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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 24405
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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I have an 8 month old Shih Tzu puppy. He is active and loves

Customer Question

I have an 8 month old Shih Tzu puppy. He is active and loves to play with people and other dogs. Just recently (this past week I would say) I noticed his two front legs are starting to look a little bowed out and I did take him to his vet. No x-rays were done but she did feel both his back and front legs and she told me I had nothing to worry about. But me being the mom I am to hi I am still worried. I have gone online and read all these horrible things about Shih Tzus with leg problems. Maybe I am overreacting and should just leave this alone but I do not want him to have any problems in the long run. I have read all sorts of things such as after he plays he just kinds of plops down on the floor and he does stretch at times when he gets up. Is my baby in pain and I just am to stupid to tell or I am overreacting to this?
Submitted: 1 year ago.
Category: Dog
Expert:  Lisa replied 1 year ago.

Hi there! My name is ***** ***** I'm happy to help you with your question today. Just like an in person consult, I have a couple questions of my own....

Have you owned dogs in the past?

Does he ever seem to have any problems getting up from laying down?

Did you get him from a breeder, and if so, did you happen to see the parents?

Customer: replied 1 year ago.
Hi Lisa,No I have never owned a dog in the past. And no he doesn't seem to have any problems getting up or walking except that he may stretch from time to time but he does run and play and just recently I received many videos from my dog sitter of him playing with her dog all weekend long during the holidays where he ran around and around without a problem! And yes I saw his mom and I did get him from a breeder.
Expert:  Lisa replied 1 year ago.

Great. Thanks for the additional information. I really appreciate it.

Since you've had the vet take a peek already, and since your little guy isn't showing any signs of pain (things like not wanting to get up and move, not wanting to play, yelping or whining when moving around), I suspect he's just in a growing phase that makes him look a little bowlegged.

Dogs of all breeds can look a little bit like that, but the fact he's a shih tzu, who can be a tiny bit bow legged anyway, I suspect this is a normal thing for him and won't likely cause any problems as he ages.

Just keep an eye on him for the next few weeks and see if anything changes. I suspect it won't get any worse at all.

I hope this helps.

Customer: replied 1 year ago.
Could you please call me to discuss?
Expert:  Lisa replied 1 year ago.

I'm afraid I'm unable to do a phone call at this time. I can opt out and see if another expert can pick up if you'd like.

Customer: replied 1 year ago.
Oh gosh. Have they charged me already for the call?
Expert:  Lisa replied 1 year ago.

I'm not sure. I don't have anything to do with that...you could contact customer service at: 1(###) ###-####br />or through their Black Belt Customer Service here: http://ww2.justanswer.com/contact-us

Customer: replied 1 year ago.
How do we get another expert to take over for the call?
Expert:  Lisa replied 1 year ago.

I can opt out. Just don't reply to me or you'll lock the other experts out.

Expert:  Dr. Michael Salkin replied 1 year ago.

I'm sorry that your question wasn't answered in a timely manner. I understand that you're concerned about angular deformaties in Swagger's front legs. Here's a good synopsis for you which I'd like you to peruse. It's written for the vet but you'll glean important information and I'd be pleased to explain anything you didn't fully understand. Most important, if you're seeing "bowing" of Swagger's front limbs and such a deformity hadn't been present earlier, Swagger should be referred to a veterinary specialist orthopedic surgeon (please see here: www.acvs.org) promptly. We need to avoid further damage to his front limbs as soon as possible.

Definition

An abnormal growth of the limb, more common in dogs than in cats, due to premature closure of a physis (growth plate). Most commonly occurs in the forelimb, with radial or ulnar physeal closure(s). Rarely affects the hindlimb, with premature closure of the tibial physis.

Synonyms

Premature closure of radial, ulnar, or tibial physis; radius curvus; carpus valgus

Epidemiology

Species, Age, Sex

Primarily young dogs (<1 year old)

Risk Factors

  • Trauma to limb and physis
  • Some chondrodystrophic breeds may be predisposed.

