Clinical Signs

Usually, a limb that was previously normal becomes bent or grows at an odd angle. Some breeds, especially the chondrodystrophic breeds (dachshunds, Pekingese, bulldogs, bassets hounds, and so on), have shortened, misshapen legs as part of their normal conformation, but ALD goes beyond what is considered normal. The opposite limb usually has a normal appearance for the breed.

Diagnostic Tests

An ALD may be suspected based on the clinical appearance of the leg. An orthopedic examination and x-rays are usually necessary to fully evaluate the extent of an ALD.

Treatment Options

If the ALD occurs in the foreleg (ulna and radius) and is detected early, before significant angling occurs, surgical removal of a small portion of the ulna is often curative. For more advanced deformities and deformities in other bones, various surgical techniques can be used to correct the malalignment. Such techniques can include removal of portions or wedges of bones, followed by insertion of a bone plate and screws into the bone, or use of external fixation devices. Other complicating factors, such as malalignment of the nearby joints, must be addressed as well.

Follow-up Care

Dogs that are still growing and sustain even mild trauma to the foreleg should be closely monitored for 4-6 weeks for the earliest signs of ALD. It is best to correct the condition early in the course, before it worsens. Postoperative care depends on the type of surgical procedure used but can involve bandage and splint changes, care of external pins, and restricted exercise until the surgery sites heals. Follow-up x-rays are performed periodically to monitor healing.

Clinical Signs

Variable degrees of lameness are observed. The lameness usually worsens with vigorous activity.

Diagnostic Tests

Manipulation of the shoulder may reveal loss of mobility and pain. Pain in the shoulder usually increases noticeably when pressure is placed on the biceps tendon while the leg is flexed.

Treatment Options

Injection of glucocorticoids (steroids that reduce inflammation) into or around the tendon may resolve the lameness, but strict rest for a minimum of 4-6 weeks is critical to allow the tendon time to fully heal. Repeated injections may be required. If an acceptable response is not observed after 3-4 injections, surgery is recommended. About 40% of affected dogs do not respond to steroid injections.

Surgical therapy involves releasing (cutting) the tendon so that it is not constantly irritated as the leg is used. Release of the biceps tendon can often be done easily by arthroscopy (involving passage of a tiny fiberoptic viewing scope into the joint). Your pet may be referred to a veterinary orthopedic surgeon for this procedure.

Follow-up Care

Steroid injections must be followed by strict restriction of exercise for a minimum of 4-6 weeks. If surgical release of the tendon is performed, exercise is restricted to short leash walks only for 4 weeks to allow the shoulder to fully heal. If signs of inflammation (excessive redness, pain, swelling, or discharge) are observed at the site of a surgical incision, notify your veterinarian. Sutures or staples are commonly removed 10-14 days after surgery.

Clinical Signs

Bone tumors typically occur in older, male, large- and giant-breed dogs. Dogs with bone tumors usually become suddenly lame. The lameness typically is not associated with trauma, but sometimes minor events can result in a fracture of the diseased bone. The lameness associated with bone tumors progresses rapidly to non–weight-bearing lameness, with the animal holding the leg up. There may also be swelling of the limb at the tumor site and loss of muscle (atrophy) in the rest of the leg. Common sites for primary tumors are the shoulder, carpus (wrist), and stifle (knee).

Diagnostic Tests

Sudden onset of dramatic lameness with no known trauma in an older, large dog strongly suggests the possibility of a bone tumor. X-rays may show classic signs of a bone tumor, such as combined bone destruction and bone production. Other diseases, such as fungal infections, can cause similar x-ray changes, so a definitive diagnosis cannot usually be made from the x-rays alone.

A bone biopsy is usually recommended to confirm the presence of a tumor, to determine the tumor type, and to provide information that affects the treatment options. Laboratory tests and chest x-rays are done to look for tumors elsewhere and to assess the status of other organs. If a metastatic tumor is suspected, a thorough search is undertaken for the origin of the tumor.

Treatment Options

The main treatment of primary tumors is amputation of the affected leg. In the case of osteosarcoma, amputation is done to relieve the intense pain associated with the tumor. The surgery rarely cures the disease, because microscopic metastasis has usually occurred by the time of diagnosis. Chemotherapy is used after amputation to slow the progression of the metastatic cancer. (See also the handouts on Limb Amputation and Chemotherapy and Your Pet.) Other bone tumors, such as chondrosarcoma, may benefit more from amputation if metastasis has not already occurred.

