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Lameness and weakness in dogs: is it


orthopaedic or neurological?
Malcolm McKee

In Practice 2007 29: 434-444


doi: 10.1136/inpract.29.8.434

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COMPANION ANIMAL PR ACTICE Targeted investigations are


required to differentiate
between orthopaedic and
neurological causes of
lameness and weakness

Lameness and weakness in dogs:


is it orthopaedic or neurological?
MALCOLM MCKEE

DIAGNOSING the cause of lameness or weakness in dogs is not always straightforward. Although
orthopaedic conditions are the most common cause of thoracic and pelvic limb lameness and
neurological disorders the most common cause of weakness, occasionally neurological cases may
be presented due to lameness and orthopaedic cases due to weakness. Diagnosing orthopaedic
and neurological disorders as causes of weakness and lameness, respectively, can be challenging. A
detailed history and thorough clinical examination, with emphasis on the orthopaedic and neurological
components, is essential. This article describes the orthopaedic and neurological causes of lameness,
and weakness and incoordination, and highlights the specific investigations that can be carried out
Malcolm McKee to differentiate between the two.
graduated from
Glasgow in 1983.
He is a partner LAMENESS – IS IT ORTHOPAEDIC? It is important to consider that many orthopaedic
in the Willows
Referral Service conditions such as elbow dysplasia, hip dysplasia, cra-
in Solihull, and an Lameness is a common presentation in small animal nial cruciate ligament rupture and osteoarthritis can be
RCVS specialist in
small animal surgery practice and is usually due to orthopaedic conditions subclinical and, hence, not cause lameness. Evidence of
(orthopaedics). His involving joints or bones, such as osteochondrosis, hip pain is thus a critical feature. However, diagnosis is fur-
particular interests
are complex fracture
dysplasia, cranial cruciate ligament rupture, patellar lux- ther complicated by the fact that some conditions may
management, joint ation, osteoarthritis, fractures, panosteitis and neoplasia. result in chronic lameness without a focus of pain being
replacement and
spinal surgery in
Signalment, particularly with regard to age and breed, detectable on examination. Soft tissue conditions in the
the dog. He is past and history are useful aids to diagnosis. For example, region of the shoulder (eg, glenohumeral ligament rup-
chairman of the osteochondrosis is primarily a condition of immature, ture) and fragmented coronoid process are examples of
British Veterinary
Orthopaedic large-breed dogs and there is often a history of stiffness occult causes of lameness.
Association. after rest. Conversely, primary bone tumours are over- Radiography, synovial fluid analysis, arthroscopy,
represented in middle-aged to old large- and giant-breed computed tomography (CT), ultrasonography, scintigra-
dogs and lameness is usually insidious in onset and pro- phy, fine needle aspirates and biopsy can all be used to
gressive. Some historical features are highly suggestive investigate lameness.
of an orthopaedic condition (eg, paw problems often
result in excessive licking of the area and lameness that
is exacerbated on hard surfaces).
A thorough and complete orthopaedic exami- Historical features suggestive
nation should follow a general physical examina- of spinal pain
tion (see Houlton 2006). Gait should be analysed,
■ Yelping (unprovoked or when handled)
and conformation and posture studied. All limbs
■ Reluctance to jump or climb
should be examined systematically from the digits
■ Arching of the back
to the proximal aspect of each limb. Particular atten-
■ Low head carriage
tion should be paid to muscle atrophy and contralat-
■ Reluctance to lower the head to eat from the floor
eral limbs should be compared, bearing in mind that
■ Reluctance to look upwards
conditions may be bilateral. Individual bones should
■ Reluctance to turn in tight circles
be carefully palpated for evidence of pain, thicken-
■ Tense neck, back and/or abdomen
ing and deformity. All joints should be evaluated
■ Restlessness
In Practice (2007)
for pain, range of motion, thickening, crepitus and
■ Panting
29, 434-444 instability.

