Page 156 - Veterinary Laser Therapy in Small Animal Practice

142 Veterinary Laser Therapy in Small Animal Practice

Case no. 18

B., canine, 8 years old, German Shepherd, MC, 39 kg
• Complaint: chronic right hindlimb lameness and weakness, occasional forelimb lameness.
• History: B. started to show symptoms 3 years ago, with hindlimb lameness and difficulty standing up. A few
months ago forelimb lameness appeared. He gets chondroprotective nutraceuticals on a regular basis and
NSAIDs when pain is worse (not at the moment). Lameness improves after exercise.
• MRI: T13–L1 disk protrusion with moderate spinal cord compression.
• Radiographic findings: severe bilateral hip OA, moderate left metatarsophalangeal OA.
• Physical examination:
• Body condition score 6/9.
• Decreased passive ROM.
• Symmetric hindlimb circumference (right 35 cm and left 39 cm, measured at 70% of thigh) with mild
atrophy of quadriceps, semitendinosus, and semimembranosus. Contracted triceps and infraspinatus
muscles.
• Mild synovial effusion in both stifles.
• No neurological deficits.
• Pain assessment: 2/10 NRS, mild discomfort at left metatarsophalangeal and T13/L1 area; difficulty
standing up and sitting down; 4/10 pain on right knee flexion and right hip extension.
Range of motion (degrees)
Hip Knee Tarsus
Flexion 50 60 45
Right
Extension 155 170 165
Flexion 55 45 45
Left
Extension 160 160 170

• Diagnosis: severe bilateral hip OA, bilateral knee arthritis, moderate left metatarsophalangeal OA, chronic
T13/L1 disk herniation.
• Treatment:
• Laser therapy:
• Dose was 6–8 J/cm over left metatarsophalangeal joints, 10–12 J/cm over T10–L3 area and both
2
2
hips, and 8–10 J/cm over both stifles.
2
• Treatment was performed every other day for the first week, then twice a week for 6 more weeks,
once a week for 2 weeks, then every 2 weeks for maintenance.
• Other physical therapies:
• Twice a week for 3 weeks, once a week for 6 weeks, then every 2 weeks.
• NMES: 40 Hz, biphasic, to stimulate hamstrings, quadriceps, and gluteus muscles; 10 min in each
limb.
• TENS: local treatment; 5 Hz, 30 min; electrodes are positioned bilateral to the spine (T13–L2), over
right hip, right knee, and left metatarsophalangeal joint.
• PMF therapy: low frequency (12–20 Hz), 90% intensity for 30 min, later increased to 100% for 40
min. Positioned over hip and shoulder areas.
• Thermotherapy: infrared lamp during TENS treatment/PMF treatment.
• Manual intervention: massage for 30 min with effleurage, petrissage, and longitudinal friction of
all limbs, neck, and spine. Passive ROM exercises for all joints. Muscle stretching in right
hindlimb.
• Home exercise program: all techniques were performed with the owners in the clinic to ensure proper
delivery. At home, owners performed them three times a week.

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