Hind leg lameness has been my biggest fear. Yet, a sore front leg can be way more complicated.
The most common causes of hind limb lameness in dogs include:
- cruciate ligament injuries
- hip dysplasia
- arthritis (often secondary to one of the above)
Front leg lameness can have various causes, the most common ones being elbow dysplasia and shoulder injuries. Neck issues cannot be ruled out with front leg lameness.
The first time Cookie started limping on a front left leg was over two years ago. It was then diagnosed as an injured shoulder, and it resolved with treatment. Cookie had no problem with that leg for two years.
Further reading: Shoulder Injury in a Dog: Observation Skills for Dog Owners—Cookie’s Sore Shoulder
Cookie’s front leg lameness
Last January, Cookie’s lameness returned. I noticed some subtle red flags before the main event, but at that time, we believed that her back muscles were sore. We had a lot of deep snow with layouts of ice throughout—bounding through that would certainly be hard on the back.
It wasn’t until the leg became visibly sore when the prior signs formed a different picture.
Further reading: Example Report for Dog PT: Cookie’s New Lameness
Everything about it looked identical to the earlier injury. Further, all examination confirmed the theory, so that’s what we were treating. Gradually, Cookie was getting better. We believed we were on the right track until Cookie had a setback. To complicate things further, this time, she was sore on her front right leg. Things became more complicated and more confusing.
As we were looking for an explanation, the theories included shoulder insufficiency, sore elbows, or root signature. Having too many potential diagnoses is just as bad as having none.
We continued with the measures that seemed to have led to the initial improvement:
- restricted exercise
- hydrotherapy
- physical therapy
- massage
- laser therapy
- acupuncture
- chiropractic
- dry needling
We tried physio taping and e-stim. Cookie got better and regressed. The first time I was patient despite the slow progress because I know that injured muscles are hard to heal and can take a long time. When the other leg became sore, I accepted that it got injured because of compensation for the left one that hasn’t fully healed. But then, lameness started switching sides.
Shifting front leg lameness
Shifting lameness is the hallmark sign of Lyme disease. But we test for that regularly, and Cookie’s most recent test was negative. Of course, neck issues or compensation injuries could also explain what Cookie was experiencing. The practitioners were unable to reach a consensus.
Either way, it was time to dig deeper. We decided to start with x-rays; at this point, I also wanted to rule out bone cancer. Fortunately, x-rays presented no evidence of osteosarcoma. In fact, there was not a whole lot visible on the x-rays at all—some minor changes in Cookie’s elbows and right wrist. I know that x-ray imaging doesn’t reflect how much pain a dog is in. You can have horribly-looking joints and a dog who is barely bothered and almost clean images and a dog with terrible lameness. Is that the case?
Meanwhile, while some minor signs remained consistent, Cookie continued to improve and regress. The more I observed her symptoms, the more I leaned toward the elbows being at the root of the problem. One thing I knew for sure—I don’t want Cookie to spend the rest of her life this way.
Consultation with a specialist
Should we consult with a specialist to finally nail the diagnosis? If the elbows are the problem, could arthroscopy fix it?
Try getting in with an orthopedic specialist during COVID. For the most part, they only accept emergencies. I decided it was time to pursue this route, though, and talked to Cookie’s vet about initiating the referral.
There was only one specialty hospital accepting referrals; we went through the process and got the appointment. I was pleased that the veterinarian reviewed all records, notes, and videos showing what the worst setbacks look like. He went over everything, examined Cookie, and concluded that her elbows are the most likely root of her problems. At this point, it is where my thinking was as well.
The only confusing part is that both the radiologist who reviewed the x-rays and the orthopedic specialist label Cookie’s problem as elbow dysplasia. How mild would it have to be to cause no problems until now? She’s eight-and-a-half years old. Like hip dysplasia, Cookie would have to have had it from a puppy. It would make more sense that the elbows suffered from all the pouncing and pounding she does during her hunts.
The theory might even explain the shifting lameness. With one elbow more sore than the other, the other leg compensates and gets sorer in the process. That way the lameness might go back and forth between the front legs.
I did expect we might proceed with arthroscopy in hopes it might debride the joints or whatever needed to be done. We discussed the option, but the specialist felt that the therapeutic benefit would be limited. Of course, I wasn’t going to put Cookie through anything that wasn’t going to make her better. He said the benefit would be mostly diagnostic—getting a better picture of what’s happening with the joints to tailor the amount and type of exercise to her condition. However, there is no way of tailoring her type of exercise. What she wants to do is hunt. If she doesn’t get to do what she craves, she’s not going to do anything.
We cannot fully rule out a neck issue but for now we’ll run with this diagnosis. Favoring the front legs and the bobbing gait could easily make neck muscles sore as a secondary problem. Making the elbows feel better might make neck soreness go away—so we shall see.
The treatment decision
We all agreed that the best treatment option for Cookie is regenerative cell therapy. I would very much like to do stem cell treatment because I believe it is more potent, but at this time, it would be a logistical nightmare. Platelet-rich plasma (PRP) is simpler and can be done during one visit under sedation. In the past, we already did PRP for Cookie’s knees, and we were pleased with the results.
We arranged the treatment for the next morning, and Cookie got PRP injections in both of her elbows and her left shoulder.
Curious side note
To assess her whole body, the veterinarian also examined Cookie’s knees. During the PRP treatment discussion, I mentioned she had PRP injections for her partial cruciate tears a few years back.
Here is the interesting thing:
- he believes that cell therapy works well in treatment of arthritis
- he does not believe it could heal a damaged cruciate ligament
- after examination of the knees, he got no drawer sign and there is no thickening of the capsules
From the above findings, he concluded that there was never anything wrong with Cookie’s cruciates, period. I mentioned that she had three independent positive drawer signs by three different vets. I have never heard about a false-positive drawer sign. He insists that the cruciates were never damaged because they are not now, and there is no evidence of scar tissue that forms during healing with conservative management.
In the end, I don’t really care whether he’s right or not—Cookie’s knees are in good shape, which is all that matters. I also understand that for PRP to work, the cruciate damage needs to be partial and just in the right way. The sad part is that since he doesn’t believe that could possibly work. Other dogs who could benefit from that option will not.
In closing
Cookie got her PRP injections, and now we’ll see what they can do for her elbows. Cookie was sent home with a “doggy bag” of additional injections, which can now be done by her local vet. That’s because the specialist is a seven-hour drive from where we live.
He feels that booster injections relatively soon after the initial treatment magnify the benefit. However, Cookie had a severe reaction to the sedation protocol—which is a story for another day—so until we figure out what happened, why, and how to avoid that, we cannot proceed with anything.
Related articles:
Shoulder Injuries in Dogs: Is Cookie Suffering From Medial Shoulder Syndrome (MSS) or Instability (MSI)?
Why Is My Dog Limping? Causes of Lameness in Dogs
Canine Hip And Elbow Dysplasia: Are They The Same Thing?
Further reading:
The Limping Dog
Elbow Dysplasia in the Dog – Investigation and Treatment
Fragmented Coronoid Process (FCP) in Dogs