Underlying causes of lameness in dogs

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08 April 2021
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Lameness in dogs can often go unnoticed by owners, or requires some real veterinary detective work to discover the underlying cause, as Vicky Payne reveals.

During the first COVID-19 lockdown, veterinary practices were asked to treat only urgent and emergency cases. Then we were struggling to make enough appointments available for all the routine work we needed to catch up on. Our clients, overall, were very good about this, but it means that now we are seeing lots of dogs with niggling illnesses that have been going on for many months.

Acute lameness usually has an obvious cause. I can’t count the times an owner has come in worried that their dog has a serious injury only for me to discover a broken nail. I always start my examination at the foot, checking carefully for sore areas in and between the pads and damage to the nails. We saw a lot of broken nails as we came out of the first lockdown as people hadn’t been able to get their dogs a nail trim! 

Next, I work up the leg feeling for any areas that are warm or swollen, before manipulating all the joints. If the cause is not obvious, I usually suggest rest and maybe some painkillers because most minor injuries will heal this way, leaving just the complicated ones to work up.

When checking for the causes of lameness, it makes sense to start with the foot first.

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Rest and Painkillers

One such case was Bertie the Shih Tzu. His owner felt he just wasn’t quite right, but due to her worries over coronavirus she had already tried the sensible approach of rest and a week of dog painkillers. When she walked him around the car park, Bertie looked stiff all over, taking short strides rather than limping. Bertie is a very stoic little dog so I had to watch incredibly closely for any reaction as I examined him; just a slight raising of his eyebrows as I palpated his lower back, and the same in his right neck muscles. Despite some scepticism from his owner, Bertie responded well to acupuncture and a supplement to support muscle health.

A similar confusing case was Fancy the French Bulldog. The first time she came in unable to jump up, she had a very sore neck. This got better with painkillers and some diazepam to relax the muscles. But a couple of weeks later she was back, unable to jump up again. This time her neck seemed fine but her back was sore and one back leg responded sluggishly to my tests. We discussed the options. As Fancy is a young dog, I thought it was unlikely that anything would show up on plain X-rays, but as an active French Bulldog the chance of a spinal disc problem was quite high. Fancy was referred for an MRI scan, which did show a disc problem. For now, her owners are trying a conservative approach, but they know surgery might be needed if her condition gets worse.

Elbow dysplasia

Sometimes I see chronic lameness cases where the owner hasn’t noticed a problem. The classic would be a dog with bilateral elbow dysplasia. When I see a Labrador sitting with elbows turned out from the body, alarm bells start to ring. In mild cases the dog will avoid pain by turning the elbows out. He may limp a bit, but if both legs are affected this is hard to spot. Careful manipulation of the elbow causes pain, which makes most dogs with elbow dysplasia jump or bark. Elbow disease can cause subtle changes on X-rays so, where a client can afford it, CT scans are recommended. Luckily, when a friend brought her spaniel in for investigation of chronic forelimb lameness recently, elbow dysplasia and humeral intracondylar fissure had been ruled out by CT scans. So why was she still lame? I went back to my careful examination and found something that is easy to miss, a triceps injury. Once found, these injuries respond well to acupuncture. Bessie continues to do well with controlled exercise, careful stretching by her owner, and a supplement for joint and muscle support.

Elbow dysplasia most commonly affects medium to large breed dogs such as Labradors.

Causes of Lameness

Another hidden cause of lameness I am always on the lookout for is iliopsoas strain. This muscle rotates and flexes the hip and can be damaged when dogs leap or accelerate quickly. The lameness often looks like hip joint pain, and although it responds to rest, is aggravated again when the dog starts to exercise. Diagnosis is made by ruling out hip dysplasia and spinal arthritis with X-rays, as well as good history taking. Recovery can take six to eight weeks and requires medications to relieve pain and relax muscles, as well as careful exercise at home. The muscle is impossible to reach with acupuncture needles, but I find our practice’s class 4 laser good for this injury.

My ‘take-home’ from this month is don’t ignore chronic mild lameness. The cause may not be obvious at first and you may need to visit a referral centre for advanced imaging, or a vet with experience in musculoskeletal problems to get to the bottom of the pain.

 DID YOU KNOW 

Symptoms of elbow dysplasia can often be managed with exercise and weight control, physiotherapy, and pain relief. Some dogs also benefit from surgery.

Remember that even if your dog’s lameness seems minor, if it persists it is important to take him to the vet’s; some dogs are very good at hiding pain from their owners.