Re: GSH Tibial Fx Odd Gait

[Guest guest]

Hi Jan,

Thanks for the response, sorry for the delay - I was flying home. Yes, I made a typo - surgery was 2 weeks ago from date of video and rads (Dec 2nd). The owners are not too helpful regarding gait questions prior to surgery. He is predominantely an outdoor farm dog and has long hair with a large bushy tail so his tarsal joint oddity could have been missed. They think that he is not doing too bad - so I assume there was some abnormality prior to the incident. I agree that he is standing with his hocks flexed. As mentioned - there is signficant restrictions in my ability to extend his right tarsal joint but the left is normal. I assumed that this had to be a new finding and possibly involving the cranial fx fragement. What abnormality regarding his calcaneon mechanism would be you referring to? I have more video - I will try to compress and post. Unfortunately it is all just from behind the dog while I'm holding the tail :)Thanks again,

Tara

Tara , DVM, CCRT

To: VetRehab From: janetvandyke@...Date: Sat, 17 Dec 2011 14:56:12 -0500Subject: Re: GSH Tibial Fx Odd Gait

Tara,

Was the surgery really 1 week ago? The video clip is quite brief, but I would be curious as to what the owners say his gait was like prior to the injury. The clip makes it appear that he initiates stance phase with his digits and tarsus flexed. Is that what you're seeing? How is his calcaneal tendon mechanism?

Jan

Janet Van Dyke, DVM

Dipl. American College Veterinary Sports Medicine and RehabilitationCEO and FounderCanine Rehabilitation Institute, Inc.www.CanineRehabInstitute.com

Affiliate FacultyColorado State UniversityCollege of Veterinary Medicine and Biomedical SciencesJanet.van_dyke@...Director, International Veterinary Academy of Pain Management (IVAPM)www.ivapm.orgTreasurer, American Association of Rehabilitation Veterinarians (AARV)www.rehabvets.orgChair, Residency and Credentials CommitteeAmerican College of Veterinary Sports Medicine and Rehabilitation (ACVSMR)www.vsmr.org

Hi all,

I have a 6 year old GSH that was HBC. Had a right comminuted tibial fracture repaired one week ago. He has hip dysplasia bilaterally - worse clinically on the left. I examined him today as he has not been doing well. Very little weight bearing and has an odd gait. He is very poor muscled in general, but significant atrophy on the right pelvic limb due to lack of use. There is mild peroneal nerve impairment on the right when reflex testing and he cannot fully extend his tarsal joint on the right (currently at 113 degrees - normal on the left). Not sure if the floating bone fragment has possibly caused some adhesions involving the cranial tibialis and is impairing full extension and if these adhesions are also possibly impairing my cranial tibilias reflex? I am curious what everyone thinks about his gait, it looks very myopathic to me (bilaterally), but there are no palpable fibrotic areas . Any thoughts would be greatly appreciated

[Guest guest]

Well from what you describe, it certainly does seem like LDE or Cranial Tib would be the culprit..how do they palpate further proximally, where the fragments sit? Was there much ST trauma around the distal T/F or proximal tarsus?J

Janet Van Dyke, DVMDipl. American College Veterinary Sports Medicine and RehabilitationCEO and FounderCanine Rehabilitation Institute, Inc.www.CanineRehabInstitute.comAffiliate FacultyColorado State UniversityCollege of Veterinary Medicine and Biomedical SciencesJanet.van_dyke@...Director, International Veterinary Academy of Pain Management (IVAPM)www.ivapm.orgTreasurer, American Association of Rehabilitation Veterinarians (AARV)www.rehabvets.orgChair, Residency and Credentials CommitteeAmerican College of Veterinary Sports Medicine and Rehabilitation (ACVSMR)www.vsmr.org

There are restrictions passively - ie. when I am trying to extend his tarsal joint it is at 113 degrees compared to ~170 on the left and it seems that the tendon along the cranial border of the tarsal joint (LDE or cranial tibialis?) is very taught at this 113 vs a true joint constriction. I would only assume that this translates into restrictions actively? I did not appreciate any changes to his calcaneon tendon but I will have the surgeons have another look at him when he is back for a recheck while I am gone.

Thanks Jan,

Tara

To: VetRehab From: janetvandyke@...Date: Mon, 19 Dec 2011 10:07:33 -0500Subject: Re: GSH Tibial Fx Odd Gait

When you say that there are restrictions in tarsal extension, is that passive or active? My question regarding the calcanean mechanism is that his stance (in the video) with tarsal flexion and digital flexion is consistent with gastroc rupture with intact SDF tendon. His calcanean tendon looks abnormally thick on the rads.