Clinical Presentation

History, Chief Complaint

  • Trauma to the limb 3-4 weeks before deformity
  • Often, dog is presented when the limb begins to appear deformed

Physical Exam Findings

  • Lameness of affected limb, with pain on palpation of carpus or elbow
  • The limb may appear shortened or have an angular deviation.

Etiology and Pathophysiology

  • Premature closure of the distal ulnar physis is the most common physeal injury, likely due to the conical shape of this physis in dogs.
    • Because of the paired bone system, cessation of growth in the ulna causes cranial bowing, external rotation, and valgus deformity of the radius. Elbow and carpal incongruities can also occur.
  • Asymmetric closure of the distal radial physis can cause an angular deformity similar to closure of the ulnar physis.
  • Symmetric closure of the distal radial physis will often lead to radial shortening and elbow incongruity but no angular deformity.

 Diagnosis

Diagnostic Overview

The diagnosis of premature closure of a physis leading to an angular limb deformity is suspected in a young dog with a shortened or angularly deformed limb, and confirmed on radiographs when compared to the normal limb.

Differential Diagnosis

  • Malunion of a fracture
  • Ligamentous or tendinous damage at the elbow or antebrachiocarpal joint
  • Retained cartilaginous cores of the ulna

Initial Database

  • CBC and serum chemistry panel: no abnormal findings expected with this disorder
  • Mediolateral and craniocaudal elbow-to-carpus radiographs of the affected and contralateral limb to assess location and degree of deformation

Advanced or Confirmatory Testing

  • Computed tomography (CT) may be used for further defining the limb deformation and joint congruency.
  • CT images can be utilized to produce three-dimensional life-sized stereolithographic models.

 Treatment

Treatment Overview

Surgical treatment aims to restore joint congruity, normalize limb length, and correct angular and rotational deformities. In immature dogs, additional aims are to restore unrestricted growth of affected bones and prevent joint incongruities from developing.

Acute General Treatment

  • Ulnar ostectomy: used in an immature dog with premature closure of the ulnar physis, to restore growth potential.
    • A fat graft placed in the ostectomy prevents premature bone union.
  • Distraction osteogenesis (via circular external fixation): used for treating premature closure of the distal radius
    • This allows for limb lengthening and correction of angular deformities.
  • Corrective closing radial wedge osteotomy or dome osteotomy (stabilized with a “T” plate, circular or linear external fixation, in combination with an ulnar ostectomy): performed in mature dogs for acute correction of angular and rotational deformities and to restore joint congruity
  • Dynamic proximal ulnar osteotomy: permits realignment of severe elbow incongruities

Chronic Treatment

  • In the postoperative period, a soft padded bandage or metasplint may be placed to protect the limb. The bandage or splint is often applied for 2-4 weeks.
  • Physical rehabilitation to reduce risk of complications

Behavior/Exercise

Exercise restriction for at least 6 weeks until radiographs confirm bone healing

Possible Complications

  • External fixation may have premature loosening of the fixation pins or pin tract infection.
  • Inappropriate amount of surgical correction may result in persistent valgus.
  • Distal radial plating may result in decreased antebrachiocarpal joint range of motion.
  • Distraction osteogenesis may lead to flexor tendon contracture.

Recommended Monitoring

  • Suture removal and recheck 2 weeks after surgery
  • Radiographs at 4 to 6 weeks to evaluate bone healing

 Prognosis & Outcome

  • Guarded after ulnar ostectomy alone. Often an additional surgical procedure is necessary at skeletal maturity to correct the angular deformity.
  • Good after definitive corrective osteotomy if the amount of correction is adequate.

 Pearls & Considerations

Comments

  • Stereolithographic models produced from CT scan images may be utilized to preplan surgical correction.
  • Corrective osteotomy is performed at the point of maximum deformity to provide optimal realignment of the articular surfaces and appropriate limb alignment.
    • The deformity may be localized and quantified using the center of rotation of angulation (CORA) method.
  • If there is minimal radial shortening but radial head subluxation, a proximal ulnar ostectomy will shorten the ulna and restore elbow congruity.
  • During ulnar ostectomy, the periosteum must be removed completely to prevent premature healing of the ostectomy site.
  • Pes varus is a rare condition associated with distal tibial physeal closure in dachshunds.