434 In Practice ● SEPTEMBER 20 07


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LAMENESS – IS IT NEUROLOGICAL? NEUROLOGICAL DISEASE AND


THORACIC LIMB LAMENESS
Any disease that causes compression or destruction of a Diseases affecting the caudal cervical spinal nerves
spinal nerve or a peripheral nerve that originates from the (C6 to C8), the brachial plexus or peripheral nerves
cervical or lumbar intumescences may cause thoracic or may cause thoracic limb lameness. The most common
pelvic limb lameness. The clinician should be suspicious conditions are degenerative disc disease and neoplasia.
of this scenario when orthopaedic examination reveals Less common causes include discospondylitis, brachial
no specific abnormalities or evidence of pain. In addi- plexus neuritis and orthopaedic implant-related nerve
tion, historical features, such as evidence of spinal pain, injury (eg, injury to the ulnar nerve by a bone plate on
weakness or incoordination, may be suggestive of neu- the medial aspect of the distal humerus).
rological involvement. Thus, owners should be carefully
questioned regarding evidence of spinal pain, stumbling,
dragging of the digits, weakness and incoordination.
Neurological examination may reveal muscle atro-
phy that may be neurogenic in origin or relate to dis-
use. Proprioception tests, such as paw position sense,
may be delayed or absent. These tests may be difficult
to perform in dogs that are reluctant to bear weight on
the affected limb. Pedal withdrawal and stretch reflexes
(eg, triceps, patellar reflex) may be reduced or absent.
Traction on the limb may stretch the affected spinal
nerve and exacerbate pain and lameness – referred to as
a nerve root signature.

A B

Lateral (A), ventrodorsal (B), right lateroventral–left laterodorsal oblique (C) and left lateroventral–right laterodorsal
oblique (D) cisternal myelograms from a 7·5-year-old cocker spaniel with neck pain and left thoracic limb lameness,
showing no evidence of extradural spinal cord compression. Note the mineralised material within the C6-C7 intervertebral
disc and the left C6-C7 intervertebral foramen (arrow). The latter is extruded nuclear disc material that is compressing the
regional (C7) spinal nerve and causing the clinical signs

C D

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Sagittal (left) and transverse (right) magnetic resonance images from a 10-year-old German shepherd dog with neck
pain and left thoracic limb lameness showing degeneration of the C5-C6 intervertebral disc and left ventrolateral spinal
cord compression (arrow). The latter is caused by extruded disc material that has migrated caudally from C5-C6. It is
compressing the ipsilateral spinal nerve

Degenerative disc disease intervertebral disc space narrowing. When the nucleus
Intervertebral discs that undergo degenerative chondroid pulposus is mineralised, extruded material may be vis-
or fibroid metaplasia may cause clinical signs in one of ible overlying the vertebral canal on a lateral view.
two ways: extrusion of the nucleus pulposus or protru- Oblique views may reveal mineralised disc material
sion of the annulus fibrosus. These are referred to as within the intervertebral foramen. Myelographic contrast
Hansen type I and II lesions, respectively. With annular studies may show extradural spinal cord compression.
protrusions there may be concomitant vertebral deformi- Oblique views may be necessary to detect ventrolateral
ty (eg, cervical spondylopathy-associated disc protrusion extrusions. Myelography is insensitive for diagnosing
or so-called wobbler syndrome). foraminal extrusions since the subarachnoid space is not
compressed. Magnetic resonance imaging (MRI) is the
CERVICAL DISC EXTRUSION preferred diagnostic test in these cases.
The nucleus pulposus may extrude dorsolaterally through
the annulus fibrosus and occupy the ventrolateral ver- CERVICAL DISC PROTRUSION
tebral canal or intervertebral foramen. Compression of The annulus fibrosus may protrude dorsolaterally into
the regional spinal nerve can result in pain and thoracic the vertebral canal and compress the regional spinal
limb lameness. Spaniels, terriers and chondrodystrophoid nerve, which may result in chronic thoracic limb lame-
breeds are most often affected. Thoracic limb lameness ness. Large-breed dogs, such as dalmatians and standard
is often associated with marked neck pain, which is typi- poodles, are over-represented. Neck pain is variable and
fied by spontaneous yelping and a low head carriage. muscle atrophy of the affected limb is often palpable.
Cervical muscle spasm and exacerbation of pain when
the neck is manipulated are common clinical features.
The affected thoracic limb is often held off the ground in
a flexed position.
Survey radiographs of the cervical spine may reveal

