Introduction To Lameness

Bone Injuries, Joint Injuries, Disc Disease & Cartilage Diseases

by Roger Ross, DVM
Diseases and Injuries of Bone, Joints, Cartilage, and Ligaments


Introduction to Orthopedic Injuries

Not much introduction needed here, but we vets see a wide variety of injuries that cause lameness' in pets.  

Typical injuries include pets being hit by cars and bite wounds, especially between cats. 

Bullets and BB Guns. 

Fan Belt Disease (what we vets call those unfortunate cats that are sleeping in engine compartments of cars when someone starts the engine)

And a whole host of various athletic and accidental injuries involving pulled muscles, torn ligaments, slipped discs, and so forth.

Be Careful Out There.

We'll discuss these problems in more detail below


A few introductory comments about Orthopedic Infections:

Sometimes pets become lame because of infections of the spine or joints. 

Lyme Disease, which is caused by an infectious agent spread by ticks is an example. 

Heartworm disease can cause inflammation and secondary infection of the joints. 

And of course, joint infections can be due to bacteria or virus'


A few introductory comments about Orthopedic problems associated with nutrition:

Nutrition during the fetal development of the skeletal system, nutrition during the growth stages of the animal, and the quantity and quality of nutrition during the rest of the pet's life can affect joint health. 

And, of course, obesity greatly affects the joints.


A few introductory comments about Orthopedic problems due to genetics

I suspect we're going to learn a lot more about genetics over the next 10 years and it's role in joint disease.
 
We already know a fair amount: that certain breeds are prone to certain diseases. 

Common examples are hip dysphasia in German Shepherds and Patellar luxations in Poms. 

And Rheumatoid Arthritis probably has a genetic component cause. 


A few introductory comments about Arthritis

Arthritis includes a whole family of diseases...hip dysphasia, for example, is a particular type of arthritis...that involve inflammation and erosion of joint cartilage that over time gets worse and worse. 

Without the cushioning effect of healthy cartilage, painful nerve endings are hammered.  With pain, the joint is used less and becomes stiff and losses it's range of motion. 

And there's more:  with inflammation there's a release of tacky inflammatory secretions and toxins into the joint leading to further destruction. 

This process is started or present in some pets and not others in different degrees for reasons we don't really understand well, but we do know that factors include genetics, old injuries, diet, cell oxidation, bacterial invasion, age, and obesity. 

To go to our page specifically about arthritis; simply click here.  Thanks





What to expect at the Hospital at our clinic if you bring in pet in with a lameness.

(Of course, other vets may do things differently)

If you read the introductory comments you realize that in addition to injuries, there are many possible causes of lameness. Some are minor and likely to self heal given a little time, and others are quite serious requiring timely treatment.

History and Signalment:  The Signalment refers to things like age, sex, and breed.  We will know this, of course, as soon as we start the exam and ask a few basic questions, but it helps influence our diagnostic decisions: we are much more likely to suspect injury in a 7 month old, hyper puppy than cancer or arthritis, for example.
And if the history is that a dog came home limping after running away from home, then again, we'd have a good clue that the problem is due to an injury. 
History is even more important in less obvious cases; it helps to know when the problem started, when it flares ups, does it involve more than one leg? and so forth

EXAM:
In addition to our normal careful exam we pay special attention to
joint heat, pain, range of motion, weight bearing pressure, & neural reflexes.

Also we look and feel closely for excessive joint laxity, evaluate gait, body posture, and check the paws and nails carefully for torn nails and tiny punctures.

Often the cause of the lameness is not obvious other than that the limb is tender or swollen.  This is true, for example, with "pulled" muscles and other soft tissue damage.

Your vet may trot your pet or otherwise purposely stress test a joint to better get a diagnosis. 