J

Janet Van Dyke, DVM

Dipl. American College Veterinary Sports Medicine and RehabilitationCEO and FounderCanine Rehabilitation Institute, Inc.www.CanineRehabInstitute.com

Affiliate FacultyColorado State UniversityCollege of Veterinary Medicine and Biomedical SciencesJanet.van_dyke@...Director, International Veterinary Academy of Pain Management (IVAPM)www.ivapm.orgTreasurer, American Association of Rehabilitation Veterinarians (AARV)www.rehabvets.orgChair, Residency and Credentials CommitteeAmerican College of Veterinary Sports Medicine and Rehabilitation (ACVSMR)www.vsmr.org<PastedGraphic-2.tiff>

Hi Jan,Thanks for the response, sorry for the delay - I was flying home. Yes, I made a typo - surgery was 2 weeks ago from date of video and rads (Dec 2nd). The owners are not too helpful regarding gait questions prior to surgery. He is predominantely an outdoor farm dog and has long hair with a large bushy tail so his tarsal joint oddity could have been missed. They think that he is not doing too bad - so I assume there was some abnormality prior to the incident. I agree that he is standing with his hocks flexed. As mentioned - there is signficant restrictions in my ability to extend his right tarsal joint but the left is normal. I assumed that this had to be a new finding and possibly involving the cranial fx fragement. What abnormality regarding his calcaneon mechanism would be you referring to? I have more video - I will try to compress and post. Unfortunately it is all just from behind the dog while

I'm holding the tai l :)Thanks again,TaraTara , DVM, CCRT

To: VetRehab From: janetvandyke@...Date: Sat, 17 Dec 2011 14:56:12 -0500Subject: Re: GSH Tibial Fx Odd GaitTara, Was the surgery really 1 week ago? The video clip is quite brief, but I would be curious as to what the owners say his gait was like prior to the injury. The clip makes it appear that he initiates stance phase with his digits and tarsus flexed. Is that what you're seeing? How is his calcaneal tendon mechanism?

Jan

Janet Van Dyke, DVM

Dipl. American College Veterinary Sports Medicine and RehabilitationCEO and FounderCanine Rehabilitation Institute, Inc.www.CanineRehabInstitute.com

Affiliate FacultyColorado State UniversityCollege of Veterinary Medicine and Biomedical SciencesJanet.van_dyke@...Director, International Veterinary Academy of Pain Management (IVAPM)www.ivapm.orgTreasurer, American Association of Rehabilitation Veterinarians (AARV)www.rehabvets.orgChair, Residency and Credentials CommitteeAmerican College of Veterinary Sports Medicine and Rehabilitation (ACVSMR)www.vsmr.org<PastedGraphic-2.tiff>

Hi all, I have a 6 year old GSH that was HBC. Had a right comminuted tibial fracture repaired one week ago. He has hip dysplasia bilaterally - worse clinically on the left. I examined him today as he has not been doing well. Very little weight bearing and has an odd gait. He is very poor muscled in general, but significant atrophy on the right pelvic limb due to lack of use. There is mild peroneal nerve impairment on the right when reflex testing and he cannot fully extend his tarsal joint on the right (currently at 113 degrees - normal on the left). Not sure if the floating bone fragment has possibly caused some adhesions involving the cranial tibialis and is impairing full extension and if these adhesions are also possibly impairing my cranial tibilias reflex? I am curious what everyone thinks about his gait, it looks very myopathic to me (bilaterally), but there are no palpable fibrotic areas . Any thoughts

would be greatly appreciated.

Thanks-you in advance,

Tara , DVM, CCRT

[Guest guest]

Hi Jan,I hope you had a Merry Christmas. There was no significant soft tissue trauma around the tarsal region or distal T/F area. I could not appreciate any abnormalities on palpation around the possible fragment. I hope to re-evaluate him after the holidays and try to see if I can put more pieces of the puzzle together. I have attached more video from the original examination as well as some slower motion clips for evaluation.Again, thanks for any input,TaraTo: VetRehab From: janetvandyke@...Date: Mon, 19 Dec 2011 16:43:00 -0500Subject: Re: GSH Tibial Fx Odd Gait

Well from what you describe, it certainly does seem like LDE or Cranial Tib would be the culprit..how do they palpate further proximally, where the fragments sit? Was there much ST trauma around the distal T/F or proximal tarsus?J

Janet Van Dyke, DVMDipl. American College Veterinary Sports Medicine and RehabilitationCEO and FounderCanine Rehabilitation Institute, Inc.www.CanineRehabInstitute.comAffiliate FacultyColorado State UniversityCollege of Veterinary Medicine and Biomedical SciencesJanet.van_dyke@...Director, International Veterinary Academy of Pain Management (IVAPM)www.ivapm.orgTreasurer, American Association of Rehabilitation Veterinarians (AARV)www.rehabvets.orgChair, Residency and Credentials CommitteeAmerican College of Veterinary Sports Medicine and Rehabilitation (ACVSMR)www.vsmr.org

There are restrictions passively - ie. when I am trying to extend his tarsal joint it is at 113 degrees compared to ~170 on the left and it seems that the tendon along the cranial border of the tarsal joint (LDE or cranial tibialis?) is very taught at this 113 vs a true joint constriction. I would only assume that this translates into restrictions actively? I did not appreciate any changes to his calcaneon tendon but I will have the surgeons have another look at him when he is back for a recheck while I am gone.