A
Eight-year-old dobermann with right thoracic limb
lameness and paraparesis (A), and resting (B) and traction
(C) cisternal myelograms from the same animal. Note the
spinal cord compression due to protrusion of the C6-C7
intervertebral disc, which is relieved with traction. The
split ventral contrast column (arrow) is consistent with
asymmetrical dorsolateral protrusion of the disc and
regional spinal nerve compression. There is vertebral
malformation and malarticulation (cervical spondylopathy) C
and spondylosis deformans

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Survey radiographs of the cervical spine may reveal Lateral (A), ventrodorsal
(B), right lateroventral–left
intervertebral disc space narrowing. Mineralisation of laterodorsal oblique (C)
the affected disc is rare. Myelography with oblique views and left lateroventral–right
laterodorsal oblique (D)
may show ventrolateral extradural spinal cord compres- cisternal myelograms from
sion. The degree of compression is often reduced when a 7·5-year-old Yorkshire
traction is applied to the neck. It is probable that the terrier with left thoracic
limb lameness due to a
associated spinal nerve compression is also reduced or nerve sheath tumour.
eliminated as the intervertebral foramen is enlarged. The Note the left ventrolateral
C5-C6 extradural spinal cord
favourable response to vertebral distraction–stabilisation compression (white arrow)
surgery in these cases supports this hypothesis. MRI and the enlarged left
A C5-C6 intervertebral
is an excellent alternative imaging modality. Traction foramen (yellow arrow)
images may be obtained to assess the effect on spinal
cord and spinal nerve compression.

CERVICAL SPONDYLOPATHY-ASSOCIATED
DISC PROTRUSION
Caudal cervical vertebral malformation and associated
protrusion of the annulus fibrosus may compress the
spinal cord and regional spinal nerves. Middle-aged
dobermanns and great danes are over-represented. Neck
pain is variable, while muscle atrophy of the affected
limb is often marked.
Survey radiographs of the cervical spine may reveal
vertebral malformation, abnormal vertebral alignment
and intervertebral disc space narrowing. Myelography
with oblique views may show ventrolateral extradural B C D
spinal cord compression. As with other cervical disc pro-
trusions, the degree of cord compression is often reduced
with traction. MRI with traction views is increasingly deficits are often only evident when the condition is
used in the diagnosis of this condition. advanced. Muscle atrophy is often marked. Careful
palpation of the axilla may reveal a mass. Pain is
Neoplasia generally exacerbated when these tumours are manip-
Tumours arising from nerve sheaths or the caudal ulated and this may even be evident when the dog
cervical spine may cause progressive thoracic limb is sedated or anaesthetised. Brachial plexus tumours
lameness. may invade along one or more spinal nerves and enter
the vertebral canal and spinal cord. Electromyographic
NERVE SHEATH TUMOURS tests may reveal spontaneous electrical activity in
Malignant peripheral nerve sheath tumours (previously affected muscles and reduced nerve conduction veloci-
referred to as neurofibromas, neurofibrosarcomas or ties. MRI and ultrasonography may enable detection
schwannomas) may involve spinal nerves, the brachial of a mass. Some of these tumours are extremely small,
plexus or peripheral nerves. even after many months of progressive thoracic limb
Nerve sheath tumours arising from spinal nerves lameness, and false negative findings are therefore
within the vertebral canal may cause spinal cord com- possible.
pression. Neck pain is a common feature and neurologi-
cal deficits may be detected in other limbs, especially the CERVICAL SPINAL NEOPLASIA
ipsilateral pelvic limb. Oblique view survey radiographs Extradural tumours (eg, fibrosarcomas) and vertebral
may show enlargement of the intervertebral foramen tumours (eg, osteosarcomas) may cause spinal nerve
containing the affected spinal nerve. Myelography or compression and associated thoracic limb lameness.
MRI may reveal a lateralised extradural or intradural– Survey radiographs may reveal osteolysis or abnormal
extramedullary space-occupying lesion. new bone formation. Myelography may show evidence
Nerve sheath tumours arising from the brachial of concomitant spinal cord compression. MRI or CT
plexus generally do not cause neck pain. Neurological may also be useful diagnostic aids.

