Too often, lameness in dogs is misdiagnosed as arthritis

Publication
Article
dvm360dvm360 April 2023
Volume 54
Issue 4
Pages: 30

Hypothetical case studies demonstrate how easy it is to make a mistake that deprives pets of desperately needed care

jhlemmer / stock.adobe.com

jhlemmer / stock.adobe.com

It is all too easy to assume a diagnosis of arthritis in an elderly dog that presents with lameness and pain. However, jumping to a premature conclusion can mean overlooking other issues and making an incorrect diagnosis, resulting in the dog not receiving its needed treatment. A thorough examination is crucial for a correct diagnosis. Read the history and have an in-depth discussion with the owner. Listen to their observations and ask lots of questions. Observe how the dog stands, walks, trots, and transitions. Perform a thorough clinical, neurological, and orthopedic examination, and encourage the owner to undertake imaging to confirm the diagnosis. Being methodical and thorough and getting the correct diagnosis means you will be able to choose the most appropriate interventions for the dog in a timely manner.

Other conditions have symptoms similar to those associated with arthritis. The following “week of case studies” will highlight the dangers of falling foul of those similar symptoms.

Case 1.

Mia, a West Highland doxie aged 7 years, had been lagging on her walks for a few weeks and had lost some of her playfulness. Once she started to wriggle when picked up and no longer enjoyed being towel dried, her humans began to suspect she was experiencing pain. With no ataxia or indications of proprioceptive deficits, their veterinarian recommended a trial course of nonsteroidal anti-inflammatory drugs (NSAIDs), suspecting underlying arthritis. Although Mia improved due to the medication, her response was not as positive as expected. She deteriorated further before the planned 3-month reassessment and started dragging her toes. Her owners, together with the vet, decided to proceed with imaging, which showed that Mia had intervertebral disc disease. Her owners were not able to afford surgery; however, they consulted a rehabilitation veterinarian. With her advice and support, Mia showed significant improvement, returning to her playful self within a few weeks.

Case 2.

Max, a cocker spaniel aged 3 years, had frequent veterinary visits. His owners previously had a spaniel with bilateral elbow developmental disease that led to early-onset osteoarthritis, so they were always expecting the worst when they visited the veterinarian. Because Max was a “wriggler,” assessing his joint range of motion and level of comfort was not easy, so radiographs and palpation under sedation were organized when he presented with lameness. Thankfully, the veterinarian checked Max’s feet. He found a couple of clumps of matted fur wedged between the metacarpal and digital pads that were like a “pebble in the shoe” for Max. These were easily removed, and Max was back to his active self again. Limping often is caused by mud or other debris stuck in the paw, so always remember to check for the “simple answers” before undertaking more extensive investigations. Encourage dog owners to keep their dogs’ paws in good condition and their nails trimmed and tidy.

Case 3.

Monty, a labradoodle aged 12 years, was already on a comprehensive care plan for his osteoarthritis. However, when he started to slow down even more, all parties thought the end was nigh, especially as recent routine blood work was unremarkable. Luckily, Monty’s owners had a great relationship with their veterinarian and felt they could discuss a few “minor” observations they had noted. These included Monty’s recent tendency to twitch when awake as well as changes in the color and texture of his coat. To ensure they were not putting all eggs in one basket, their veterinarian suggested another blood panel including cholesterol and T4. The results showed that Monty had hypothyroidism. Addition of a thyroxine replacement rapidly resolved the twitches. Monty also continued taking his analgesics for osteoarthritis, so his previous energy levels returned, and he was able to continue enjoying daily walks in the park.

Case 4.

