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Dr. Kara
Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 16309
Experience:  Over 20 years of experience as a veterinarian.
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Our 2 year old Yorkie keeps walking out of step with her back

Resolved Question:

Our 2 year old Yorkie keeps walking out of step with her back legs, and sometimes carries her right rear leg for a couple of steps. when this happens her whole back end wobbles and her walking speed drops from her usual quick trot to a very slow pace. We have taken her to the local vet who has x-rayed her rear right hip but found nothing wrong, but has offered no alternative. But she obviously has a problem which needs sorting as we do not want her to have worse troubles in later life.
Please Help
Richard Swan
Submitted: 2 years ago.
Category: Vet
Expert:  Dr. Kara replied 2 years ago.
Hello, my name is***** and I have over 20 years of experience as a veterinarian. I'd like to help with your concerns about Pixie's intermittent lameness and carrying her right rear leg for a couple steps.
In a small breed dog with rear leg lameness the two most common reasons are a luxating patella (knee cap that pops in and out of place, or stays out of place) or a condition called Legg-Calve-Perthes disease which is a congenital problem with the growth and maturation of the hip joint.
Legg-Calve-Perthes disease happens when the blood supply to the femoral head is interrupted, resulting in the bone dying. When the blood supply is re-established the femoral head is rebuilt and remodeled, but the head often collapses and reforms in an abnormal fashion creating an irregular fit in the socket part of the joint, the acetabulum. This process of bone cells dying and collapsing followed by new bone growth and remodeling of the femoral head and neck, can lead to stiffness and pain.
This is an inherited disease so dogs that are diagnosed should not be used for breeding.
Some dogs will tolerate the arthritic pain and not limp but suddenly become lame if a piece of the arthritic joint breaks off and floats in the joint, causing acute pain. Some dogs are on and off lame depending upon the type and length of exercise or activity they are involved in.
Diagnosis is by radiographs of the hips. It sounds like that was already done by your veterinarian and that her hips looked fine.
With a patellar luxation the kneecap slides out place rather then staying in the patellar groove. When that occurs the leg cannot bend or flex as it should and the dog becomes lame.
This condition is usually congenital, meaning the puppy is born with the genetics to develop the condition as they grow. It doesn't mean that the pup is affected as soon as they are born however, and in most cases it is a condition that we see develop as the bones, ligaments and tendons that form the knee joint grow and develop or in an older pup that gets arthritic. Not all pups in a litter are necessarily affected.
I recommend your veterinarian can examine her and palpate her knee to see if her kneecap can be displaced. Then, I recommend that they take some radiographs of her knee and determine the severity of her condition. That will tell you whether surgery is needed now or she could benefit from joint supplements such as glucosamine/chondroitins and omega 3 fatty acids or a supplement called Duralactin as well as pain medication. I do think that Pixie is painful because she is carrying her leg when these episodes occur.
If you'd like to read more about pateller luxations here is a link to an excellent article written by the American College of Veterinary Surgeons: http://www.acvs.org/AnimalOwners/HealthConditions/SmallAnimalTopics/MedialPatellarLuxations/
In mild cases of patellar luxation some dogs learn to kick their rear leg and pop the knee cap back into place. I suspect that is what she is able to do now since she isn't always carrying her leg. Over time however because of the constant wear and rubbing of the knee cap moving in and out of place we see secondary arthritis forming. Whether she needs surgery or not now will depend upon how severely she is affected. In most cases the dog does need surgery at some point.
Treatment will depend upon how severely she is affected by her disease.
It may be a simple as medications to control her pain and lessen her arthritis formation or she may need surgery to keep her comfortable.
I would start with medication to see if we can get her relatively comfortable now.
Long term for any joint pain I recommend using a combination of a glucosamine/chondroitin product (examples are Dasuquin or Cosequin) and an omega 3 fatty acid (like 3V Caps or Derm Caps). I recommend an omega 3 fatty acid dose based upon the EPA portion (eicosapentanoic acid) of the supplement as if we do that the rest of the supplement will be properly balanced. Give her 40mg of EPA per kilogram of body weight per day. For example a 5 kilogram dog could take 200mg of EPA per day.
Omega 3's and glucosamine/chondroitins work synergistically and improve cartilage health and joint fluid quality and quantity as well as reducing inflammation. They can take several weeks to see full improvement but some dogs do very well with them alone. They are available over the counter.
Another option is a product called Duralactin. This is an anti-inflammatory product derived from milk proteins and it also has omega 3 fatty acids incorporated into it which can be very helpful. See this link for further information: http://www.duralactin.com/products_canine.htm
If those medications are not enough her veterinarian can prescribe drugs that are more potent. Veterinary drugs we can add include a nonsteroidal like Metacam, Deramaxx, Previcox or Rimadyl. If those aren't enough we can add another drug in the opiod family called Tramadol and/or another drug called Gabapentin.
Finally if this occurred suddenly another possibility is a partial tear of her anterior cruciate ligament in her knee. This ligament crosses the knee and stabilizes the joint. When the ligament tears there is no stability to the knee joint and the dog suddenly becomes leg carrying lame, and when we have a partial tear the dog is often intermittently lame. It can happen suddenly with the smallest slip, especially one that causes a twisting motion to the knee.
Ideally with cruciate ligament injuries surgery would be done to give her knee normal stability because without surgery secondary arthritis formation will occur sooner and to a more severe degree then with surgery. It is also more likely that she will rupture the cruciate ligament in her other knee because she will be putting more stress and strain on the other leg.
Your veterinarian will likely examine her, paying close attention to the ability to manipulate the joint and check "drawer" or forward laxity of the knee. We will often sedate our patients if they are very nervous or painful to check the knee and take radiographs of the knee joint to look for a characteristic change in the location of the fat pad in the knee joint.
If surgery is absolutely not in your budget you can try strict rest. Given her small size that may be fine depending on how painful she is and whether we are able to get her more comfortable with medications and rest. With very strict rest the knee will form scar tissue and gain some stability with time but it won't ever be normal and it will be arthritic. When I say strict rest I mean cage rest, no running, jumping, climbing stairs or playing for at least 6 to 8 weeks. She needs to go outside to eliminate on a leash so she is not overly active.
Surgery or not I also recommend keeping her on the thin side, or weight loss if she is overweight to decrease stress on her knees.
Long term for cruciate injuries I recommend using a combination of a glucosamine/chondroitin product (examples are Dasuquin or Cosequin) and an omega 3 fatty acid (like 3V Caps or Derm Caps). As with the other conditions we are trying to slow arthritis formation.
Best of luck with your pup, please let me know if you have any further questions.
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