(left) Eleven-year-old labrador retriever with right thoracic limb lameness due to a brachial plexus
nerve sheath tumour. (middle) Transverse magnetic resonance image showing right C8 spinal nerve
enlargement (arrow). (right) Brachial plexus mass (arrow) on postmortem examination

In Practice ● SEPTEMBER 20 07 439


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A B

(A) Nine-year-old labrador retriever with right thoracic


limb lameness due to a vertebral osteosarcoma. Lateral (B),
ventrodorsal (C) and left lateroventral–right laterodorsal
oblique (D) radiographs show osteolysis and irregular new
bone formation affecting the right craniolateral aspect of
C6 (arrows)

and orthopaedic implant-related nerve injury (eg, injury


to the sciatic nerve by an intramedullary femoral pin or
ischioilial pin [DeVita pin]).

Degenerative disc disease


C D Intervertebral discs of the caudal lumbar and lumbosac-
ral spine may degenerate and cause clinical signs in a
similar way to cervical discs. Caudal lumbar disc lesions
NEUROLOGICAL DISEASE AND tend to be nuclear extrusions in contrast to lumbosacral
PELVIC LIMB LAMENESS disc lesions, which are invariably annular protrusions.
Diseases affecting the caudal lumbar spinal nerves (L5
to L7), the lumbosacral plexus or peripheral nerves may LUMBAR DISC EXTRUSION
cause pelvic limb lameness. The most common are The nucleus pulposus may extrude dorsolaterally through
degenerative disc disease, neoplasia and discospondyli- the annulus fibrosus and occupy the ventrolateral verte-
tis. Less common causes include acetabular/ischial frac- bral canal or intervertebral foramen. Compression of
tures, orthopaedic surgery (eg, triple pelvic osteotomy, the regional spinal nerve can cause pain and pelvic limb
femoral head and neck excision), cauda equina neuritis lameness. Spaniels, terriers and chondrodystrophoid

A B C

(A) Five-and-a-half-year-
old cocker spaniel with
back pain and left pelvic
limb lameness. Lateral
(B), ventrodorsal (C),
right laterodorsal–left
lateroventral oblique (D)
and left laterodorsal–right
lateroventral oblique (E)
myelograms show left
ventrolateral extradural
spinal cord compression
at L5-L6. The intervertebral
disc space is narrow and
the disc is mineralised.
Extruded nuclear disc
material is compressing the
L5 spinal nerve and causing D E
the clinical signs

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reveal intervertebral disc space narrowing. Spondylosis


deformans is common. A ventrodorsal view with the
spine flexed may show new bone formation in the
region of the intervertebral foramen. Myelography is an
extremely insensitive test for assessing lumbosacral disc
disease, as are epidurography and discography. MRI is
the imaging modality of choice as it enables the detec-
tion of L7 spinal nerve compression. Some compressions
are dynamic in that they are influenced by the position
of the spine, and flexed and extended views may be
informative in these cases. Generally, extension exacer-
bates compression while flexion reduces compression as
the intervertebral foramen is enlarged.

Lumbosacral magnetic resonance image from an Neoplasia


8·5-year-old Border collie with back pain and left pelvic
limb lameness. Dorsolateral protrusion of the L7-S1 Tumours arising from nerve sheaths or the lumbosacral
intervertebral disc is compressing the left L7 spinal nerve spine may cause progressive pelvic limb lameness.
as it exits the intervertebral foramen (arrow). There is left
lateral and ventral spondylosis deformans
NERVE SHEATH TUMOURS
Malignant peripheral nerve sheath tumours may involve
breeds are most commonly affected. Pelvic limb lame- spinal nerves, the lumbosacral plexus or peripheral nerves.
ness is often associated with back pain. Spontaneous When they involve spinal nerves within the vertebral
yelping and arching of the back are typical features. The canal they can compress the cauda equina and cause neu-
affected pelvic limb is often held off the ground in a rological deficits. These dogs frequently have back pain.
flexed position alongside the abdomen. Survey radiographs are often unremarkable. MRI allows
Survey radiographs of the lumbar spine may reveal detection and assessment of the extent of the tumour
intervertebral disc space narrowing. When the nucleus within the vertebral canal and also potential involvement
pulposus is mineralised, extruded material may be vis- of the intervertebral foramen and paraspinal musculature.
ible overlying the vertebral canal on a lateral view. Nerve sheath tumours involving the lumbosacral
Myelography may show extradural spinal cord/cauda plexus and peripheral nerves do not generally cause back
equina compression. Oblique views may be necessary pain. Neurological deficits are often only evident when
to detect ventrolateral extrusions. Myelography cannot the condition is advanced. Palpation of the pelvic canal
assist in the diagnosis of foraminal extrusions – MRI is per rectum may reveal a mass or thickening of the lum-
preferable in these cases. bosacral trunk. Pain is usually exacerbated when these
tumours are manipulated. Electromyographic tests may
LUMBOSACRAL DISC PROTRUSION reveal spontaneous electrical activity in affected muscles
The annulus fibrosus may protrude dorsolaterally into and reduced nerve conduction velocity. MRI may enable
the vertebral canal and compress the seventh lumbar spi- the detection of a mass.
nal nerve as it exits the intervertebral foramen. Chronic
pelvic limb lameness may result. Concomitant pathol- LUMBOSACRAL SPINAL NEOPLASIA
ogy (eg, spondylosis deformans, articular facet new bone Extradural tumours (generally sarcomas) and vertebral
and hypertrophy of joint capsule and interarcuate liga- tumours (eg, osteosarcomas) may cause spinal nerve
ment) may contribute to vertebral canal and foraminal compression and pelvic limb lameness. Survey radio-
stenosis. The condition is often referred to as degenera- graphs may reveal osteolysis or abnormal new bone
tive lumbosacral stenosis. Large breeds such as German
shepherd dogs are over-represented. Palpation of the
lumbosacral spine and extending the lumbosacral spine
(lordosis test) may exacerbate back pain.
Survey radiographs of the lumbosacral spine may