Thanks Jan,

Tara

To: VetRehab From: janetvandyke@...Date: Mon, 19 Dec 2011 10:07:33 -0500Subject: Re: GSH Tibial Fx Odd Gait

When you say that there are restrictions in tarsal extension, is that passive or active? My question regarding the calcanean mechanism is that his stance (in the video) with tarsal flexion and digital flexion is consistent with gastroc rupture with intact SDF tendon. His calcanean tendon looks abnormally thick on the rads.

J

Janet Van Dyke, DVM

Dipl. American College Veterinary Sports Medicine and RehabilitationCEO and FounderCanine Rehabilitation Institute, Inc.www.CanineRehabInstitute.com

Affiliate FacultyColorado State UniversityCollege of Veterinary Medicine and Biomedical SciencesJanet.van_dyke@...Director, International Veterinary Academy of Pain Management (IVAPM)www.ivapm.orgTreasurer, American Association of Rehabilitation Veterinarians (AARV)www.rehabvets.orgChair, Residency and Credentials CommitteeAmerican College of Veterinary Sports Medicine and Rehabilitation (ACVSMR)www.vsmr.org<PastedGraphic-2.tiff>

Hi Jan,Thanks for the response, sorry for the delay - I was flying home. Yes, I made a typo - surgery was 2 weeks ago from date of video and rads (Dec 2nd). The owners are not too helpful regarding gait questions prior to surgery. He is predominantely an outdoor farm dog and has long hair with a large bushy tail so his tarsal joint oddity could have been missed. They think that he is not doing too bad - so I assume there was some abnormality prior to the incident. I agree that he is standing with his hocks flexed. As mentioned - there is signficant restrictions in my ability to extend his right tarsal joint but the left is normal. I assumed that this had to be a new finding and possibly involving the cranial fx fragement. What abnormality regarding his calcaneon mechanism would be you referring to? I have more video - I will try to compress and post. Unfortunately it is all just from behind the dog while

I'm holding the tai l :)Thanks again,TaraTara , DVM, CCRT

To: VetRehab From: janetvandyke@...Date: Sat, 17 Dec 2011 14:56:12 -0500Subject: Re: GSH Tibial Fx Odd GaitTara, Was the surgery really 1 week ago? The video clip is quite brief, but I would be curious as to what the owners say his gait was like prior to the injury. The clip makes it appear that he initiates stance phase with his digits and tarsus flexed. Is that what you're seeing? How is his calcaneal tendon mechanism?

Jan

Janet Van Dyke, DVM

Dipl. American College Veterinary Sports Medicine and RehabilitationCEO and FounderCanine Rehabilitation Institute, Inc.www.CanineRehabInstitute.com

Affiliate FacultyColorado State UniversityCollege of Veterinary Medicine and Biomedical SciencesJanet.van_dyke@...Director, International Veterinary Academy of Pain Management (IVAPM)www.ivapm.orgTreasurer, American Association of Rehabilitation Veterinarians (AARV)www.rehabvets.orgChair, Residency and Credentials CommitteeAmerican College of Veterinary Sports Medicine and Rehabilitation (ACVSMR)www.vsmr.org<PastedGraphic-2.tiff>

Hi all, I have a 6 year old GSH that was HBC. Had a right comminuted tibial fracture repaired one week ago. He has hip dysplasia bilaterally - worse clinically on the left. I examined him today as he has not been doing well. Very little weight bearing and has an odd gait. He is very poor muscled in general, but significant atrophy on the right pelvic limb due to lack of use. There is mild peroneal nerve impairment on the right when reflex testing and he cannot fully extend his tarsal joint on the right (currently at 113 degrees - normal on the left). Not sure if the floating bone fragment has possibly caused some adhesions involving the cranial tibialis and is impairing full extension and if these adhesions are also possibly impairing my cranial tibilias reflex? I am curious what everyone thinks about his gait, it looks very myopathic to me (bilaterally), but there are no palpable fibrotic areas . Any thoughts

would be greatly appreciated.

Thanks-you in advance,

Tara , DVM, CCRT