Truffle, a golden retriever aged 10 years, had been slowing down in recent months and her owners had simply attributed this to her getting older. When she came home from a routine walk lame in one of her hind legs, the owners were quick to visit their veterinarian. Clinical examination highlighted a painful caudal lumbar spine, reduced range of motion in both hips, and remodeled, crepitus stifles, but no instability of the stifle joints. Their veterinarian advised 2 weeks of rest and NSAIDs. Truffle’s lameness improved, but she remained very stiff through her hind leg. Her owners were open to radiographs, which showed that Truffle had a moderate joint effusion and abundant osteophytic change around the stifle. While Truffle was under sedation, the veterinarian could elicit a cranial drawer in flexion and extension, indicating that Truffle had fully ruptured her cranial cruciate ligament, which required surgery. This was undertaken, and during the next 3 months Truffle’s function gradually improved with the help of the practice’s rehabilitation team. Following her rehabilitation, Truffle regained full function in her hind leg.

Case 5.

Tilly, a senior border collie, was taken to the veterinarian by her owner due to a change in her gait. She appeared quite stiff in her hind limbs. An assumption of this being “simple osteoarthritis’’ was narrowly avoided, as her vet noticed her dropped tail and the arching of her caudal lumbar spine. Aware of lumbosacral stenosis being prevalent, especially in very active dogs like border collies, the veterinarian applied direct pressure over the lumbosacral junction. This caused a pronounced response and dipping of the dog’s back, which is characteristic of the disease. The doctor was able to diagnose lumbosacral disease, and Tilly received not only anti-inflammatory painkillers but also adjunct medications targeting neuropathic pain. The appropriate medication took a few months to work; however, Tilly gradually returned to moderate levels of exercise and lived for many more happy and pain-free years.

Case 6.

Rusty, a Jack Russell terrier aged 11 years, had been labeled a grumpy dog by almost all who knew him. He was irritable and tended to snap at anyone, including his owners. This had been going on for years before a tense moment of coat-sleeve chomping in the clinic luckily occurred in front of a veterinarian interested in behavior. She recognized the physical and behavioral signs of pain and pointed these out to Rusty’s owners. They felt terrible because the signs of pain, such as Rusty’s unusual gait, lack of movement in his neck, and strange sleeping positions, had developed slowly over the years. It did not occur to them that these could be indicative of pain. Further diagnostics showed Rusty had a herniated disc and required surgery. This was a huge success and after a period of rest and rehabilitation, Rusty was able to return to a near-normal life.

Case 7.

Otis, a mixed breed aged 12 years, was one of the most enthusiastic patients of the practice. He was always happy when offered a biscuit by the veterinary team. He was used to peaks and troughs of pain because of fluctuating arthritis, but a recent incident had left him 10/10 lame on his left forelimb. Otis’ human had phoned in, hoping to avoid an in-person consultation, as she did not want to transport him while he was so lame. Fortunately, the veterinarian insisted on seeing him, as the owner had not noticed that the swelling, assumed to be a joint, was not located over the carpus but was proximal to it, in the distal radius. Sadly, an osteosarcoma was diagnosed, and everyone agreed the kindest thing to do was to let Otis pass away peacefully.

Never has chronic musculoskeletal disease in canines been as exciting as it is these days. We are developing a much greater understanding of the myriad presentations of different diseases and have readily available diagnostic tools. In addition, owners today consider their pet to be one of the family. All of which equates to superior care regarding pets that present as “just slowing down,” and it is our duty to investigate these cases thoroughly in the pursuit of an effective, minimal-risk, long-term management plan for each dog.

Tread the path of excellence in practice. Do not fall foul of “long-distance assumptions.”

Hannah Capon, MA, VetMB, MRCVS, graduated from Cambridge University in 2002 and has worked in a large variety of practices and roles, from sole charge, first opinion to teamwork emergency practice. She won the 2020 Royal College of Veterinary Surgeons Impact Award, was named the 2019 CEVA Vet of the Year, and was a finalist for the 2019 Petplan Vet of the Year. Capon has a passion for chronic pain management, geriatrics, and musculoskeletal health and rehabilitation. She has been recognized for her tireless work with Canine Arthritis Management, an online education and support service for professionals and owners of arthritic dogs. When Capon is not working you can find her paddle boarding, kitesurfing, and camping with her dog Luna.

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