(above) Twelve-year-old lurcher with non-weightbearing


right pelvic limb lameness due to a spinal nerve sheath
tumour. (right) Dorsal magnetic resonance image showing
right L6 spinal nerve enlargement (arrow)

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Radiograph showing a vertebral osteosarcoma in an Lateral (above) and flexed ventrodorsal (below) radiographs
8·5-year-old mixed breed dog with back pain and left showing extensive vertebral end-plate osteolysis in a 4·5-
pelvic limb lameness. Note the osteolysis affecting the year-old boxer with back pain and left pelvic limb lameness
L5 vertebral body and regional extradural cauda equina due to lumbosacral discospondylitis
compression

formation. MRI or myelography may be necessary to


provide additional information such as evidence of com-
pression of the cauda equina or spinal nerves.

Lumbosacral discospondylitis
Infection of the lumbosacral disc and adjacent vertebral
endplates may result in compression of the seventh lumbar
spinal nerve. This scenario is most likely in advanced cases
where marked destruction of the vertebral bodies results in
stenosis of the intervertebral foramina. Back pain and pel-
vic limb lameness can be severe. Survey radiographs show
osteolysis of vertebral endplates and irregular new bone
formation. MRI enables detection of early discospondyli-
tis prior to radiographic changes, but pelvic limb lameness
is not generally a feature in these cases. The infected disc WEAKNESS AND INCOORDINATION
space may be aspirated and material submitted for culture. – IS IT ORTHOPAEDIC?
Blood and urine may also be cultured.
Orthopaedic conditions may also cause weakness and
hence mimic neurological conditions. Furthermore, they
WEAKNESS AND INCOORDINATION may occasionally cause apparent incoordination and thus
In addition to – IS IT NEUROLOGICAL? further mimic neurological disorders.
neurological and An abnormal increase in flexion or extension of a
orthopaedic Weakness is a common presentation in small animal joint when weightbearing is the main reason orthopaedic
conditions, there are practice and neurological conditions are some of the conditions cause weakness. This is due to a lack of pas-
many other causes of most common causes. Diseases of the central nerv- sive or active joint support. Passive support depends on
weakness including ous system (brain and spinal cord), peripheral nervous joints being reduced and stable. It is reduced or absent
cardiovascular and system, neuromuscular junction and muscles may all when joints luxate or ligaments rupture. Active joint
metabolic disorders, cause weakness and/or incoordination. Spinal cord dis- support depends on intact, functioning musculotendi-
such as shock and orders are the most common and, of these, degenerative nous units. Rupture or avulsion of these units reduces
hypoadrenocorticism. intervertebral disc disease (cervical and thoracolumbar) or prevents active joint support. Orthopaedic conditions
is the most frequently diagnosed. cause apparent incoordination as a result of abnormal
The signalment may be useful as specific conditions limb movement during the gait cycle. Muscle contrac-
are over-represented in certain breeds (eg, thoracolumbar tures and limb deformities can have profound effects on
disc disease in dachshunds). Historical features may be limb movement.
suggestive of particular conditions (eg, exercise-induced Examination of dogs with orthopaedic causes of
weakness is typical of myasthenia gravis and some poly- weakness and incoordination will often reveal abnormal
myopathies). Spontaneous yelping is characteristic of joint movement, muscle contracture or limb deformity.
spinal pain. Neurological examination will generally be unremarkable.
Neurological examination should be thorough and
complete following a general physical examination (see THORACIC LIMB WEAKNESS
Garosi 2004). Gait analysis, proprioception tests, assess- Glenohumeral (shoulder) luxation may cause apparent
ment of segmental spinal and cranial nerve reflexes, and weakness, especially if it is developmental in nature
evidence of spinal pain may enable neurolocalisation. and bilateral. Triceps tendon rupture or avulsion, and
Neurological causes of weakness and incoordination olecranon fractures may result in an inability to extend
can be investigated using radiography, MRI, CT, mye- the elbow and bear weight. Carpal hyperextension with
lography, cerebrospinal fluid analysis, electrophysiologi- a palmigrade stance is not uncommon, especially in col-
cal testing, biopsy and blood tests. lie breeds, where the aetiology tends to be degenerative.

