Buddy: Osteoarthritis (OA)

2013-09-04 15.57.19History of Presenting Complaint:

Buddy had surgery to correct a luxating patella and torn cruciate ligament in the left stifle in 2008.  In April 2013, he was re-examined for a right hind limb lameness.  He was diagnosed with a torn cruciate ligament in the right rear leg.

Radiographs were taken by the referring veterinarian in April 2013 that showed severe osteoarthritis (OA) bilaterally.  Implants in the left stifle are in good position, and the pins look good.

Owner is unable to pursue any further surgery for Buddy.

He was started on an anti-inflammatory, two types of pain relievers (Tramadol and Gabapentin), and multiple supplements, including glucosamine and chondroitin.

He is also overweight and was started on a diet.

He was referred to See Spot Run for rehabilitation.

Physical Exam Findings:

Buddy’s stifles have medial buttresses bilaterally, indicating that his stifles have been chronically unstable.

Crepitus is palpable throughout the range of motion in both stifles, consistent with OA.

Buddy has limited extension in the right stifle.  Cranial drawer sign and tibial thrust are present.

The plate and screws are palpable in the left stifle, but do not seem painful.

Buddy is reactive to palpation of the latissimus dorsi muscles and iliopsoas muscles bilaterally, indicating overuse and strain.

Treatment Plan:

Owner is able to bring Buddy in once a week for physical rehabilitation as they live out-of-town.

Manual Therapy:

Joint compressions and passive range of motion to both stifles to help with pain management and to help with joint lubrication.

Cranial glides to the right tibia to improve extension.

Trigger point release to the latissimus dorsi muscles.

Laser

Laser to both stifles and both iliopsoas muscles to treat inflammation and pain.

Hydrotherapy

Underwater treadmill is ideal for providing low impact exercise to help with weight management and to encourage active range of motion of all of the affected joints.

Home Exercise

Owner walks Buddy to a swimming hole on his property for swims.  Owner reports that the walk is about 0.25 miles, and Buddy enjoys swimming.

Progress

Buddy is no longer painful in his latissimus dorsi muscles, and his extension in the right stifle is improving.

Buddy has increased his time in  the underwater treadmill from 5 minutes to 17 minutes.  When his time increased to 15 minutes on the treadmill, he started short striding in the hind legs and trying to sit.  I started him on an interval training program, and his endurance is now improving.  He walks on the treadmill for three intervals of 5-6 minutes with a 30 second rest between intervals, and he is able to increase the walking time with each session.

Unfortunately, Buddy has not lost any weight.  Owner confesses to giving Buddy treats in the evenings, and Buddy has access to fresh fruit as it falls from the trees.  I am encouraging his owner to stick with his diet.

Owner understands that this is a long-term commitment.  I will continue to modify his exercise program as needed.

 

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