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Lameness

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Abstract

The lame dog is one of the more common presentations to first-opinion vets and any vet working in a busy genial practice will be faced with such a case on a daily basis. Rather than a systematic review of all causes of lameness, this chapter will focus on the initial approach to the lame dog, to help the clinician develop a list of the common differential diagnoses for further investigation and treatment. This chapter looks at observation, history: baseline data, physical examination: identifying the seat of pain, differential diagnosis, further investigations and treatment. : Assessment of anterior cruciate instability; Assessing hip laxity.

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Figures

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15.1 Dogs with stifle disease usually adopt a characteristic sitting posture, with both hindlegs to one side of the body.
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15.2 Panosteitis is one of the few common causes of bone pain. Radiographically it presents as radiodense ‘thumbprint’ lesions on the long bones (arrowed).
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15.3 Primary bone neoplasia, most commonly osteosarcoma, usually affects the extremities of the long bones away from the elbow and towards the stifle. Unusually, the distal tibia was involved in this case.
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15.4 Salter–Harris type II fracture of the proximal tibia. On presentation, such fractures are often remarkably stable, but there is marked pain and swelling of the metaphyseal region. Note the small bone fragment below the avulsed tibial tuberosity (white arrow) and the fracture line extending from the physis (red arrow).
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15.5 Elbow effusions can be particularly voluminous, as in this 6-month-old Golden Retriever with osteochondrosis dissecans (OCD). There is a large distension caudal to the lateral epicondyle.
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15.6 Stifle effusion is easily palpated as a bulging of the joint capsule to either side of the straight patellar ligament.
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15.7 Examining the carpus for hyperextension injury is best achieved by simultaneously compressing from the olecranon and the palmar aspect of the foot.
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15.8 Periarticular new bone formation can be dramatic compared with the normal joint causing marked thickening which is readily palpable.
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15.9 Avulsion of the tibial tuberosity is a common injury in juvenile dogs, requiring prompt surgical attention.
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15.12 It is important not to overlook early changes in a joint that, although subtle, may be more significant than advanced changes elsewhere that may be quiescent. Comparison with the contralateral limb can be useful, as in this case of early cruciate disease: early changes are shown by joint effusion and subtle new bone deposition. A = fat pad; B = synovial fluid; C = osteophytes.
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15.13 Two radiographs of a dog with hip dysplasia. In the standard ventrodorsal view, the joint structure looks reasonable. With the legs raised into a weight-bearing position, subluxation of the joints is obvious.
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15.14 Hip dysplasia is essentially increased elasticity of the coxofemoral joint. Whilst the joint may have the ability to be congruent, weight-bearing allows the femoral head to subluxate so that weight-bearing is focused through a much reduced joint surface area. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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15.16 Arthroscopic view of the elbow in a 6-month-old Labrador Retriever, showing joint incongruency with severe cartilage destruction.
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