Thanksgiving is just around the corner. In past November issues I have shared some of the many advances in veterinary medicine for which I am thankful, and stories of some of the special people for whom I am thankful. We have also discussed many different animal health topics related to the season, such as traveling with your pet, avoiding the mistakes of feeding leftovers, and cold weather comfort and safety for your pet. These are important subjects, and you and your pet will benefit greatly if you understand the basics of those issues. If you have any specific questions about these topics feel free to give me a call, or ask your own family veterinarian.
This is also the season for my favorite team sport, college football. (ClemsonUniversityis where I did my undergraduate studies, and now that our two youngest children attend Clemson I must admit that my football loyalties lie with the Tigers.)
Despite how much fun it is to watch football, I do cringe when I see the collisions and wonder how any of the players get up after those dramatic hits. Unfortunately, they don’t always get up, and many orthopedic injuries occur.
The same is true for dogs. Even without football, they often injure their paws, knees and hips, and limping is one of the most common clinical problems seen in our office. Let’s look at several of the most frequently encountered orthopedic injuries; the types of injuries, the parts of the legs involved, and the treatment options.
Because they don’t wear shoes the feet of dogs are exposed to all sorts of risks. Pad cuts from metal, glass, and even sharp rocks, though technically not orthopedic injuries, do cause limping and typically bleed profusely. Often a pad cut is discovered when the dog walks across the floor or the patio leaving bloody footprints just like a stamp pad. Because the pad is made of spongy tissue which doesn’t hold sutures well and closing the wound can make infection more likely, treatment usually involves cleaning the wound, bandaging the foot to control the bleeding and protect the open wound, and antibiotics to control infection. The spongy pad tissue can take weeks to heal, and the wounds can remain painful for an extended time. It can be difficult to prevent pad cuts, but removing obviously dangerous debris in the dog’s environment is good common sense.
Toenail injuries are also one of the common injuries of the feet. Dogs often get their nails caught in carpet fibers or between the boards of porches or decks, and the nails can be broken or torn away. Just as a hangnail for us, the injured nail can be easily caught as the pet walks. These are very painful injuries, and the pet will usually resist having the paw examined or cleaned. As with pad wounds, we typically clean the base of the nail (sometimes having to clip close or even completely remove the nail if it is dangling), apply a temporary bandage, and provide pain medicine and antibiotics to prevent infection.
Sprains and strains and bruises of the lower legs are less common, but can be more serious than paw injuries. The bones of the wrist and ankle, properly known in the dog as the carpus and the tarsus, are connected to each other by a complex arrangement of ligaments, designed to allow movement while still providing strong support for the body. These ligaments can be injured while pets are playing in the back yard, running up the stairs, or even jumping down from the sofa. If the ligament damage is severe we will even see the occasional dislocation. The pet is usually in severe pain, and will hold up the affected limb to avoid pressure on the joint. There is often swelling in the joint, and the area is extremely sensitive to touch. Because of the swelling it is often necessary to radiograph (X-Ray) the area to be certain that there is not a fracture. Treatment can be as simple as rest and anti-inflammatory medication, or may require special bandaging or splints. Rarely, surgery is necessary to repair torn ligaments in the lower leg or to permanently fuse a joint if severe ligament damage results in instability.
Knee injuries are the most common serious orthopedic traumatic condition of dogs. The knee (stifle) is the most complex joint in the body. It is designed to provide support for the weight of the body, and to allow the joint to move in two different planes: flexion and extension as well as rotation. The knee, unlike many joints, is not supported by the anatomy of the bones. (The hip, for instance, is a ball and socket joint, in which the femur is surrounded by a ring of bone in the pelvis. The knee, however, has a flat lower leg surface facing a rounded surface of the femur, and is supported only by ligaments, tendons, and other soft-tissue structures.) This arrangement leaves the knee joint especially susceptible to injury. The lifestyle of many of our dogs also tends toward obesity, and this extra strain makes knee ligament injuries more likely. The most common and most serious ligament injury of the knee (for both the dog and the college football player) involves the structure known as the anterior cruciate ligament.
Knee injuries can stretch ligaments or may actually tear them. Regardless of the specific injury, knee damage causes limping, pain, and the affected pet will hold up the leg. Careful palpation of the leg will usually reveal pain and swelling at the knee, and special manipulation can sometimes cause the knee to be moved into abnormal positions. We may need to sedate the pet so that the leg can be relaxed to test the stability of the joint, and take radiographs to evaluate the bones for fractures.
Treatment for knee ligament injuries can range from rest and medication to bandaging and physical therapy to surgery. Small dogs can often respond well to surgical techniques that many general veterinary practitioners can perform. Unfortunately, the type of surgery that many large breed dogs require can be quite intense and expensive. Specialized techniques performed by referral veterinary orthopedic surgeons are often needed for these large breeds.
The benefits of these surgeries include freedom from pain and restoration of function, and the prevention or slowing down of the progression of degenerative arthritis. In order to be most effective, surgery must be done before the instability of the knee has caused damage to the cartilage of the joint, because once that damage has begun arthritis is almost inevitable. We would certainly hope that surgery is not needed, so for some knee ligament injuries that are not obviously complete tears we will try a short course of conservative therapy to see how the pet responds. If bandaging, enforced rest, and anti-inflammatory medication don’t help the pet’s injury heal within a few weeks surgery is then considered.
Aftercare for ligament surgery involves rest, medication, and rehabilitation therapy.
Carefully-prescribed exercise, passive physical therapy, and even sophisticated techniques such as water tank treadmills can help the pet maintain flexibility in the joints and improve muscle tone while the limb heals. The post-op therapy period can last for months.
One specific joint injury that we see occasionally is the dislocation of the hip. Because the hip is well-protected by the surrounding muscles, and because the joint itself has a solid ball-and-socket structure with an internal ligament keeping it in place, it generally takes a severe stress such as a vehicle impact to dislocate the hip. For the same reason, a dislocation often means that the damage is not limited to the joint, with potentially threatening trauma often accompanying the dislocation. As with most orthopedic injuries, the common clinical sign is lameness, with the pet holding up the affected leg. Examination and X-Rays can clearly show the dislocation. Pets must be anesthetized and placed in traction in order to relax the strong hip muscles so that the dislocated bones can be guided back into place. Special bandaging can hold the hip in place while it heals, but sometimes the connecting tissues are so damaged when the dislocation occurs that surgery is needed to allow a return to function.
Very different types of orthopedic injuries in dogs can cause very similar clinical signs: pain, limping, and reluctance to bear weight. This is why it is important to have your pet examined by your veterinarian to obtain an accurate diagnosis and determine the best way to care for the injury. Hopefully it is a minor bump or bruise, but if it is something more serious the best opportunity to avoid permanent disability is to begin the proper therapy as soon as possible.
Even better than treating joint injuries properly is to be able to avoid them altogether. And even though we certainly cannot always prevent injuries, there are a few things you can do to lessen the risks for your pet. First, keep your pet in a lean physical condition. Overweight pets put more stress on their joints, making them more susceptible to injury. Regular and reasonable exercise will also keep the muscles in good tone, protecting the joints. It is also very important to protect your pet from serious joint damage by keeping them at home and out of the street where so many of these injuries occur.
Even though our pets don’t play football, they do commonly hurt themselves on their own “playing field” and a little knowledge can go a long way towards preventing and properly treating these injuries.