Careful history taking can be crucial in the diagnosis of many types of lameness. After noting your pets age, sex and breed and asking about general health issues, questions specific to the lameness may include:
a) How long has the problem been going on?
b) Is it getting better or worse?
c) Is it worse in the morning, worse at night, worse after rest, worse after exercise?
d) Does it wax and wane or remain constant?
e) Does your dog cry in pain?
f) Has it responded to any treatment?
Following a general physical examination your pet will be observed as he/she sits/stands in the examination room. For dogs it is common to observe walking and trotting. Sometimes owners find it helpful to bring along home videos of their pet's gait, particularly if the problem appears to come and go.
Orthopedic evaluation usually concentrates on examination of all four limbs, palpating the bones, muscles and joints for pain, swellings and decreased or abnormal ranges of motion. Your veterinarian may also focus on specific areas to look for certain causes of lameness in areas like the hip (hip dyplasia – Ortolani maneuver), elbow (elbow dysplasia) and stifle (cruciate disease – cranial drawer sign).
Your veterinarian will also manipulate the neck and palpate the spine along its length. If neurological disease is suspected a more detailed neurological examination will be necessary.
If an abnormality of bone or joint is detected on the examination, radiographs of that region may be taken. Radiographs are not always necessary, however, although they can be helpful to confirm a suspected diagnosis, to discover the exact diagnosis (say there is elbow pain but the exact cause could be one of several different problems with different treatment plans) or to give an owner a more accurate prognosis.
Sometimes, with more subtle problems, it is necessary to radiograph the opposite normal limb for the purposes of comparison. Radiographs may lead to a suspicion of a certain problem, but not definitive confirmation. In some cases, further x-rays of the same site, taken in another 4 to 6 weeks may be suggested, to see if the area of interest has changed or the lesion progressed after that time.
Radiographs may also suggest that other diagnostic tests are appropriate such as a biopsy or a joint tap. A joint tap involves the insertion of a sterile needle into a joint, with your pet either sedated or anesthetized. The fluid is evaluated to define the type of pathology present in the joint.
In certain challenging lameness cases, CT scans or MRI can be helpful, such as in the diagnosis of a subtle cruciate injury in the knee. Alternatively, arthroscopy, that is visualization of the inside of the joint using a small camera inserted into the joint, can be minimally invasive and allow diagnosis of certain joint diseases. This is a less invasive alternative to surgically opening the joint, and obviously there is less discomfort associated with arthroscopy.
Where neurological disease is suspected, specific diagnostic tests may include myelography, CT scan, MRI, and spinal taps.
On occasion, injection of a water-soluble dye into a joint, a procedure called arthrography, can be helpful to define the extent and shape of a joint. Problems of the biceps tendon that runs through a sheath in the shoulder joint can be demonstrated, in some cases, using this technique.
Use of bone scans has limited applications in the diagnosis of small animal lameness.
Most lameness problems do not produce a specific change that can be detected with routine blood work. However blood samples may be obtained where infectious or auto-immune causes are suspected, and in cases where an animal will undergo general anesthesia for surgical correction of the lameness.
If conservative management, that is rest and the use of ant-inflammatory medications, is suggested, then it is imperative to adhere to the recommendations made by your vet. Many cases of lameness are caused by soft tissue injuries, like pulled muscles, ligament and tendon sprains and strains, and in most cases will not require specific diagnosis or treatment. But most dogs will not limit their own exercise for a sufficient period of time to allow proper healing to occur. Exercising too fast and too hard after an inadequate period of rest can re-injure or exacerbate the problem.
Sometimes the conservative treatment approach is used as a test of the severity of the problem. If after a period of restriction the lameness has not improved, your vet will have to believe that his/her suspicions of a minor cause were not correct.
There are obviously a multitude of levels of surgical intervention dependent on the underlying cause of the lameness, the number of limbs involved and concurrent problems. For more minor procedures, like removal of a plantar wart on a foot pad, a dog may be discharged the same day. In the case of multiple pelvic fractures, which may take many hours of anesthesia and surgical time to repair, a dog may be severely debilitated, needing intensive supportive care, intravenous fluids, intravenous or transdermal narcotics for alleviation of pain and indwelling urinary catheter. Such patients will require around the clock nursing care until they reach a point in their recovery at which their management can be performed at home.
Dogs are marvelously resilient and durable creatures. Despite receiving highly invasive treatment options, such as a total hip replacement, or a plate and screw fixation of a femur fracture, dogs can be up and around the day after such surgeries, in many cases using the surgical leg almost 100 percent.
In cases where a lameness is caused by a bone tumor, necessitating an amputation, almost all dogs are up and around the next day, invariably with a much improved attitude, because they are no longer carrying the painful tumor on the lame leg.
Restriction often lasts for four to six weeks and requires, in most cases, confinement to a single room, restriction from going up or down stairs, avoiding slippery surfaces such as tile, hardwood floors or linoleum, and leash walking for bathroom trips only. In some instances your vet may recommend cage or crate rest, which means the "single room" is replaced by a cage or crate, depending on the size of your pet. If this kind of restriction promises to prove difficult, then this problem should be discussed with your vet so that alternative treatment options may be adopted
Following many types of limb surgery, a soft-padded bandage may be placed on the leg to offer comfort, reduce some of the normal postoperative swelling, and provide some support. Because it is not possible to observe the surgical incision for any problems, it is imperative to check the toes on a daily basis for swelling, excessive heat or pain. If your pet is persistently trying to chew the bandage and is not behaving normally in any other respect, a bandage change might be helpful to evaluate the surgical site. Similar care would apply if a limb was in a splint or cast.
If your pet has a visible incision it should be checked daily for swelling, redness or discharge. Stitches or staples will need to be removed in 10-14 days following surgery.
Some dogs just do not tolerate a bandage very well, despite the absence of complications at the surgical site. Elizabethan collars can be helpful in most instances, but in some cases the bandage should be removed if it becomes more trouble than it is worth.
In some instances, passive range of motion, particularly after certain surgical procedures like FHO, will be demonstrated at the time of discharge in order to maximize postoperative range of motion in a joint.
Follow-up visits with your vet will be important to re-evaluate the lameness or to assess the healing from surgical intervention. Further radiographs may be indicated at this time.
Return to normal use of a limb after surgery should be done slowly and gradually. Start with five minutes of leash walk, twice a day for a week, building up to ten minutes twice a day for a week and so on. Don't be in a hurry. Start to introduce stairs and short periods off leash slowly.
When lameness is due to a fracture, most fractures occur secondary to severe traumatic events and can therefore be prevented by keeping your dog on a leash. Spaying or neutering your pet will reduce the tendency to wander that can lead to trauma and fractures. Careful containment with fencing can also be helpful.
Sometimes lameness is secondary to nutritional problems. Dogs should be fed a carefully balanced diet to ensure a strong and healthy skeleton. In the case of "homemade recipes," consult with your veterinarian so that vital minerals and vitamins for good bone development and maintenance are adequately provided.
Monitor your puppy's growth, checking on limb length and straightness. If any bowing or abnormal curvature seems to be developing, consult with your veterinarian.
The number one nutritional disorder in small animals is obesity, a problem that can lead to, and exacerbate many causes of frontleg and hindleg lameness. Be sure to avoid obesity in your pet.
When selecting a pedigree dog, ask the breeder about the OFA hip scores, elbow dysplasia and PennHIP scores for the dam and sire, if they are available.
Finally, consult with your veterinarian at the earliest sign of a sudden onset of limb lameness.