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Dr. John
Dr. John, Texas Veterinarian
Category: Dog Veterinary
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Experience:  Over 14 years of clinical veterinary experience
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My 8-year old dog has had a slight lameness on his forelimb

Customer Question

My 8-year old dog has had a slight lameness on his forelimb for a year or so now; it has recently become more noticeable. It appears to be his right forelimb that is limping.He also appears to be having some stiffness and pain on his back, near the hips. He had intermittent bouts of pain where he would drop, recoil his right hip and leg, and pant heavily.X-rays were taken and I was told that he didn't seem to have any obvious skeletal issues.I was hoping for a second opinion and for whoever responds to this question to take a look at the images.Thanks.
Submitted: 5 months ago.
Category: Dog Veterinary
Customer: replied 5 months ago.
Here are the images.
Expert:  Dr. Bruce replied 5 months ago.

Hi. My name is***** I'm sorry to hear about this going on with Wee Wee. Good job on posting those 5 films. Those were all very good positional x-rays of various areas of the body with very good detail. From a direct aspect, there weren't any specific lesions that I could see that would tie into the issues that you're seeing with him. There is one skin lump on his mid abdomen on the left side. This though shouldn't be the main issue. Did your vet recommend a trial of some pain medications like Rimadyl for a couple weeks to see what the response to therapy is? Some dogs can have arthritis and it can be so subtle that it isn't apparent on x-rays but still clinically affecting them. It would be something easy to try and to see what the response to it is.

Expert:  Dr. Bruce replied 5 months ago.

I just looked at the time stamp on your initial posting and realized it was last night. I just got on this morning and I'm sorry that no one was able to read your posting till I got on this am.

Customer: replied 5 months ago.
No, my dog seems to be extremely sensitive to NSAIDs; he had some vomiting and diarrhea when taking metacam for his lipoma removal surgeries. He did seem to be more energetic, though, when given tramadol as a substitute. Do you think arthritis could be a potential culprit for my dog's condition?My vet did suggest that potentially his back pain and sensitivity could be a lumbosacral issue, and his right forelimb's lameness could be elbow dysplasia. Would these two issues be obvious on x-rays?I did notice when looking at the third radiograph image that his left humeral head seems to have a black line halfway through it. I have attached the picture with a circle around the area to identify it.
Expert:  Dr. Bruce replied 5 months ago.

I noticed that area too on the area of the humeral head. It is not isolated on those films so that line could be summation from the leg being on top of that area. If that is the left humeral head that has that line, the right proximal humerus is summated on that region. Some can handle one of the NSAID's better than another. IF the Meloxicam wasn't well tolerated, then could Deramax or Carprofen be tolerated better. If one of those was tried, then at the same time using a stomach protectant like famotidine could be done too to maybe lessen stomach irritation. Tramadol is an opiod oral pain medication that can have some sedative effects, but could its dose amount or frequency be adjusted to lessen this but still have some relief? Arthritis is a possibility. Lyme disease could be an issue too. A simple blood test could be run to see if there are antibodies for it in his system. Back pain is definitely on the list of rule outs here. Could there be a pinched nerve or stability issue? Elbow dysplasia is a rule out, but the elbow itself was not on the films.

Expert:  Dr. Bruce replied 5 months ago.

As I look at that area more and more, it does catch more attention. IT is summated with the other limb, but it would be nice to get films of it being isolated. That can be done with some light sedation to be able to get the best positioning of it. IT can be isolated on a lateral and a VD to get much more direct attention to it. Could what is being seen be an artifact? Some can have cartilage issues where a piece can break off and cause similar lameness as to what he's having, but the location is typically on the caudal aspect of the humeral head.

Customer: replied 5 months ago.
Oh, apologizes. The humeral head with the line is his right one, not his left. The cartilage issue does seem interesting. What could potentially cause the issue and could it be treated with good results?On his back pain, a pinched nerve was suggested, and its possibility was pointed to as potentially due to lumbosacral stenosis; however, I can't tell whether or not that area seem to be fine on the images of my dog's pelvis area. Could that cause the bouts of pain he has experienced in that area?I believe Lyme disease was tested and ruled out; my dog also didn't have any of the associated symptoms of the disease, like a fever and lymph node swelling.
Expert:  Dr. Bruce replied 5 months ago.

The cartilage issue is called osteochondrosis dessicans. That is where some of the cartilage will collapse and flake off. I would say it is typically a younger breed issue. Plain x-rays are not good at looking for pinched nerves. MRI's or CT scans are the best for this. That is good that the Lyme has been ruled out.

Customer: replied 5 months ago.
The osteochondrosis condition - could it appear in older dogs, as well? Do arthritic changes typically occur around the humerus, or is it more so found in the other joints?
Expert:  Dr. Bruce replied 5 months ago.

Arthritic changes can sometimes be very obvious in a single joint or multiple joints or it can be extremely hard to find. I've seen dogs diagnosed with arthritis that radiographically look stellar and other cases where dogs with radiographically severe degenerative joint changes present that never have any discomfort. The saying goes, they don't walk on the x-rays, you have to look at the patient. The OCD (osteochondrosis) could happen in a later dog. It basically is where the joint cartilage becomes unhealthy in a specific spot and then it is a source of discomfort as it breaks off.

Customer: replied 5 months ago.
That is an interesting comment about arthritis. So even if the x-rays look normal, arthritis can be diagnosed based on clinical signs?For the OCD, if it does turn out to be the case for my dog, what would be the treatment options?
Expert:  Dr. Bruce replied 5 months ago.

Arthritis can be present even if there are no obvious radiographic changes present. If it is the OCD, then surgical removal of the compromised cartilage flap is recommended and they typically do well after this is done.

Customer: replied 5 months ago.
Looking more into the area now, I seem to be able to spot some other anomalies in the area. Would you mind taking a look? I have circled the areas in red. Are they normal or could they be something that warrants a second look, considering these x-rays were taken 6 months ago?
Expert:  Dr. Bruce replied 5 months ago.

If these x-rays were taken 6 months ago, then repeating them at this time if the clinical signs haven't improved / resolved would be a good idea. Those areas circled, are they associated with the bone, or are they areas of summation from other things on the skin or muscle. Films are basically 2-d images of 3-d objects. That is where summation happens.

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