Sometimes a good exam is enough to rule out major injuries, and if the pet owner wants to minimize expense, then sometimes we treat the case conservatively.  Just be aware this doesn't always work out and a repeat visit and a more aggressive work up may be in order

Initial Diagnostics and/or treatment:

If the cause for the problem isn't obvious on exam but I'm pretty sure a fracture or dislocation or ligament rupture is not present, we will often treat the case conservatively.  This means skipping radiographs and other diagnostic tests in lieu of rest, time, and medication for pain, swelling, and inflammation. 

This approach often works out well IF IF IF your vet is experienced and skilled at distinguishing the minor cases from the more serious. 

And if we do miss a more serious injury than first thought, it's usually not that bad a thing to find out a week later when you return because the initial treatment didn't work. 

But there's at least one big exception.  It's fairly easy to miss a dislocation and if we don't reduce ("pop" back in) a dislocated joint in the first 48 hours after an injury we usually can't fix the problem without expensive surgery.  (the joint fills up with clotted blood and other fluids making manual replacement impossible)

And now that we routinely take radiographs when a pet is lame, I'm finding that this experienced and skillful vet was missing a lot of things that didn't turn up on physical exam.

So, listen to your vet if he or she recommends radiographs.



RADIOGRAPHS:

Like most things in medicine, how aggressive to get is a judgement call,  but if the extent of the injury is suspected to be serious, then we'll certainly recommend radiographs.  They're excellent at discerning fractures, dislocations, foreign bodies (such as bird shot), cortical inflammatory diseases such as panosteitis, and cancer.

Other imaging techniques, such as MRI's which are excellent for soft tissue injuries, are not yet common in most veterinary practices, but may be in the near future.
(there will probably "be an app for that" someday soon)

Sedation/Light Anesthesia:  I am often able to better examine, extend, twist, and torque painful and injured limbs, thereby getting a diagnosis if we take the time, trouble, and expense of putting the patient under light sedation.  This is especially true of ligament damage. 

Light anesthesia is often needed to get high quality (wiggle free) x-rays as well.


LAB WORK

There are two main reasons for considering blood work in a lameness case:

1.  to rule out infectious, excessive inflammatory, or metabolic problems that may be involved with the lameness.  This would also include rarer problems such as mineral deficiencies and diseases that affect calcium and phosphorous.

2.  For anesthetic safety:  we often (usually) have to anesthetize limb injured patients for x-rays, wound repair, splinting, and surgery. Ideally, this means making sure liver, kidney, and sugar, red blood cell levels, platelet levels, and electrolyte are all within normal range and not likely to cause complications.  That's what blood work is for.

Treatment

Treatment will consist of anything from:
laser therapy
enforced rest or strictly limited activity for awhile
medication for pain, inflammation, and infection
medication to stimulate or promote healing
nutritional support
a simple support bandage
a splint or cast
surgical treatment of a wound (especially common in cats)
surgical pinning, plating, or other immobilizing surgical devices
bone grafts
amputation
stem cell therapy !!!
referral to an orthopedic specialist

euthanasia ... sometimes due to the severe extent of the injury but
                     often because of the expense of repair.  Please
                     consider pet insurance; it saves a lot of pet lives.

RECHECKS: almost all lameness cases require careful management and frequent rechecks ... all kinds of little things can go wrong during the healing process that need to be watched. Especially if bandages, splints, or casts are involved.

Other possible treatments might include:

Anabolic Steroids in rare, geriatric cases

Sedatives or anti-anxiety medications to enforce rest

Duralactin ... an interesting new natural medication that seems to work well in some cases

Antioxidants (oxidation is especially damaging to joint cartilage)

Alternative Treatments such as acupuncture, herbs etc ???

Newer and pretty amazing treatments such as laser therapy and stem cell therapy

Of course, there are often multiple problems that need to be addressed such as an open wound, lots of abrasions and swellings, possible nerve damage, and fractures ...all in one case, especially if the patient was hit by a car.

Rest and time

Physical Therapy

Prayer

These last 3 steps are very important.  I mention prayer, because sometimes injuries to joints, ligaments, tendons and bones are permanent just as they are in humans, no matter which Earth bound treatment we use. 

