Rizzle Finch

Pets Age: 
21 month old
Pet Type: 
Male neutered, Boxer cross

Rizzle first presented to the Smart Clinic in March this year. Right fore lameness had been noted in early January and signs had waxed and waned with only temporary response to periods of rest. Radiographic and CT findings were consistent with bilateral elbow dysplasia with a fragmented coronoid process on the right. The CT imaging also showed signs of right biceps tendon pathology. He had seen an orthopaedic specialist who felt that arthroscopic assessment may be required with a view to surgery. The decision was made to try rehabilitation before proceeding with this.

During his initial assessment he showed decreased weight bearing through the right fore in stand. On gait evaluation he displayed a high head carriage with a bilaterally stilted forelimb gait. The right fore demonstrated a 2/10 lameness characterised by lack of dynamic flexion of the elbow in limb protraction. Right fore distal limb placement was also poorly controlled. When observed from the plantar aspect he had a pronounced movement of his tail base to the left in a compensatory fashion. Right hind placement was heavy and abducted, also in compensation. The right fore lameness worsened when walking on a circle to the right and he would compensate by flexing his neck laterally to the left. He lacked tolerance for walking in circles in either direction. His default gait was a trot.

On initial palpation there was marked tension affecting the caudal brachiocephalicus muscle, particularly on the right. There was some tenderness on palpation of the soft tissue structures on the medial aspect of her glenohumeral joint on the right. There was resentment to a right biceps stretch. There was also marked tension affecting the triceps on the right. He resented flexion and extension of the right elbow. Both elbows showed mild lateral effusion. There was effusion, heat and discomfort on digital pressure of the medial aspect of the right elbow. His overall muscle mass and tone was reasonable and this included his abdominal and paraspinal musculature. However, there was a muscular deficit affecting the proximal right fore. There was generalised hyperaesthesia and allodynia of the longissimus dorsi muscle. There was also some discomfort on palpation of both sacro-iliac joints and over both greater trochanters. Left sciatica was detected.

He attended the clinic once per week for eight weeks. Our initial aims were to address pain and muscle spasm and to encourage more functional recruitment of the right fore proximal musculature. Physiotherapy initially aimed to take the load off the elbows and shoulders by encouraging more functionally sound recruitment of his core and hind limb muscles. We also addressed the secondary inflammatory changes in the right biceps.  

Techniques employed in his rehabilitation included aquatic treadmill work, physiotherapy exercises, hot and cold therapies, acupuncture, chiropractic treatment and soft tissue work. His homework regime was built on week by week and included static weight bearing exercises on and off the balance cushion, stepping over obstacles and proprioceptive wrapping targeting his triceps and biceps muscles and his core musculature.

When he started his treatment he was on 2mg/kg daily of carprofen but it was possible to wean him off this after six weeks of treatment. He also received a four week course of Cartrophen.

After 8 weeks he started some interval jogging in preparation for off lead and from here he was able to start off lead exercise at the end of a walk for a few minutes. His last visit at the time of writing was in early June he was able to be off lead for a large part of his walks lasting 45-60 minutes. There was no lameness detected on gait evaluation. The effusion and heat in the right elbow had completely subsided and he tolerated manipulation of the joint through full range well. Proximal right fore muscle mass and tone had improved. The only abnormal findings were mild muscular tension in the brachiocephalicus on the right and in the paralumbar musculature. We will soon be able to reduce his treatment frequency further and his activity levels will be gradually increased toward discharge.

This is an example of how the signs of elbow dysplasia in certain cases will resolve with rehabilitation, rather than requiring surgery. We are all aware that any osteoarthritic changes that are present will likely develop further in later years but the severity of the wear and tear will be less dramatic due to his improved biomechanical picture.