Bella Williams

Pets Age: 
4 year old
Pet Type: 
Female neutered German Shepherd dog
Problem: 
Lateral Meniscal Issues

Two interesting cases involving stifles

As veterinary practitioners, we all see multiple cases of stifle disease in one form or another every day. They all respond to treatment differently. Two cases have stood out as unusual recently:

 

1) Bella

We had been treating Bella for lumbosacral pain for 3-4 weeks when she started to show signs of intermittent right hind lameness. There had been some response to non-steroidals but as soon as the intensity and duration of activity was increased to a near-normal level, the lameness would recommence. The lameness score was normally 10/10 on the onset of the episode and would subside to 1-2/10 in the 1-2 days following this. The lameness was characterised by reduced loading during the stance phase of the stride and shortening in protraction due to a reduced range of dynamic stifle extension. She was also offloading the right hind in stand. Passive range of flexion of the right stifle was limited with a pain end point. Marked compensatory muscle tension in the longissimus lumborum and iliocostalis lumborum was noted on the right

Bella was referred to an orthopaedic specialist. We were all suspicious of cranial cruciate disease but wanted to rule out any sinister pathology. Radiographs showed mild osteoarthritic changes in the stifle. It was surprising to find that a lateral meniscal tear was diagnosed via arthroscopy. Meniscectomy via arthroscopy took place in September 2014. Although there was a possibility of concurrent cruciate disease this was not grossly visible. It was interesting to note that she showed the unusual finding of lateral buttress effect.

Bella attended the Smart Clinic again six weeks post-op in late October 2014. Recovery post-operatively had been uneventful. On presentation she showed a 1/10 right hind lameness which was characterised by a reduced range of dynamic stifle flexion into protraction of the limb as before. At this stage there continued to be some reticence about passive extension of the right stifle with concurrent passive hip flexion. Mild effusion of the joint was present. There was marked discomfort on palpation of the quadriceps, gluteals, gastrocnemius and semimembranosus muscles. There was also a considerable level of fascial constriction over the quadriceps and the flank on the right which was addressed with soft tissue work over the coming weeks.

Bella underwent an integrated rehabilitation programme aimed at alleviating the soft tissue abnormalities described above. At one point there was a high level of tension and discomfort affecting the gracilis muscle on the right. This was likely related to her reduced range of passive and dynamic stifle extension into protraction and was addressed with soft tissue work, stretches and therapeutic ultrasound. We worked to improve proprioceptive function through the right hind and to start to build endurance and strength. Although the lameness was low-grade post surgically, this work aims to provide a sustainable improvement which will allow her to perform her obedience tasks without ill-effect and without worsening any mild arthritic changes present. After two months of treatment she is at the stage where we can start a gradual introduction of her obedience work.

 

Next case involving stifles: Baloo Williams