Eirevet is a veterinarian specialized in canine and feline internal medicine who owns a small animal veterinary hospital in Ireland.
Part 1: Lameness in the Forelimb
This is the first of two articles describing lameness in dogs, which includes forelimb and hindlimb lameness. Despite many owners stating that their lame dog is quite comfortable and happy, it is important to realise that limping is a sign of pain, and so any lame dog warrants attention. My aim in these articles is to help owners distinguish minor injuries which may improve with rest and appropriate physical therapy from those cases which are more serious and require veterinary attention.
Signs of Lameness
It may be difficult to detect a mild lameness, so the following are the signs to look for.
- Shortened stride.
- 'Stiffness' after rest.
- Head nodding when walking. The head nods when placing the good leg and rises on the lame leg.
- Altered carriage of the leg. Toes may point inward or outward when compared to other leg.
Uncomplicated Causes of Forelimb Lameness
It is important when dealing with a limping dog not to overlook obvious problems, and so the first step is to visually examine your dog's leg. I will assume that any major injuries such as a fracture will be immediately obvious, and so I will not dwell on these. Are there any abrasions or wounds visible? Look closely at the nails. Are there any cracks or is there any blood at the base of any nail? Are the pads cracked or raw-looking? Is there any foreign material trapped in the hair between the pads? I have cured several very lame dogs by simply clipping out things such as dried chewing gum from this area.
The areas between the pads and the webbing between the toes (interdigital spaces) are particularly prone to irritation and infection, which should be suspected if there is a strong or unusual smell from the paw. Dogs with interdigital problems are often much more lame on rough surfaces such as gravel, and may be almost sound when walked on grass. If mild, interdigital infections may be treated by bathing in an antibacterial/antifungal shampoo such as Malaseb once daily for one week, but if not, improving will require veterinary treatment.
If there are no visible problems with the paw or leg, the next step is palpation. Palpation (feeling) of the leg should start at the toes and work towards the shoulder. Apply a moderate amount of pressure to each nail base, toe, and individual interdigital space to check for a pain response, such as pulling the foot away, whining, growling, or attempts to bite. Palpate the bones of the leg from the toes upwards. Bone pain in young dogs under 12 months of age may be due to metabolic bone disorders such as panosteitis or metaphyseal osteopathy. In older dogs, it may indicate a bone tumour, particularly if the pain is located close to the shoulder or wrist joints. Dogs with bone pain will always need to be x-rayed.
Apply gentle but firm pressure to the major muscle groups of the forearm (below the elbow), triceps (above and behind the elbow), and biceps region (above and in front of the elbow). If you are able to feel the spine of the shoulder blade, apply pressure first in front and then behind it, as strains of the supraspinatus and infraspinatus muscles are quite common; see the video below.
If you have found evidence of mild to moderate muscle pain, it may be possible to treat the dog at home with a combination of rest (no walks for five days) and application of cold compresses such as a bag of frozen peas in a damp cloth applied to the affected area for 10 minutes, four times daily. Muscle strains are often overlooked as a cause of lameness in dogs, but given their active nature it is no surprise that most dogs will injure themselves more frequently than the average human. Flexion and extension of the wrist, elbow, and shoulder should be carried out next. Mild pain on flexion of the wrist may indicate a sprain, which may also be treated with rest and cold compresses,
If you do not find any evidence of muscle injury, or your dog's lameness does not improve after rest, then please visit your veterinarian for further advice. The rest of this article details the more serious causes of lameness in the forelimb.
Elbow dysplasia, or developmental abnormalities, are becoming an increasingly common problem in young large breed dogs such as German Shepherds and Bernese Mountain Dogs. Lameness is usually first seen from 4-10 months of age, but they may not become obvious until 18 months old. The term elbow dysplasia encompasses a number of different abnormalities, but all result in an incongruity of the elbow joint. Put simply, the bones of the joint no longer 'fit together properly'. With each movement of the forelimb, bone rubs on bone, resulting in a rapid onset of osteoarthritis.
If detected early, there are a number of surgical techniques which may be attempted in order to improve the function of the joint. Unfortunately, even with surgical intervention, arthritis develops in most cases. Total elbow replacement is an option for severely affected dogs, but it must be delayed until the dog is mature, and it is expensive.
For dogs which are not candidates for surgery, or in those in which osteoarthritis has developed, there are many treatments available. Talk to your veterinary surgeon to discuss treatment options.
It is worth mentioning that Springer Spaniels have an inherited weakness in the elbow joint, where the growth plate between both halves of the humerus may fail to fuse properly. Affected dogs may fracture the joint as a result of very minor trauma such as jumping from a chair, and any Springer with elbow pain should be examined by a veterinarian ASAP.
Supplement for Treatment and Prevention of Osteoarthritis
The most common cause of shoulder lameness in young dogs is osteochondrosis of the humeral head, a developmental abnormality of growing joint cartilage. It is most commonly seen in 4 to 12-month-old male dogs of large breeds. Lameness is usually mild in the first few months of the problem, but worsens over time. Dogs with osteochondrosis usually show signs of pain on extension of the shoulder joint. Diagnosis requires radiography, and surgery will often be advised to remove any loose or damaged cartilage.
Many cases of osteochondrosis can be prevented or ameliorated by feeding a good-quality large breed puppy food and by restricting exercise in the first 12 months of life. Large breed puppies should not be vigorously exercised for an extended period of time, and regular lead exercise is advised, rather than infrequent bursts of hectic off-lead activity (e.g., throwing a ball around the park for an hour once weekly).
Bicipital tenosynovitis is a condition which usually affects middle-aged, active medium- and large-breed dogs. Lameness with this condition is usually mild for an extended period of time, and in my experience many patients have been limping for several months before owners have felt it necessary to present them to me for examination. There is a characteristic restricted gait with the condition, where the dog is very obviously avoiding full extension of the shoulder joint when walking/running. It is often possible to elicit pain with the biceps tendon test (backwards flexion of the shoulder while applying fingertip pressure to the front of the shoulder joint), but diagnosis requires radiography. Various treatments may be employed; usually a period of rest combined with anti-inflammatory drugs is tried first. If this fails to resolve the problem, your veterinarian may inject a steroid into the tendon sheath under sedation or anaesthesia, and if this fails to cure the problem, surgery may be recommended.
There are a number of other uncommon developmental shoulder conditions which are too rare to be discussed in detail.
- Many strains and sprains may be treated at home—but you must at least examine your dog yourself to localise the pain and help treat the problem.
- Large and giant breeds are prone to developmental problems of the elbow and shoulder.
- Bone, elbow, or shoulder pain all require veterinary attention.
- Most of the causes of elbow and shoulder discomfort will lead to osteoarthritis and long-term damage unless dealt with promptly.
- Keeping your dog at a healthy weight and feeding a good quality food minimises the risk of these conditions developing and reduces pain in affected dogs.
This article is accurate and true to the best of the author’s knowledge. It is not meant to substitute for diagnosis, prognosis, treatment, prescription, or formal and individualized advice from a veterinary medical professional. Animals exhibiting signs and symptoms of distress should be seen by a veterinarian immediately.