Conservative Management of Stifle Injury for Working Dog
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Published: Veterinary Practice News. September 2017. Vol 29, No 9, Pg 44
Author(s): "Debbie (Gross) Torraca, DPT, MSPT, Dipl. ABPTS, CCRP"
This article details the various components of a successful mulitmodal treatment approach for a competitive 5-year-old Rottweiler diagnosed with inflammation and minor tearing in both the medial collateral and cranial cruciate ligaments. The patient was able to continue conformation competition for 2 years before undergoing TPLO surgery.
Tug, a 5-year-old intact male Rottweiler, presented with an acute lameness after playing ball in his backyard. He responded to three weeks of rest, which reduced the lameness. Tug is heavily involved in conformation events and obedience, and he is currently ranked in the top 10 Rottweilers in conformation. The owner pursued further testing due to his performance status.
Diagnostic findings
Hip, pelvic, and stifle radiographs were insignificant. Magnetic resonance imaging revealed Tug receiving cryotherapy with intermittent compression. 44 inflammation and minor tearing on the right hindlimb by 25 of the medial collateral ligament percent. Thigh circumference of the stifle, and minor tearing of the cranial cruciate ligament. The medial meniscus was intact. Clinically, Tug had a grade I valgus instability of the stifle. In addition, his hip extension was limited by 15 degrees of motion, and he experienced pain with palpation on the right iliopsoas. А diagnostic ultrasound of the right hip soft tissue revealed a minor sprain to the iliopsoas at the insertion. The owner chose not to pursue a repair to the right stifle at this time secondary to his current conformation shows, inclusive of was reduced by 3 centimeters on the right compared to the left, measured at 70 percent thigh length, and was reduced by 5.5 centimeters on the right compared to the left measured at the fold of the thigh. Digital thermal imaging revealed heat and inflammation on the stifle, hip, right lumbosacral region, right lumbar spine, and the right iliopsoas. Functionally, he was striding and pushing off with less force on the right hindlimb compared to the left hindlimb. Westminster Kennel Club.
Clinical findings
Static gait analysis revealed a reduction of weight bearing Obtaining standing weight bearing data for Tug. I Veterinary Practice News | September 2017 The right pelvic area presented with a slight caudal rotation as measured by the cranial dorsal iliac spine and the ischial tuberosity. This may be in part secondary to the positioning of Tug working on his core strength. the right hindlimb in slight flexion due to diminished weight bearing.
Treatment
1. Ice compression on the right stifle on a daily basis, 15 minutes three to five times a day. As his activity level increased, the ice compression remained the same to account for the increase in activity.
2. Photobiomodulation to the right stifle in a circumferential contact pattern, right iliopsoas at origin and insertion, and right lumbar component. Treatment was performed in a functional position for the right iliopsoas to encourage stretching and range of motion to the hip flexor and the lumbar extensor. This was performed after the acute phase. Photobiomodulation on Tug's iliopsoas.
3. Joint mobilization and manual therapy to the right pelvic region and hip.
4. Range of motion and stretching to the right hip flexor, lumbar spine, and right hindlimb.
5. Core strengthening focused on the lumbar region and hips.
6. Underwater treadmill at varying programs to regain strength, endurance, and function. Water level filled above the level of the stifle. Programs varied for strength: 3.0 to 5.0 miles per hour at intervals for up to 20 minutes and endurance: 4 miles per hour for up to 35 minutes. These were performed on varying days, four to five days a week.
7. Cavalettis to work on reach and drive in the rear.
8. Eccentric strengthening to focus on the iliopsoas.
9. NSAIDS for the first three weeks, along with weekly Adequan injections for first month, and then every other week for second month.
Summary
Tug was treated for eight weeks, four to five times a week. At the end of the treatment, digital thermal imaging did not indicate any abnormalities. The Stance Analyzer demonstrated equal weight bearing on the right and left hindlimb. Range of motion was full in the hip and stifle. Circumferential measurements indicated a 0.5-centimeter difference on the right compared to the left. The owner returned him to the conformation ring, and he won a Working Dog Group 1 in the owner/handler division. He continued to maintain his top 10 position for the next two years. Tug's owner then decided to go ahead with a tibial-plateau leveling osteotomy for the right stifle after Tug retired.