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Ask Dr. Michael Salkin Your Own Question

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 24424
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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We have a 4.5 year old Samoyed dog who has been very healthy.

Customer Question

We have a 4.5 year old Samoyed dog who has been very healthy.
About 2-3 months ago after a walk and rest he started to limp on his right front. After a few steps he walked it off. The following mornings he would be fine and the process would start again. He would be completely rested for 3-4 days, be fine a couple of days, then start the limping process again. He did start to limp on a walk after urinating and scratching up the ground.
Our vet diagnosed 'canine equivalent of tennis elbow', which if I am correct is elbow dysplasia. That is not prevalent in Samoyeds, and while he has not been tested for it, 2 of his litter sisters are 0:0. The vet was advocating CT scan and surgery; which may or may not find the problem.
Before even considering that, we sought alternative therapy and have taken him to a massage therapist who found he had stiffness around his right shoulder and elbow, specifically of the triceps tendon and biceps brachii muscle, with associated tightness to the pectoral muscle. He also had a more chronic stiffness to the trapezius, and deeper neck muscles on his right side.
Following on from her suggestion we visited a canine chiropractor with him a few weeks later who found a trapped sciatic nerve, and trapped nerves in the neck on the right side. After rest and lead walks, building up walk time with short off lead time, a week later he started to limp again after rest.
Back to a canine chiropractor (closer to us), who found trapped nerves in the neck, the lumbar and pelvis area out of alignment on the the left side (compensation for right side pain and limp). These were relieved, short lead exercise and a visit 10 days later showed all was well, but for a little tightness in the back muscles. He was released.
All was well for almost 2 weeks. He has been lead walked - on harness - approximately a 1-1.5 miles 2x a day and allowed 5 mins per walk off.
He has not been allowed to run wild, jump, or engage in play fighting with other dogs during this time.
However, he has now started the limping again.
Frankly at this point we don't know what our next move should be. Our vet is predisposed to his diagnosis, simply because the wussy boy yelped when the vet bent his leg up, under, up and out at a painful angle. (I would have yelped too given the angle.) He is also dismissive of the alternative therapies.
I should mention that the three who have had hands on him, massage therapist, and 2 canine chiropractors, believe we are dealing with soft tissue.
I would appreciate some thoughts and guidance as to what should be our next move.
Surgery is a scary thing if it's not going to produce and answer, and possibly leave our boy permanently lame.
The boy is on YuMove and Manganese with no other medication.
Thank you.
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Michael Salkin replied 1 year ago.
Aloha! You're speaking to Dr. Michael Salkin
I'm sorry that your question wasn't answered in a timely manner. Can you tell me, please, if "tennis elbow" were diagnosed based upon physical exam only or were there changes in the bones composing the elbow in X-rays? If there were no bony changes I would be more inclined to suspect an injury to the ligaments, joint capsule, or tendons of the shoulder. These injuries are fairly common in canine orthopedics but tend to be underdiagnosed.
Consultation with a specialist veterinary orthopedic surgeon should be considered. Please see here: http://vetspecialists.co.uk/clinical_services/orthopaedics_service.html and here: http://www.rvc.ac.uk/small-animal-referrals/orthopaedic
Customer: replied 1 year ago.

Hello Dr Salkin,

Steiff was only physically examined, i.e. hand felt and manipulated. On the day of the examination Steiff had become lame whilst on the walk. He was very lame during the course of the day showing no desire to use the leg, or walk the pain off. Of course that changed when at the vet office, (he wanted out of there) but he certainly was lame.

The vet immediately started to discuss performing CT scans and surgery after giving him a week on anti-inflammatory medication. X-rays were never mentioned.

By the next morning all trace of the limp was gone. My husband and I decided to try alternative therapy following on from the vet's suggestion of possible hydrotherapy. (Steiff hates water and it would stress him beyond all senses.) After 5 days of rest, and a few short lead walks, he saw the massage therapist. Following her advice, a week of short lead walks, with increasing the length every third day, and allowing 5 minutes off lead 2x a day, all progressed well until about a week and a half in. The limp would return after a walk and rest period.

Steiff has always been a full on boy. He did a lot of trotting and cantering, a bit of free running, and is quite exuberant. His gait has always been very free and easy, very ground eating and effortless. Prior to this he was fit for purpose. He has been hip scored and they are good (not that has a bearing on what is going on in the front.) He is well muscled and fit - except for this that suddenly cropped up and now seems to be ongoing.

Would you advise x-rays prior to asking to be referred?

Expert:  Dr. Michael Salkin replied 1 year ago.
Thank you for the additional information. By all means X-rays are indicated and I would X-ray each joint of that leg - shoulder, elbow, and carpus. If no bony changes were seen, careful attention to possible mineralization of the ligament(s) associated with the shoulder in the X-rays and careful palpation and manipulation of the shoulder for "rotator cuff" injury should be performed. Many local vets aren't familiar with the manipulation techniques necessary to detect rotator cuff injury; hence, my recommendation to have a specialist veterinary orthopedic surgeon involved.
Please continue our conversation if you wish.

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