When amputation is not an option, limb-sparing surgery, chemotherapy, or radiation therapy may reduce the pain caused by the tumor and improve the dog’s quality of life for a short period of time. Limb-sparing surgery allows the dog to keep the leg but does not change the overall prognosis. The surgery is a very demanding procedure and significant complications can occur, so it is often performed by an experienced veterinary surgery specialist.

Follow-up Care

Following surgery, the incision is observed daily for signs of infection (excessive redness, swelling, pain, or discharge), and the sutures or staples are removed in 10-14 days. It is important to provide the animal with surfaces that allow a secure footing, especially for the first few days while it is adjusting to using three legs. Most dogs and cats do extremely well after amputation. Obese and very large dogs and dogs with other orthopedic or neurologic diseases are the least likely to do well as amputees.

Clinical Signs

Rupture of the tendon causes the hock (ankle) to drop toward or almost touch the ground. The hock may be swollen. Swelling may also occur above the hock, with a thin, flat space visible between the hock and the swelling. When trauma is the cause, usually only one side is involved. In the more chronic form of tendon degeneration, both rear legs may be affected.

Diagnostic Tests

The diagnosis can often be made on the basis of physical examination. X-rays may reveal a fracture of the calcaneus bone where the tendon attaches. Ultrasound examination may be recommended to show where the rupture occurred.

Treatment Options

If the injury is recent, reattachment of the tendon to the calcaneus bone or suturing of the torn ends of the calcaneal tendon is the preferred treatment. Following repair of the tendon, the hock must be prevented from moving by application of a cast (see the handout on Fracture Repair: Casts and Splints) or an external skeletal fixator device (see the handout on Fracture Repair: External Skeletal Fixation). Usually, the hock is immobilized (kept rigidly bent) for 6-8 weeks or longer, because tendons have a poor blood supply and heal very slowly.

If the injury is chronic and less likely to be successfully repaired, then fusion of the hock (see the handout on Arthrodesis) is an acceptable alternative treatment.

Follow-up Care

If the tendon is surgically repaired, the cast or external skeletal fixator requires special care for as long as it is in place. (See the appropriate handouts for details.)

Clinical Signs

Dogs and cats that sustain shearing injuries often have other serious injuries related to the traumatic event, so a variety of clinical signs may be observed. The skin and tissue over the involved joints and varying amounts of bone are usually missing and often grossly contaminated with debris and bacteria. Affected joints are often unstable, making the leg unusable. Non–weight-bearing lameness is common.

Diagnostic Tests

Routine laboratory tests, x-rays of the chest and abdomen, an electrocardiogram (to evaluate the heart rhythm), and an abdominal ultrasound may be recommended to identify and evaluate other injuries. X-rays of the affected joint are taken to identify fractures or dislocations associated with the shearing injury. Swabs and tissue samples of the injured joint may be submitted for bacterial culture.

Treatment Options

Initially, the wound may be splinted and bandaged while other injuries are treated and stabilized. Once the animal is stable, the wound is cleaned, and dead or excessively injured tissue is removed (débrided) under anesthesia. Fractures may be stabilized by various methods, and joint ligaments are reconstructed as needed.

The wound may be managed with multiple bandage changes until it heals on its own, or it may be closed by a number of different reconstructive surgical techniques. If injuries to the leg are severe, amputation of the limb may be the best method for resolving the problem and returning the animal to a pain-free, functional state. (See also the handout on Limb Amputation.)

Follow-up Care

Frequent recheck visits are usually needed for weeks following shearing injuries. The wounds are checked and cleaned, bandages are changed, and any orthopedic devices are evaluated. X-rays may be repeated to monitor healing of accompanying fractures and to check for signs of bone infection (osteomyelitis). Additional testing and monitoring may be needed for other accompanying injuries.

Clinical Signs

Although CCL disease is a chronic, progressive condition, in many cases sudden onset of lameness occurs in association with activity. If not immediately treated, the lameness often improves to some degree but does not completely resolve. Signs typical of arthritis (lameness that is worse with rest and improves with mild exercise, stiffness, and muscle wasting) are usually present and worsen with time.

