Introduction: Injuries:
Not much introduction needed here, but we vets see a wide variety of injuries that cause lameness' in pets. Some are quite simple and inexpensive to treat, and others can be quite involved. And occassionly we need to amputate: Be Careful Out There.
Typical injuries: #1 Hit by Car. Bite wounds, especially between cats. Bullets and BB Guns. Fan Belt Disease (what we vets call those unfortunate cats that are sleeping in engine compartments of cars when someone starts the engine) and a whole host of various athletic and accidental injuries involving pulled muscles, torn ligaments, slipped discs, and so forth.
We'll discuss these problems in more detail below
Introduction: Infectious:
Sometimes pets become lame because of infections of the spine or joints. Lyme Disease, which is spread by ticks is one of the more familiar causes. Sometimes heartworm disease will cause inflammation and secondary infection of the joints. Bacteria and virus' are sometimes the primary cause of joint disease.
Introduction: Nutrition:
Nutrition during the fetal development of the skeletal system, nutrition during the growth stages of the animal, and the quanity and quality of nutrition during the rest of the pet's life can affect joint health. And, of course, obesity greatly affects the joints.
Introduction: Genetics:
I suspect we're going to learn alot more about genetics over the next 10 years and it's role in joint disease. We already know a fair amount: that certain breeds are prone to certain diseases. Common examples are hip dysplasia in German Sheperds and Patellar luxations in Poms. Rheumatoid Arthritis probably has a genetic component cause.
Introduction: A little about Arthritis:
Arthritis includes a whole family of diseases...hip dysplasia, for example, is a particular type of arthritis...that involve inflammation and erosion of joint cartilage that over time gets worse and worse. Without the cushioning effect of healthy cartilage, painful nerve endings are hammered. With pain, the joint is used less and becomes stiff and losses it's range of motion.
And there's more: with inflammation there's a release of tacky inflammatory secretions and toxins into the joint leading to further destruction.
This process is started or present in some pets and not others in different degrees for reasons we don't really understand well, but we do know that factors include genetics, old injuries, diet, cell oxidation, bacterial invasion, age, and obesity.
Speaking of bacterial invasion, you might be surprised to know that the number one cause of bacterial entry into the blood is through gum disease. Gum inflammation allows easy bacteria access into the blood stream, and once in the blood, some of the bacteria survive our defense mechanisms and are able to establish destructive colonies in different parts of our bodies.
Bacteria seem to do especially well in or on our heart valves, liver, and joints (also mammary tissue if nursing and the uterus if pregnant). Bacteria invasion may also be involved in the sequence of events leading to auto-immune inflammation of our joints. So, listen to your vet when he or she recommends dentistry.
The Symptoms of Arthritis: What we notice:
Pretty much all the symptoms revolve around pain and stiffness of the joints which show up as "morning stiffness", less activity in general, trouble climbing stairs or getting into your car or truck and so forth.
Often one joint will be worse than others, so your pet will be lame on one leg. Or lame on those days when it's cold or damp or after an activity. Another similar symptom is what my vet school professor called "Monday Morning Disease" where the dog was active during the weekend when the family was home from work and school...but come Monday morning, the pet can hardly move without obvious pain and stiffness.
What to Expect at the Vet when you have an Arthritic patient:
(Of course, your vet may do things differently)
What to expect at the Hospital at our clinic if you bring in pet in with a lameness.
(Of course, other vets may do things differently)
There are many causes and different injuries that cause lameness, some of them minor and likely to self heal given a little time, but others are quite serious and where timely treatment is important.
History and Signalment: The Signalment referes to things like age, sex, and breed. We will know this, of course, as soon as we start the exam and ask a few basic questions, but it helps influence or diagnostic decisions: we are much more likely to suspect injury in a 7 month old, hyper puppy than cancer or arthritis, for example.
And if the history is that a dog came home limping after running away from home, then again, we'd have a good clue that the problem is due to an injury...usually being hit by a car. History is even more important in less obvious cases; it helps to know when the problem started, when it flares up?, does it involve more than one leg? and so forth
EXAM:
In addition to our normal careful exam we pay special attention to
joint heat, pain, range of motion, weight bearing pressure, & neural reflexes.
Also we look and feel closely for excessive joint laxity, evaluate the circumstances, and check the paws and nails carefully for torn nails and tiny punctures.
Often the cause of the lameness is not obvious other than that the limb is tender or swollen. This is true, for example, with "pulled" muscles and other soft tissue damage.
Your vet may trot your pet or otherwise purposely stress test a joint to better get a diagnosis.
Sometimes a good exam is enough to rule out major injuries, and if the pet owner wants to minimize expense, then sometimes we treat the case conservatively. Just be aware this doesn't always work out and a repeat visit and a more aggressive work up may be in order
A Conservative Approach:
If the cause for the problem isn't obvious on exam but I'm pretty sure a fracture or dislocation or ligament rupture is not present, we will often treat the case conservatively. This means with rest and medication for pain and inflammation. And return for more aggressive work up and treatment only if not greatly improved soon.
