What do you think is wrong with Dinho?

January 19, 2011

Dinho is a 1.5 yr old MN Golden Retriever. He came for rehab a couple months

after 2 separate TPO surgeries done at the university. The owner noted that he

developed neuropraxia after the right side was done. They haven't been

interested in more rehab than UWTM to build muscles. He has significant rear leg

muscle atrophy, walks with a very wobbly gait, and recently has taken to trying

to sit (or actually float his rump) in the UWTM while it is moving. I sent him

back to the university to have him evaluated for neurologic problems, but he

never saw a neurologist. The orthopod said he was fine and just needed to build

his muscles. Please let me know what you see in these videos.

This one is several weeks ago.

This is the same date as the first one from another angle. Sorry about the

sideways production.

This one is last week.

I've talked to the owner about my concerns that there is more going on than just

lack of good muscle mass. She insists he is getting better because he will stand

up to look for food on the counter which he has never done before.

Thanks for your help.

Christie Carlo, DVM, CCRT

Avondale Healthcare Complex

Des Moines, IA 50320

January 19, 2011

Can you feel his hips click/sublux on extension?How old was he for each of the surgeries – and in particular the Right?Does he have sunken atrophy of his gluteals on the right?Have you tried using NMES as a diagnostic tool over the gluteals? 1) It is possible that there was damage to the gluteal nerves during surgery, and that what you are seeing is a lack of gluteal muscle. The knuckling would fit (have seen it before with a similar situation) – as would crossing over (i.e. if the animal is unable to abduct the hip). One particular dog that I saw with this problem would run in the field and periodically trip when his back leg (surgical side) would cross under and trip him up. He also had regular SIJ dysfunctions b/c of his falls. And, unfortunately, there was nothing that could be done except teach the owner how to deal with the issue at hand as needed. 2) Alternately, if the Sx was done too late in life (after the 5 - 8 month window) and there wasn’t the ‘time’ for the pelvis to reform/grow as is hoped for with this surgery, then there can continue to be degeneration of the joint d/t the mismatch of the hip and pelvis. There was a fascinating lecture on it at NAVC last weekend by Dr. Aldo Vezzoni of Spain. He was rather adamant that the surgery should not be done past the 8 month mark, and had some interesting radiographs to show. I have a dog on treatment right now that had his second TPO done at 10 months of age – he continues to clunk with every step he takes and I have concerns for his long term prognosis, as the hip is now becoming a bit sore. Perhaps one of the surgeons would like to comment further. Cheers, Laurie Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRT From: VetRehab [mailto:VetRehab ] On Behalf Of ChristieCSent: January-18-11 8:10 PMTo: VetRehab Subject: What do you think is wrong with Dinho? Dinho is a 1.5 yr old MN Golden Retriever. He came for rehab a couple months after 2 separate TPO surgeries done at the university. The owner noted that he developed neuropraxia after the right side was done. They haven't been interested in more rehab than UWTM to build muscles. He has significant rear leg muscle atrophy, walks with a very wobbly gait, and recently has taken to trying to sit (or actually float his rump) in the UWTM while it is moving. I sent him back to the university to have him evaluated for neurologic problems, but he never saw a neurologist. The orthopod said he was fine and just needed to build his muscles. Please let me know what you see in these videos.This one is several weeks ago.http://www.youtube.com/watch?v=ATG88M5xURcThis is the same date as the first one from another angle. Sorry about the sideways production.http://www.youtube.com/watch?v=T5xfEzs5YWgThis one is last week.http://www.youtube.com/watch?v=mSsw0Xfb7loI've talked to the owner about my concerns that there is more going on than just lack of good muscle mass. She insists he is getting better because he will stand up to look for food on the counter which he has never done before.Thanks for your help.Christie Carlo, DVM, CCRTAvondale Healthcare ComplexDes Moines, IA 50320 __________ Information from ESET NOD32 Antivirus, version of virus signature database 5800 (20110119) __________ The message was checked by ESET NOD32 Antivirus. http://www.eset.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 5800 (20110119) __________ The message was checked by ESET NOD32 Antivirus. http://www.eset.com __________ Information from ESET NOD32 Antivirus, version of virus signature database 5800 (20110119) __________The message was checked by ESET NOD32 Antivirus.http://www.eset.com

January 20, 2011

Christie,I am probably not adding much to Laurie's excellent comments but what I see is significant coxofemoral joint dysfunction, especially the right side. Limited rom of the joint is requiring excessive lateral flexion of the lumbar spine and movement of the pelvis from side to side rather than being in a more proper alignment with the lumbar region. I would expect that there are numerous areas of pain in both dorsal and ventral paraspinals perpetuated by this dysfunction, especially the cranial m. Iliocostalis lumborum. It would be interesting to see radiographs of the hips. With age there is often too much remodeling of the acetabulum resulting less than satisfactory outcomes to TPO. Managing pain and musculoskeletal strengthening will still improve to the functional impairment effecting your patient!What is the ROM of the coxofemoral joints? Is there pain in the m. pectineus? The rotation of the acetabulum should have removed all stress on that muscle.Rick WallSent from my iPad

Dinho is a 1.5 yr old MN Golden Retriever. He came for rehab a couple months after 2 separate TPO surgeries done at the university. The owner noted that he developed neuropraxia after the right side was done. They haven't been interested in more rehab than UWTM to build muscles. He has significant rear leg muscle atrophy, walks with a very wobbly gait, and recently has taken to trying to sit (or actually float his rump) in the UWTM while it is moving. I sent him back to the university to have him evaluated for neurologic problems, but he never saw a neurologist. The orthopod said he was fine and just needed to build his muscles. Please let me know what you see in these videos.

This one is several weeks ago.

This is the same date as the first one from another angle. Sorry about the sideways production.

This one is last week.

I've talked to the owner about my concerns that there is more going on than just lack of good muscle mass. She insists he is getting better because he will stand up to look for food on the counter which he has never done before.

Thanks for your help.

Christie Carlo, DVM, CCRT

Avondale Healthcare Complex

Des Moines, IA 50320

January 24, 2011

I haven't been able to touch Dinho in a couple of weeks (he comes for UWTM when

I'm not there or are swamped with other patients), but I plan to check some of

the things mentioned. How are you suggesting I use the NMES as a diagnostic

tool? Please define the word " neuropraxia " if that is how it is spelled. I'm

still working on getting the radiographs. I have them on a CD from the

University, but have unable to open it.

Diho was 8 months old when the right TPO sx was done. I think the left was done

within the month before that.

What if the gluteal nerves have been damaged? What kind of therapy would help

this? You mention cross the rear legs. I have alot of old timers that do this.

Is that due to gluteal atrophy?

Thanks for answering my dumb questions.

Here's a couple of videos taken on land 6 or so weeks ago.

Christie Carlo, DVM, CCRT

>

> > Dinho is a 1.5 yr old MN Golden Retriever. He came for rehab a couple months