By Dr. Laura Hady
As the weather begins to cool, we may notice our dogs limping more or having greater difficulty getting up or down in the mornings and evenings. While I have covered several musculoskeletal issues in the back legs, this column focuses on problems in the front limbs that may be harder to diagnose and treat.
Unlike humans, pets bear 60% of their weight on their front limbs, as their center of gravity is just behind their shoulders. The following are some tips, issues and treatment options for lameness in the front limbs.
- Check the paws. While pet owners know to check paws for stickers, ticks, and burns from hot concrete, it is still smart to examine the feet in cooler months. Trauma to the ligaments and bones of the toes may present as an on/off lameness that increases with activity. Cysts between the toes and masses such as tumors can start on the toes, under the skin of the feet, and can even affect the bones. Keeping the nails trimmed every four to six weeks throughout the winter on older pets is a good way to remember to examine the feet and may make walking more comfortable. Also, put waterproof or graphite booties on dogs that will be walking long distances in the snow or ice. Muttluks or Paw-Tectors are two brands that I have used that provide protection without causing sores.
- Wrist issues. Problems in the wrist include fractures, arthritis, dropping of the wrist due to lax tendons, and a bowing forward of the wrist due to radial nerve damage. Palpation of the wrist, radiographs, and ultrasound are three commonly used diagnostic tools. Soft braces, surgery to fuse the wrist, low level laser therapy, and pain medications are some treatment options that your veterinarian may recommend based on the diagnosis.
- The rugged elbow. Fast-growing and more active breeds of dogs can have growth abnormalities known as a fragmented medial coronoid process of the ulna or osteochondrosis dissecans of the humeral head. When detected, these issues are found in both elbows up to 68% of the time. These can result from the radius and ulna growing at two different rates or too rapidly. The result is a bone flap or chip in the joint, which causes pain and inflammation, and may lead to arthritis. Dogs with this condition may first show pain between five and eight months of age that is exacerbated when the treating vet flexes the elbow and turns the wrist inward. As the condition progresses, the dog may become more bow-legged, tending to shift the weight to the outside of the joint. Your veterinarian may recommend baseline radiographs to look for secondary changes or may refer you and your dog to an orthopedic surgeon for advanced diagnostics like a CT scan. Arthroscopic surgery that involves removal of the piece of bone or flap, followed by treatment with platelet rich plasma or stem cells is the route of choice.
- Demystifying the shoulder. Issues with the shoulder include OCD (osteochondritis dissecans) on the humeral head, causing arthritis and tendonitis, or inflammation in the tendons that connect the muscles to the bones. Less common problems include dislocations (more common in small breeds and cats), or cancer involving the soft tissue or bones (more common in large breeds). Issues in the neck muscles or disc disease in the cervical spine can present like a problem in the shoulder. While NSAIDs (non-steroidal anti-inflammatory drugs) may help problems directly in the joint, they might not resolve the lameness if the main issue is in the tendons. Your veterinarian may test for pain in and around the shoulder by flexing the shoulder and extending the elbow. Baseline radiographs may show arthritis; ultrasound or even an MRI is best to see changes in the muscles and tendons. Treatments may include surgery, joint injections with steroids, and/or platelet-rich plasma injected into the tendons, and physical rehabilitation.
Please remember that diagnosing and treating front limb lameness may be done in a step-wise approach. I often encourage pet owners to send me videos of their pet walking and running if possible before coming to the first appointment. Seeing a veterinarian sooner than later, even for a subtle lameness, can help your pet be more comfortable and able to move better.
