Dog Health by LowchensAustralia.com

DEFINITION
A disturbance in gait and locomotion as a response to pain or injury

Pathophysiology
• Severe, sharp pain will cause an animal to carry or nonweight-bear on its affected limb while in motion.
• Lesser, dull, or aching pain will result in a limp or offweight-bearing use of the limb; at rest, the affected limb will bear less weight.
• Pain that is produced only during certain phases of movement will cause the animal to adjust its motion and gait during those phases to minimize discomfort.

Systems Affected
• Musculoskeletal
• Nervous

SIGNALMENT
• Can affect any age or breed
• Certain diseases have specific age, breed, and sex predilections.

SIGNS

General Comments
• Forelimb lameness--animals with unilateral forelimb lameness compensate by moving the head and neck upward as the affected limb is placed on the ground and dropping the head and neck when the sound limb bears the weight.
• Hindlimb lameness--movement of the head and neck is less pronounced and more weight is shifted to the forelimbs by dropping the forequarters. With unilateral lameness, animal drops lower on the sound limb when it strikes the ground and elevates its hindquarters when the affected limb is on the ground.
• Always assess the neurologic status of the animal, especially if a proximal lesion is suspected.

Historical Findings
• A complete history is mandatory--signalment, identification of affected limb(s), known trauma, changes in weather, exercise, or rest, and responsiveness to previous treatments are important.
• Onset of lameness? Acute versus chronic. Progression? Static versus slow versus rapid.
• Is the animal demonstrably in pain or just lame?

Physical Examination Findings
• Do a complete routine exam.
• Observe gait during a walk, trot, climbing stairs, or figure-of-eights.
• Palpate for asymmetry of muscle mass and bony prominences.
• Manipulate bones and joints, beginning distally and working proximally.
• Assess for instability, incongruency, luxation or subluxation, pain, abnormal range of motion, and abnormal sounds.
• Avoid the suspected area of involvement until last. It is better to examine the normal limbs first in order to allow relaxation and to assess normal reactions to manoeuvres.

Common Causes of Lameness in Dogs

Forelimb
GROWING DOG (< 12 MONTHS OF AGE)
• Osteochondrosis of the shoulder
• Shoulder luxation/subluxation (congenital)
• Osteochondrosis of the elbow
• Ununited anconeal process
• Fragmented medial coronoid process
• Elbow incongruity
• Avulsion/calcification of the flexor muscles (elbow)
• Asymmetric growth of the radius and ulna
• Panosteitis
• Hypertrophic osteodystrophy
• Trauma (soft tissue, bone, joint)
• Infection (local or systemic causes)
• Nutritional imbalances
• Congenital anomalies
MATURE DOG (> 12 MONTHS OF AGE)
• Degenerative joint disease
• Bicipital tenosynovitis
• Calcification of supra/infraspinatus tendon
• Contracture of supra/infraspinatus muscle
• Soft tissue or bone neoplasia (primary or metastatic)
• Trauma (soft tissue, bone, joint)
• Panosteitis
• Polyarthropathies
• Polymyositis
• Polyneuritis

Hindlimb
GROWING DOG (< 12 MONTHS OF AGE)
• Hip dysplasia
• Avascular necrosis of femoral head (Legg-Calv?-Perthes)
• Osteochondrosis of stifle
• Patellar luxation (medial or lateral condyle)
• Osteochondrosis of hock
• Panosteitis
• Hypertrophic osteodystrophy
• Trauma (soft tissue, bone, joint)
• Infection (local and systemic causes)
• Nutritional imbalances
• Congenital anomalies
MATURE DOG (> 12 MONTHS OF AGE)
• Degenerative joint disease
• Cruciate ligament disease
• Avulsion of long digital extensor tendon (stifle)
• Soft tissue or bone neoplasia (primary or metastatic)
• Trauma (soft tissue, bone, joint)
• Panosteitis
• Polyarthropathies
• Polymyositis
• Polyneuritis

RISK FACTORS N/A

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS
Must differentiate musculoskeletal causes from neurogenic causes of lameness

CBC/BIOCHEMISTRY/URINALYSIS
Hemogram, serum chemistry profile, and urinalysis are usually normal.

OTHER LABORATORY TESTS
Dependent on suspected cause of lameness

IMAGING
• Radiographs are recommended for all suspected causes of musculoskeletal lameness.
• CT scans, MRI, and bone scans using radioisotopes are useful in identifying and delineating causative lesions.

OTHER DIAGNOSTIC PROCEDURES
• Cytologic examination of joint fluid is useful in identifying and differentiating intraarticular disease.
• EMG is useful for differentiating neuromuscular disease from musculoskeletal disease.
• Muscle/nerve biopsies are useful in establishing the presence and identity of neuromuscular disease.

TREATMENT
Dependent on cause of lameness

MEDICATIONS

DRUGS AND FLUIDS
• Analgesic and antiinflammatory drugs (NSAIDs) are often indicated to symptomatically treat the manifestations of lameness.
• Corticosteroids should be used judiciously, unless specifically indicated, due to potential side effects and articular cartilage damage associated with long-term use.

CONTRAINDICATIONS N/A

PRECAUTIONS
Gastrointestinal irritation may occur with the use of NSAIDs and may preclude their use in individual animals.

POSSIBLE INTERACTIONS N/A

ALTERNATE DRUGS
If treating degenerative joint disease, chondroprotective drugs such as polysulfated glycosaminoglycans may be of benefit in limiting cartilage damage and degeneration. They may also help alleviate pain and inflammation.

FOLLOW-UP

PATIENT MONITORING
Dependent on cause of lameness

POSSIBLE COMPLICATIONS N/A

MISCELLANEOUS

ASSOCIATED CONDITIONS N/A

AGE RELATED FACTORS N/A

ZOONOTIC POTENTIAL N/A

PREGNANCY N/A

SYNONYMS N/A

SEE ALSO
See Causes

ABBREVIATION
EMG = electromyographic

Reference
Brinker WO, Piermattei DL, Flo GL. Physical examination for lameness. In: Handbook of small animal orthopedics and fracture treatment. 2nd ed. Philadelphia: WB Saunders, 1990.
Author - Peter D. Schwarz
Consulting Author - Peter D. Schwarz
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