems worse after heavy > exercise, particularly when he has been " rough housing " with her other dog. > This dog is lean but big (43 kg) and is used for herding and bomb detection. > He has never been evaluated by a veterinarian for this problem. We could > not detect any lameness, so we did a gait analysis (corn starch test) which > confirmed a slightly shortened stride on the R fore. I couldn't feel any > abnormalities or elicit any kind of a pain response on examination of the R > foreleg. There was normal ROM of all joints however he did have a > repeatable audible " click " at end extension of the R elbow. I can feel a > ropey structure (medial collateral ligament?) on the medial aspect of the > elbow joint whose movement seems to coincide with this click. > > > > His elbows were x-rayed and sent to a radiologist for interpretation and the > report came back as " subtle and minimal degenerative changes in both elbows, > probably not severe enough to account for clinical signs " . (This dog also > had his elbows evaluated by the OFA at 2 years of age and they were found to > be clean). > > > > I have tried to research this " click " as the owner is curious and would like > a diagnosis, but have not had much luck. Has anyone else ever come across > this and, if so, are you able to clarify for me what is likely happening and > what we should do about it? I realize that the lameness may be unrelated. > > > > Thanks to anyone who can shed some light on this for me! > > > > Sylvie Abrioux, DVM, CCRT > Messages in this topic (2) ------------------------------------------------------------------------ Quote Link to comment Share on other sites More sharing options...
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