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Traumatic carpal hyper-


extension can result from
a fall. In immature dogs
(typically 10 to 12 weeks
of age), hyperextension of
the carpus can develop as
a result of inadequate flex-
or muscle tone.

THORACIC LIMB
INCOORDINATION
Contracture of the infra-
Straight patellar tendon
spinatus muscle and, less rupture in a 4·5-year-old
Degenerative bilateral
carpal hyperextension in commonly, the supraspina- Border terrier with right
a seven-year-old Shetland tus muscle results in a pelvic limb weakness.
sheepdog with thoracic limb Bilateral cranial cruciate ligament rupture in a 2·5-year-old Note the increased distance
weakness and lameness characteristic thoracic limb golden retriever, which presented with arching of the back between the patella and
posture and gait abnormal- and apparent pelvic limb weakness the tibial tuberosity

ity. Flexion of the shoul-


der joint results in external rotation of the humerus and
abduction of the distal limb. Circumduction of the limb
during the swing phase of the stride and lateral flipping
of the paw are typical features. The condition is most
frequently recognised in working dogs. There is often a
history of sudden onset lameness, presumably associated
with injury to the muscle, which improves prior to the
development of the muscle contracture.

PELVIC LIMB WEAKNESS


Hip dysplasia with (sub)luxation of the coxofemoral
joints can cause apparent weakness, especially in imma-
ture dogs. Palpation of the hips may reveal instability Bilateral gastrocnemius tendon avulsion in a nine-year-
and positive Ortolani signs. Cranial cruciate ligament old golden retriever, which resulted in severe pelvic limb
rupture results in femorotibial instability and this may weakness

cause apparent weakness, especially when bilateral. The


cranial drawer test enables diagnosis. stifle when the hip is flexed results in the paw being
Failure of the quadriceps musculotendinous unit may moved caudally just prior to being placed on the ground.
result in a reduction or inability to extend the stifle when Furthermore, the hock tends to displace laterally and
weightbearing. Patellar fractures, patellar tendon rup- the paw medially during the swing phase of the stride.
tures, patellar luxations and tibial tuberosity avulsions The contracted gracilis muscle may be palpated as a taut
are possible causes. Similarly, failure of the Achilles band on the caudomedial aspect of the thigh.
mechanism due to muscle or tendon avulsion/rupture, Growth deformities such as tibial varus and tibial
or fracture of the calcaneus, may result in an inability to valgus may cause significant alterations in pelvic limb
extend the hock and a plantigrade stance. Degenerative gait that can mimic neurological causes of incoordina-
and traumatic intertarsal and tarsometatarsal hyperex- tion. Careful examination reveals evidence of long bone
tension may also result in a plantigrade stance. deformity (angular ± rotational). Radiography provides
additional information.
PELVIC LIMB INCOORDINATION
Gracilis muscle contracture is an uncommon condi-
tion primarily recognised in the German shepherd dog.
Muscle fibrosis and contracture produce a character-
istic alteration in gait. An inability to fully extend the

