Why the diagnosis changes treatment for forelimb lameness

Treatment for forelimb lameness is not one-size-fits-all. Management can look very different depending on whether the underlying issue is osteoarthritis or a soft tissue injury, a distinction that, according to Leilani Alvarez, DVM, DACVSMR, CVA, CCRT, makes obtaining a definitive diagnosis imperative.

In this clip, Alvarez, the head of the Integrative and Rehabilitative Medicine Department at the Schwarzman Animal Medical Center in New York, NY, outlines when pharmacologic therapy is appropriate, including the role of non-steroidal anti-inflammatory drugs (NSAIDs) in inflammatory joint disease. She also explains why chronic tendinopathies often fail to respond to anti-inflammatories and discusses nonpharmacologic options, such as shockwave therapy and platelet-rich plasma (PRP) injections, that may be more effective in those cases.

Below is the video transcript, lightly edited for clarity.

Alvarez: Hi, I'm Dr Leilani Alvarez. I'm the head of Integrative and Rehabilitative Medicine at the Schwarzman Animal Medical Center in New York City.

Treatment strategies for forelimb lameness should always begin with pain management, and you want to include a multimodal approach of pharmaceutical drugs and non-pharmacologic approaches.

From the pharmaceutical side, you want to reach for non-steroidal anti-inflammatories when you're pretty sure that you're dealing with an osteoarthritis or a joint-related problem. Anything that's inflammatory, you want to use a pharmacologic anti-inflammatory agent. For very severe inflammatory conditions, I do like to combine other drugs. So for example, amantadine pairs really nicely with an NSAID if you're dealing especially with a chronic tendinopathy.

Shoulder tendinopathies are the classic forelimb lameness that does not respond to NSAIDs, and the reason for that is tendons—especially avascular tendons—don't have a great blood supply. They are not going to respond to NSAIDs because in the chronic stages of injury, there isn't an inflammatory nature to that injury. Instead, you want to rely on non-pharmacologic strategies that will actually bring blood flow back to the area—things like shockwave therapy or PRP injections that can really stir up that healing response back to those tissues. The approach is quite different between an osteoarthritic problem versus a soft tissue problem and that underscores the importance of definitive diagnosis in your forelimb lameness.