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Pointing light at musculoskeletal and neurological conditions: clinical applications 147

Case no. 21

N., canine, 4 years old, Boxer, MC, 36 kg

• Complaint: lameness and inflammation of the stifle.
• History:
• N. underwent TTA surgery for partial left CCLR a week ago. Before surgery, his lameness was minimal. He
has been on cephalexin since then.
• Everything seemed to be going well until yesterday, when he started to be very lame in the same limb, so
he came for a second opinion. No trauma after surgery.
• Tramadol does not seem to be helping and owners want to avoid NSAIDs because he has chronic
leishmaniasis and IRIS stage I renal disease.
• Physical examination: 4–5/5 left hindlimb lameness (Fig. C21.1a, b). Pain score 7/10. Severe inflammation of

the stifle, with marked edema and tumefaction. Inflammation of the surgical incision (Fig. C21.1c).

• Diagnosis: surgical site inflammation.

• Treatment:
• Laser therapy:
2
• To treat the incision site plus its margin (total 50 cm ), a low power density was used (0.2 W/
2
cm ), while slightly higher values can be reached around the rest of the joint. Power was kept low to

moderate due to the severe inflammation.
• The patient was treated on 2 consecutive days, then twice more at 48 h intervals, and once more
another 72 h later.

• Outcome: in 9 days and with LT as the sole treatment, the inflammation was resolved (Fig. 21.2); lameness
score was reduced to 1/5 and pain score to 1/10.

Figure C21.1 (a, b) Severe left hindlimb lameness and (c) severe Figure C21.2 (a) Stifle and (b) patient walking 9 days

inflammation of the stifle a week after surgery. later.

Spot No.
Area P (W) Tx time J/cm 2 Total J/Tx (cm ) W/cm 2 Tx/week Tx
2
a
Wound (50 1.6 125 s (2.1 min) 4 200 8 0.2 4-2 6
2
cm )
Stifl e/prox.
tibia (150 4 262 s (4.4 min) 7 1050 5 0.8 4-2 6
cm )
2

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