Diagnostic Tests

Orthopedic examination reveals varying degrees of stiffness, fluid, pain, and crepitus (crunching sound) in the stifle. The inside edge of the stifle is often thickened as well. Thorough examination of the stifle with the animal under sedation often reveals excessive instability, particularly excessive movement of the tibia with respect to the femur (large thigh bone).

X-rays may reveal signs of osteoarthritis (degenerative arthritis) and malalignment of the tibia with the stifle, but they cannot show a ruptured ligament or torn meniscal cartilage. Sometimes the diagnosis is confirmed only at the time of surgery or with arthroscopy (passage of a fiberoptic viewing scope into the stifle).

Treatment Options

The best treatment for CCL disease is greatly debated. Medium, large- and giant-breed dogs recover quicker and regain the best function with surgery. Small dogs and cats are often treated initially with restricted exercise and medical therapy. (See the handout on Osteoarthritis: Medical Management.) In these latter animals, surgery is reserved for those that do not respond to medical therapy.

Numerous techniques are available for stabilizing the stifle. Keep in mind that the phrase “cruciate repair” is inaccurate, because in CCL disease the ligament is always beyond repair. Surgery is actually designed to improve stability of the joint. Available surgical techniques can be divided into three different types:

Currently, no single technique has been proven to be superior. Biomechanical techniques are often favored for large and giant breeds, whereas extracapsular techniques are often used for smaller dogs and cats (and in some situations for larger dogs). Many of the described techniques can have good results in the hands of a capable veterinary surgeon. If the medial meniscus is damaged, it is removed.

Follow-up Care

Regardless of which technique is chosen, strict restriction of activity for at least 8-10 weeks after surgery is critical for ultimate success. The incision is observed daily for excessive redness, swelling, pain, or discharge. Physical rehabilitation and/or exercises at home also greatly improve the outcome of surgery.

Clinical Signs

The most common clinical sign is lameness of varying degrees that typically is worse after rest and heavy exercise. The lameness often gets better with stretching and mild exercise. Loss of muscle mass (atrophy), joint swelling, and pain are also common. When growth disturbances of the ulna are seen, both the elbow and carpus may be involved. The most severe changes may be observed at the carpus and consist of rotation and angling of the paw.

Diagnostic Tests

The diagnosis may be suspected following an orthopedic examination. X-rays confirm the diagnosis and further define the extent of the abnormality. Arthroscopic examination of the joint (via insertion of a tiny fiberoptic viewing scope) allows further characterization of the disease, provides an avenue for treating FMCP, and assists in the surgical treatment of other elbow conditions. Laboratory tests are usually normal but are commonly recommended prior to anesthesia.

Treatment Options

Treatment options depend on the exact abnormalities present, and the best treatment is somewhat debated. FMCP can be treated via arthroscopic surgery, whereas other forms of elbow incongruency may require open surgery and cutting (osteotomy) the ulna below the elbow joint.

Elbow incongruency caused by growth abnormalities in the ulna is usually treated surgically, with correction of the abnormal angle in the bone at the carpus and cutting of the ulna just below the elbow at the same time. If the incongruency is severe or if severe degenerative arthritis is present in the elbow and is unresponsive to medical therapy, then arthrodesis (surgical fusion of the joint) or amputation may be indicated. (See the handouts on Arthrodesis and Limb Amputation.)

Follow-up Care

Oral analgesics (pain-relief) medications are commonly given before and after surgery. If signs of inflammation (excessive redness, pain, swelling, or discharge) are observed at the incision, notify your veterinarian. Sutures or staples are commonly removed from the incision at 10-14 days after surgery.

The dog’s progress is checked again in 4-6 weeks, depending on the exact cause of the elbow incongruency. If cuts were made in the bone, x-rays are taken to evaluate the healing process. All dogs are restricted to short leash walks as their only activity for at least 4-6 weeks or until such time as bone healing occurs.

Clinical Signs

Elbow luxation makes the foreleg unusable, so a non–weight-bearing lameness occurs. The leg may be flexed (bent, held up) and the forearm outwardly rotated. The elbow is usually swollen and/or misshapen. Other signs of trauma (cuts, scratches, bruises) may also be present.

Diagnostic Tests

Palpation of the joint usually reveals malalignment of the elbow, loss of normal range of motion, and pain when the joint is manipulated (moved). X-rays confirm the diagnosis and help to identify fractures and any preexisting conditions (such as degenerative osteoarthritis) of the elbow. Routine preanesthetic laboratory tests are often performed, and additional tests may be recommended to evaluate other traumatized areas of the body.

