Case Courtesy of Aimee Mathers RVN
Scout, a 4 years old, crossbreed dog, presented to see Dr. Andrew Armitage at Greenside Vet Practice with intermittent lameness after exercise to left hind, bunny hopping on hind limbs and intermittent reluctance to jump.
A thorough physical examination carried out by Dr. Armitage indicated the possible start of a medial buttress on left pelvic limb and slight joint effusion. Cruciate test elicited the pain response as does full extension, as does full extension, and internal rotation, but cranial drawer was negative.
On Gulick tape muscle measurement there was a 2 cm difference in muscle diameter. In the left hind (42 cm) present compared to right hind (44 cm). On palpation she was also painful at lumbosacral region and had sciatic pain throughout limb. Also there was illiopsoas pain on palpation of the muscles and tendon of insertion.
Gait analysis which showed a 7 cm reduction in stride length on left hind and a substantial reduction on weight through the limb at walk.
Stance analysis showed she was only applying 13% of her weight to her left hind, shifting this weight across on to her right fore. Non-steroidal anti-inflammatory and joint supplements were started.
Radiographs showed sclerosis of the end plates at L7-S1, Osteoarthritis and early stage of spondylosis in lumbar spine. Both hips had osteoarthritic changes which was worse on the right and there was evidence of left cruciate degeneration.
Musculoskeletal ultrasound showed there were significant changes to both illiopsoas tendons, which was more advanced on the left. Disc degeneration at L6-L7, joint effusion on both hips, which was worse on right and a joint effusion on left stifle was also noted.
Investigation found that Scout has left cruciate disease, bilateral hip osteoarthritis, illiopsoas tendinopathies, spondylosis and lumbosacral disease. This will continue to be a lifelong debilitating situation for the patient of only 4 years old without intervention.
Non-steroidal anti-inflammatory and joint supplements were started.
The decision was made to start Scout on a non-steroidal anti-inflammatory, joint supplements and begin a regenerative medicine program. This includes Adiposed Derived Mesenchymal Stem Cells, Platelet Rich Plasma and Laser Therapy (Class IV) to treat both hips, left stifle, spine and both iliopsoas tendons.
Once Scout’s own stem cells had completed culture expansion the patient was sedated and implantation took place. Stromal cells and PRP were intra-articularly implanted in to both hips and left stifle. An epidural was performed to introduce stem cells into lumbosacral region and ultrasound guided implantation was performed into both illiopsoas tendons. Initial laser to all areas post implantation using a Litecure Companion Therapy Laser was performed, this is to help re-energize cells and reduce pain and inflammation. A total of 6 laser sessions were performed over a 2 week period.
Scout was restricted to gentle lead exercise with a gradual increase over the following 6 weeks. She was re-examined by Dr Armitage. Her general demeanour and willingness to play had greatly increased. On physical exam there were improvements noted, no back pain, no cruciate pain or joint effusion, illiopsoas pain still present but reduced. Gulick measurements had improved to a 0.5 cm difference in muscle diameter.
Stance analysis showed that her bearing in the left hind had improved to 14% but she was still off loading. Hydrotherapy (underwater treadmill) was advised.
Exercise continued to increase and at 12 weeks. A re-examination showed further improvements, further reduction of pain. She is continuing her hydrotherapy sessions and re-examinations. Owner notes overall improvements are fantastic.