This has the advantage of saving a good deal of money and trouble and usually works out well, but, of course, entails risk that I might miss something that I would have picked up had we done radiographs, etc.
In truth, missing a fracture on initial exam is usually not a big deal as long as we catch the problem quickly on recheck...
with one exception: It's important to diagnois dislocations in the first 48 hours or they're very difficult to get back into joint. So if in doubt, your vet will recommend further work up...usually an x-ray.
RADIOGRAPHS:
Like most things in medicine, how aggressive to get is a judgement call, but if the extent of the injury is suspected to be serious, then we'll certainly recommend radiographs. They're excellent at discerning fractures, dislocations, foreign bodies (such as bird shot), cortical inflammatory diseases such as panosteitis, and cancer.
Other imaging techniques, such as MRI's which are excellent for soft tissue injuries, are not common yet, but may be in the near future.
Sedation/Light Anesthesia: I am often able to better examine, extend, twist, and torque painful and injured limbs, thereby getting a diagnosis if we take the time, trouble, and expense of putting the patient under light sedation. This is especially true of ligament damage. We often have to sedate or lightly anesthize the patient anyways, for the x-rays.
LAB WORK
There are two main reasons for considering blood work in a lameness case:
1. to rule out infectious, excessive inflammatory, or metabolic problems that may be involved with the lameness. This would also include rarer problems such as mineral deficiencies and diseases that affect calcium and phosphorous.
2. For anesthetic safety: we often (usually) have to anesthetize limb injured patients to x-rays, wound repair, splinting, and surgery. Ideally, this means making sure liver, kidney, and sugar and electrolyte are all within normal range and not likely to cause complications.
Treatment
Treatment will consist of anything from
enforced rest or strictly limited activity for awhile
medication for pain, inflammation, and infection
medication to stimulate or promote healing
nutritional support
a simple support bandage
a splint or cast
surgical treatment of a wound (especially common in cats)
surgical pinning, plating, or other immobilizing surgical devices bone grafts
amputation
referral to an orthopedic specialist
euthanasia ... sometimes due to the severe extent of the injury but
more likely due to the expense of repair. Please
consider pet insurance; it saves a lot of pet lives.
In every case, though, understand that injuries of the legs...especially fractures and dislocations...require careful management and frequent rechecks ... all kinds of little things can go wrong during the healing process that need to be watched.
Possible medications we might use include:
Rimydal, Ectogesic, Dermaxx, Zubrin or other meds for pain
Prednisone, very short term, for swelling and inflammation
Antibiotics to fight and prevent post trauma infection
Anabolic Steroids in rare, geriactric cases
Sedatives to reduce activity, pain, and anxiety
Antioxidants (oxidation is especially damaging to joint cartiledge
Alternative Treatments such as acupunture, herbs etc ???
Of course, there are often multiple problems that need to be addressed such as an open wound, lots of abrasions and swellings, possible nerve damage, and fractures ...all in one case, especially if the patient was hit by a car.
Rest and time
Physical Therapy
Prayer
These last 3 steps are very important. I mention prayer, because sometimes injuries to joints, ligaments, tendons and bones are permanent just as they are in humans. And we can't tell until we try and give the injury some time to heal.
Realistic Expectations:
There's a saying in orthopedic medicine that our treatment goal is a "return to function". Not necessarily perfection.
Usually we can fix the problem adequately and sometimes we think we can, but despite a lot of effort and expense; we can't. Not because of lack of skill, but because of the extent of the damage. Just be aware of this.
A special caution about splinting fractures: Immobolizing a fracture, especially of the lower limbs, with a splint or cast is often successful and much less expensive than "internal fixation"methods such as bone plates and pins. And many clients choose a splint because of the expense factor and are happy with the results.
But there's a reason internal fixation is often worth the extra cost: it's much more likely to work. Splints sometimes fail to adequately immobilize the broken bone ends and the bones don't heal.
Splints also pose additional problems; getting them tight enough to stay on and immobolize the bone ends well sometimes result in circulation problems, occasionally disastrous, to the paw and lower leg. You have to be very careful about keeping spints dry and checking for pain, odor, cold toes, and other signs of trouble.
REFERRAL
The equipment and expertise for doing a good job of surgically repairing bone fractures has become highly developed, and specialized. The proper equipment is very expensive. Because of this, most general practioners send major fractures to a specialist for repair.
Amputation:
If the leg is squished, shattered, or so badly damaged that repair is unlikely ... or if you are unable to afford the $200-2,000 cost of a typical fracture case (please look into pet insurance) then the best option short of euthanasia is amputation. It's nice to avoid this, but in truth, most pets get along really well with a missing leg.
Chiroprators: In certain types of injuries this mode of treatment seems to be very beneficial. Especially for lower back or neck injuries.
Abscesses: we frequently have pets brought in for what the owner assumes is a leg injury because the pet is limping ... and they're correct ... it is an injury ... but not the kind they thought: it turns out to be a hidden abscess or infected wound, often from a bite ...this is very common in cats and treatment is somewhat different than that discussed above.
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