Page 1149 - Cote clinical veterinary advisor dogs and cats 4th

572 Lameness

• Observation at a walk and trot for gait • Arthrocentesis (p. 1059) nutraceuticals such as chondroitin and
abnormalities to help localize the limb that ○ Can aid in differentiating degenerative glucosamine.
VetBooks.ir ○ Failing to bear full weight on limb, leaning ○ Culture and sensitivity: joint fluid should Behavior/Exercise
joint disease from infectious, inflamma-
is affected
tory, or immune-mediated joint disease
Behavioral and physical activity recommenda-
off affected limb when standing
○ Short stride on affected limb
highest yield.
○ Head bob (down on sound: head moves be cultured in blood culture medium for tions include moderation of physical activity,
physical rehabilitation, stretching, and eliminat-
down when patient bears weight on • Immunologic testing: rheumatoid factor ing environmental risks such as slippery walking
normal limb and then up when bearing (low yield), antinuclear antibody test if surfaces, stairs, and need for jumping. Toe
weight on affected limb to decrease weight systemic lupus erythematosus suspected grips, rough-surfaced booties, or painted-on
on affected limb) with forelimb lameness (p. 955) pad products (e.g., PawFriction, Pawtology
○ Toeing in or out • Ultrasound of tendons or muscles LLC) can be useful in some cases.
○ Dragging feet or scuffing nails • CT, MRI (p. 1132): CT is most useful for
○ Bunny hopping (hindlimb weakness) bones and joints, whereas MRI is most useful Drug Interactions
○ Stumbling for soft tissue and spinal disease. Glucocorticoids potentiate the gastrointestinal
○ Ataxia • Arthroscopy: can be used for diagnostic and (GI) ulcerogenic effects of NSAIDs; this
○ Hypermetria therapeutic purposes. combination is contraindicated.
○ Stiff, stilted gait: walking on egg shells • Arthrotomy
• When both hindlimbs are affected, weight • Soft-tissue or bone biopsy of specific lesions Possible Complications
may be shifted onto forelimbs, resulting • Force plate and gait analysis NSAIDs may be associated with GI irritation
in arched posture and abduction of the • Nuclear scintigraphy: used for localizing for some patients. They should also be used
elbows. disease such as a difficult-to-diagnose lame- cautiously in animals with pre-existing renal
ness or metastatic tumors disease.
Etiology and Pathophysiology • Electromyography (EMG): useful for evaluat-
• Lameness secondary to pain from the ing neuromuscular conditions Recommended Monitoring
musculoskeletal system: pain causes decreased • Muscle or nerve biopsy Response to therapy
weight bearing on the affected limb and
shortness of stride. Severe, acute pain may TREATMENT PROGNOSIS & OUTCOME
cause non–weight bearing on affected limb.
• Mechanical lameness: may be caused by Treatment Overview Varies, depending on underlying cause of lame-
abnormal length or angulation of bones, Treatment of lameness requires a multimodal ness. For example, most cases of panosteitis in
joints, ligaments, or tendons approach to alleviate pain and treat the underly- growing dogs resolve spontaneously over time
• Endocrine-related lameness: hyperadrenocor- ing disorder causing the lameness. (prognosis excellent), whereas lameness due
ticism may cause myopathy, and diabetes to osteosarcoma of a long bone has a poor
mellitus may cause peripheral neuropathy. Acute General Treatment long-term prognosis.
• Neurologic disorders may cause ataxia, Lameness is a clinical sign, not a specific disease.
paresis, pain manifesting as lameness, or Treatment is based on determination of the PEARLS & CONSIDERATIONS
holding limb up as root signature underlying cause.
• Mono or polyarthropathy of any cause can Comments
result in lameness. Chronic Treatment Attention to signalment, history, and thorough
• Depends on underlying cause exam is essential for generating a short list of
DIAGNOSIS • Adjunctive/supportive treatment may include differential diagnoses. Common signalment
one or several of the following: profiles are provided on p. 1262.
Diagnostic Overview ○ Weight loss, if indicated (p. 700)
Accurate diagnosis of lameness combines a ○ Glycosaminoglycan administered intra- Prevention
thorough history, clinical exam, and consid- muscularly or intraarticularly (p. 469) Weight management has been shown to reduce
eration of patient signalment. An orthopedic ○ Nonsteroidal antiinflammatory drugs the incidence and severity of osteoarthritis and
exam is indicated in every case, and additional (NSAIDs) (p. 469) clinical signs in patients with orthopedic disease.
tests such as radiographs are selected based ○ Analgesics (e.g., amantadine, tramadol,
on abnormalities identified in the exam and gabapentin) (p. 469) Technician Tips
medical history. ○ Intraarticular hyaluronic acid or intraar- Use a soft surface for patient and examiner
ticular corticosteroids can be administered comfort and to reduce patient stress.
Differential Diagnosis for severe arthritis unresponsive to other
See Lameness on p. 1249 for detailed differential therapies. SUGGESTED READING
diagnosis. ○ Platelet-rich plasma (PRP) therapy for Fossum TW: Orthopedic examination. In Fossum
osteoarthritis and soft-tissue injury TW, editor: Small animal surgery, ed 4, St. Louis,
Initial Database ○ Stem cell therapy derived from autoge- 2013, Mosby, pp 931-941.
• Complete orthopedic and neurologic exams nous adipose tissue has recently become AUTHOR: David A. Puerto, DVM, DACVS
• Radiographs of affected limb(s) available. EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
○ Acupuncture provides anecdotal relief for
Advanced or Confirmatory Testing some dogs (p. 1056).
• CBC, serum biochemistry panel, urinalysis: ○ Physical/rehabilitative be useful.
for abnormalities suggesting metabolic or
systemic causes Nutrition/Diet
• Serologic titers for infectious disease (e.g., Nutritional and dietary therapeutics include
Lyme disease, ehrlichiosis) as appropriate eicosapentaenoic acid (EPA)–rich diets and

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