Infraspinatus contracture
in a three-year-old springer
spaniel with apparent left
thoracic limb incoordination.
This was due, in part, to the Bilateral gracilis muscle contracture in a 4·5-year-
contracture causing external old German shepherd dog, which presented with
rotation of the humerus and apparent pelvic limb incoordination. This was
abduction of the distal limb due, in part, to the contracture causing internal
with flipping of the paw as rotation of the tibia as the hip flexed and the
the shoulder joint flexed stifle extended

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Acknowledgements
The author is grateful to Toby Gemmill for his assistance
in the final preparation of this paper, Ruth Dennis
for magnetic resonance imaging and the veterinary
surgeons who referred the cases.

Further reading
BAGLEY, R. S., TUCKER, R. & HARRINGTON, M. L.
(1996) Lateral and foraminal disk extrusion in dogs.
Compendium on Continuing Education for the
Practicing Veterinarian 18, 795-804
BREHM, D. M., VITE, C. H., STEINBERG, H. S., HAVILAND,
J. & VAN WINKLE, T. V. (1995) A retrospective study of
51 cases of peripheral nerve sheath tumors in the dog.
Journal of the American Animal Hospital Association
31, 349-359
CHAMBERS, J. & HARDIE, E. (1986) Localization and
management of sciatic nerve injury due to ischial or
acetabular fracture. Journal of the American Animal
Hospital Association 22, 539-544
COCKSHUTT, J. R. & SMITH-MAXIE, L. L. (1993) Delayed
onset sciatic impairment following triple pelvic
osteotomy. Progress in Veterinary Neurology 4, 60-63
FANTON, J., BLASS, C. & WITHROW, S. (1983) Sciatic
nerve injury as a complication of intramedullary pin
fixation of femoral fractures. Journal of the American
Animal Hospital Association 19, 687-694
FELTS, J. F. & PRATA, R. G. (1983) Cervical disc disease in
the dog: intraforaminal and lateral extrusions. Journal
of the American Animal Hospital Association 19, 755-760
Bilateral proximal tibial valgus deformity in a 16-month- GAROSI, L. (2004) The neurological examination. In
old great dane, which presented with apparent pelvic limb Canine and Feline Neurology. Eds S. R. Platt and N. J.
incoordination Olby. Quedgeley, BSAVA. pp 1-23
GILMORE, D. R. (1987) Lumbosacral discospondylitis
in 21 dogs. Journal of the American Animal Hospital
Association 23, 57-61
SUMMARY
HOULTON, J. E. F. (2006) An approach to the lame dog
or cat. In Canine and Feline Musculoskeletal Disorders.
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CLARIFICATION

Emergency care of the cat with multi-trauma (In Practice, July/August 2007, volume 29, pp 388-396)
The paragraph on ‘Analgesia’ on page 395 stated that meloxicam (Metacam Oral Suspension; Boehringer Ingelheim)
had been recently licensed for long-term use in cats at a dose of 0·05 mg/kg orally, once daily, for up to 14 days.
Boehringer Ingelheim points out that Metacam Oral Suspension for Cats has been granted a long-term licence in
which there is no restriction on the duration of use, thus allowing, where indicated, the product to be continued beyond
the 14-day period stated. It says that a loading dose of 0·1 mg/kg should be administered on the first day of treatment
to ensure that stable, therapeutic plasma levels are reached quickly, within the 48-hour period stated on the licence.
The authors add that Metacam injection is currently licensed as a single subcutaneous injection, at a dose of 0·3
mg/kg, for preoperative use in cats for pain related to minor surgical trauma. It may therefore be used off label for
pain related to trauma according to the same dosing regimen; owners should obviously be appraised of the off-label
use of this product before treatment. If Metacam therapy is continued orally after this time it should be used at a
dose of 0·05 mg/kg. If no improvement is seen in seven to 14 days, the authors suggest that Metacam therapy should
be discontinued.

CORRECTION

Total intravenous techniques for anaesthesia (In Practice, July/August 2007, volume 29, pp 410-413)
In the table of ‘TIVA protocols’ on page 413, the doses for propofol induction and maintenance in horses were incorrect.
The induction dose should have read 2 mg/kg and the maintenance dose 0·1 mg/kg/minute. The author regrets the error.

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