Treatment Options

If the luxation is recent, it can often be reduced (manipulated back into normal position) with the animal under deep anesthesia. If the luxation is chronic or if other preexisting disease or bony abnormalities of the joint are present, surgical reduction must usually be performed. If significant damage to the elbow is present or the luxation is very chronic, arthrodesis (surgical fusion) of the joint or amputation of the limb may be the best solution. (See the handouts on Arthrodesis and Limb Amputation.)

Follow-up Care

Once reduction is complete, the leg (limb) is placed in a splint in a slightly extended (straightened) position for 2 weeks to allow fibrous (scar) tissue to develop. The toes and skin at the ends of the splint are observed twice daily for slippage of the splint and for any swelling, odor, pain, rub sores, or discharge around the toes and the upper end of the splint. Report any abnormalities to your veterinarian immediately.

If surgery is required, the bandage is observed daily for seepage of fluid through the bandage. After the bandage is removed, the incision is checked daily for excessive redness, discharge, swelling, or pain. Activity is limited to leash walking for at least 2 weeks after surgery or removal of the splint.

Clinical Signs

Loss of the muscle results in lameness and joint immobility. Sometimes these myopathies are also painful. Dogs and cats with QC hold their hind leg out straight and the stifle (knee) and hock (ankle) cannot be bent. In severe cases, muscle contracture may even dislocate the hip.

The lameness that results from IT is classic for this condition. The dog outwardly rotates the front leg and flips the carpus (wrist) as it walks. Less common myopathies of the back leg result in an odd lameness that jerks the leg up suddenly with each step, as if it is being pulled upward by a string.

Diagnostic Tests

Diagnosis is often made by a thorough physical examination and observation of the lameness. With myopathies of the hind leg, a tense band of muscle can often be felt. Ultrasound examination of the muscle and tendon also helps identify the condition. Laboratory tests and x-rays are normal except for abnormalities caused by prior trauma.

Treatment Options

QC is a condition that must be prevented by proper surgical management of a fractured bone and rehabilitation (physical) therapy after surgery. Once QC occurs, no effective treatment is available to restore leg function, and amputation is usually required. In rare cases, arthrodesis (fusion of the stifle or knee joint) may be considered. (See the handouts on Limb Amputation and Arthrodesis.)

The treatment for IT involves surgically cutting the tendon as it crosses the shoulder joint.

The treatment for other hind leg myopathies is removal of the affected muscles and their tendons.

Follow-up Care

Activity after surgery for IT or the uncommon hind leg myopathies is limited to short leash walks for 2 weeks. The incision is inspected daily for signs of infection (excessive redness, pain, swelling, or discharge) and seroma (pocket of fluid buildup under the skin at the incision site) formation. Physical rehabilitation can help improve mobility of the shoulder.

Clinical Signs

The clinical signs are the same as for any joint condition, namely lameness, pain, and joint stiffness after rest that initially improves with activity but then worsens with further activity.

Diagnostic Tests

Examination of the elbow reveals loss of range of motion and pain with movement of the joint. Muscle shrinkage (atrophy), joint stiffness, and thickening of the joint may be detected. Fluid (effusion) may also be felt in the joint. Direct pressure against the inside aspect of the elbow may cause a painful response.

X-rays often show signs of secondary arthritis but rarely reveal the fragment, because it is surrounded by normal bone, making it hard to see with most angles of the x-ray beam. If (after x-rays) doubt still exists regarding the diagnosis, computed tomography (CT) scanning can be done and has a high degree of accuracy. It is important to identify other developmental diseases in or around the joint as well.

Treatment Options

Although some debate exists regarding the best treatment, removal of the fragment and associated unhealthy cartilage is generally considered the best treatment. Fragment removal is ideally done by arthroscopic surgery (through a small fiberoptic viewing scope), but traditional open-joint surgery can also be effective. Medical treatment alone can be tried by administering drugs for arthritis, sometimes with acceptable results.

Follow-up Care

Dogs that undergo surgery are restricted from full activity for 8 weeks to allow the cartilage in the joint to completely heal. Physical rehabilitation therapy can also significantly improve the function of the elbow following surgery. Medical management (see the handout on Osteoarthritis: Medical Management) is pursued aggressively to slow the progression of the osteoarthritis.