Realistic Expectations:

There's a saying in orthopedic medicine that our treatment goal is a "return to function".  Not necessarily perfection. 

Usually we can fix the problem adequately and sometimes we think we can, but despite a lot of effort and expense; we can't.  Not because of lack of skill, but because of the extent of the damage. Or a patient that just doesn't heal well due to age, genetics, poor nutrition, a suppressed immune system due to parasites, and many other factors.  Just be aware of this.

A special caution about splinting fractures:  Immobilizing a fracture, especially of the lower limbs, with a splint or cast is often successful and much less expensive than "internal fixation"methods such as bone plates and pins.  And many clients choose a splint because of the expense factor and are happy with the results. 

But there's a reason internal fixation is often worth the extra cost: it's much more likely to work.  Splints sometimes fail to adequately immobilize the broken bone ends and the bones don't heal. 

Splints also pose additional problems; getting them tight enough to stay on and immobilize the bone ends well sometimes result in circulation problems, occasionally disastrous, to the paw and lower leg.  You have to be very careful about keeping splints dry and checking for pain, odor, cold toes, and other signs of trouble.

REFERRAL

The equipment and expertise for doing a good job of surgically repairing bone fractures has become highly developed, and specialized.  The proper equipment is very expensive.  Because of this, many general practitioners (including me) send major fractures to a specialist for repair. 

Amputation:

If the leg is squished, shattered, or so badly damaged that repair is unlikely ... or if you are unable to afford the $1200-4,000 cost of a typical fracture case  (please look into pet insurance) then the best option short of euthanasia is amputation.  It's nice to avoid this, but in truth, most pets get along pretty well with a missing leg.

Chiropractors:  In certain types of injuries this mode of treatment seems to be very beneficial.  Especially for lower back or neck injuries.

Abscesses: we frequently have pets brought in for what the owner assumes is a leg injury because the pet is limping ... and they're correct ... it is an injury ... but not the kind they thought: it turns out to be a hidden abscess or infected wound, often from a bite ...this is very common in cats and treatment is somewhat different than that discussed above.  Please go to our page about the treatment of abscesses for more specific treatment information. 


This page was meant to be a general introduction to lameness. I have written about how I treat different, specific bone and joint problems on other pages.  Links are to your left.

Thanks,  Roger Ross, DVM

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There is a complete site map at the bottom of this page
What's On This Page:

Introduction: Lameness in pets do to...
    Injuries
    Infectious
    Nutrition
    Genetic
    Arthritis

What To Expect When You Go To The Vet When Your Pet Is Limping:


What's on Other Pages about Joint & Bone Related Problems

What To Expect When You Go To The Vet When Your Pet Has Arthritis

Femoral Head Removal

Hip Dysplasia

Cruciate Ligament Ruptures and Repairs

Panosteitis

Disc Disease

Bone Surgery

Therapeutic Diets and Supplements used to treat Arthritis and other Joint Disease

A complete directory of links is at the bottom of the page.





A note about bacterial infections of the joints:

You might be surprised to know that the number one cause of bacterial entry into the blood is through gum disease. 

Gum inflammation allows easy bacteria access into the blood stream, and once in the blood, some of the bacteria survive our defense mechanisms and are able to establish destructive colonies in different parts of our bodies. 

Bacteria seem to do especially "like" heart valves, liver, and joints  (also mammary tissue if nursing or the uterus if pregnant).

Bacteria invasion may also be involved in the sequence of events leading to auto-immune inflammation of our joints.  So, listen to your vet when he or she recommends dentistry.


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Veterinary Pet Insurance

Lameness in cats is often due to bite wound abscesses ... or as in the case above ... an abscess from a "bot fly larvae"
In some parts of the country, lameness from Lymes or Ehrlichia Disease is common. 

Both diseases are transmitted by ticks. 

On both incidence maps; the darker the color, the more prevalent the disease
Lymes Incidence Map
Ehrilichia Incidence Map