Thursday, July 26, 2012

Lexi's Injury: In Detail

Caution: This is a long, detailed post about Lexi's injury.  It's likely quite boring to everyone (including me).  I plan to use it as a reference in case it's needed in the weeks/months to come.

Does she look pathetic, or what?!

The whole story…

I want to write everything down so that in the follow up appointments (crossing my fingers that there aren’t any!) that I have a good record of exactly what happened.

Two weeks ago in class I made a poorly timed rear cross and Lexi slipped while turning to her right.  Her left rear leg went out from under her and she immediately lifted it up—non weight bearing.  I picked her up and put her in the car.  Went back to check on her a few minutes later and she set had set her foot down.  When we opened the crate she walked out—no more limping. 

We put her on crate rest for two days.  No walks, no jumping, no running.  She seemed fine (incredibly bored) so we started taking her for short walks to see how she’d do and she had no trouble.  Walks were increased, though we kept her from running, chasing or any agility for the entire week. 

The following week we took her to class and decided to see how she would do.  She was tugging like crazy (pushing off her back legs like she always does) so we decided to jump her at 12” just to keep an eye on things.  The first sequence she did great.  She was running at her usual speed, turning like normal, etc…The sequence included the dogwalk as well.  The second sequence was much more difficult.   Again, I placed a last minute rear cross (this time turning to the left) and she immediately slipped and came up lame on the same leg holding it up in the same way.  We put her right in the car (where she set the leg down) and we left.  45 minutes later we got home and she walked around outside with no more limp.

The following morning we went to see the orthopedic vet.  After the physical exam the vet found nothing.  A very slight movement in the left patella (slightly luxating) but was not able to manually displace it.  Several months ago our veterinary chiropractor remarked the same thing—that she was able to move the patella just slightly, but not much.  We then took her to a vet familiar with agility who confirmed the same sentiment—slight movement but not even a grade I.

Lexi showed no discomfort on the physical exam though she did show slight hesitation when he tried to move her patella on both knees. The vet commented that this is likely uncomfortable for all dogs, so not necessarily an important indicator.  There was also no inflammation or heat coming from anywhere.  The vet mentioned that her hocks were very stable.

He then attempted to get her to run (to try to recreate the limp to examine exactly at the time of injury) but she was too worried about the environment to run.  I was a bit surprised that she wouldn’t run for him, but he had her in the small exercise area out back with other dogs and she was more interested in sniffing the ground.  The vet student did mention that she jogged a bit and limped slightly—but the resident we spoke to did not confirm this.  He only said that they brought her back and both he and the orthopedic specialist re-examined her and found nothing.  Again, neither were able to luxate her patella at this time.

I did ask the resident if he thought it would be helpful to take an x-ray.  He said that he was happy to do it, but did not think it was necessary at this time.  He said that x-rays are more often used to confirm a diagnosis, and in Lexi’s case—there was no diagnosis other than muscle injury/soreness.  He said that an issue with the patella would be difficult to see on an x-ray because she is at rest, and based on her physical examination there is nothing wrong with her while at rest—only exercise induced (and specific exercise at that).

I specifically asked about a CCL or ACL injury and he said definitely not—that all of that was stable and good.  That’s a big relief.  I also called him back to ask if they had checked for luxation of the superficial digital flexor tendon and he said that they had.  He said that she would have shown pain or heat on manipulation in that area and she did not.  He said that it was possible that it was tendonitis of some kind, but the prescription for that would be exactly what he recommended to us at this point.

His conclusion was to recommend a month of limited exercise (walking on leash only) because she is so active.  He hopes that with a re-introduction of exercise and sport that she will be fine, but admitted that we could be seeing them again in a month for the exact same symptoms.

I honestly am at a loss.  Some people have suggested a second opinion, but honestly these are some of the leading veterinarians in the field of orthopedics (this is at Ohio State’s facility).  I am not even sure what the next step would be. 

Part of me thinks it’s something other than muscle injury/soreness.  I feel like that would present differently—possibly limping every time she is exercised.  But I also know from Bentley’s injury that that isn’t the case.  He has (had?) a confirmed muscle injury, but we only saw him limp on 2 occasions.  I guess it’s possible that the muscle could only tweak when she turns a certain way (a rear cross would indicate maybe her head is turned looking at me while her body is turning the other way, and her leg slipped causing the twinge of pain).

Another part of me thinks that the luxating patella fits.  A luxating patella fits because it’s said that it is only painful as it luxates over the bony ridge.  Once it is displaced (or replaced) it is no longer painful.  Dogs often present by immediate limping, and a low grade luxation will just pop right back into place and the dogs are good to go again, which fits 100% with her limping symptoms.  But, the fact the 4 vets could not manually luxate the patella doesn’t fit.  Even the lowest grade definition of a luxating patella reads “the kneecap can be moved out of place manually but will fall back into its natural position once the manipulator lets go”.  That doesn’t fit at all since no one can manually displace her kneecap.  And only a grade II luxating patella could potentially require surgery, and that’s defined “kneecap does not move back to its normal position when the manipulator lets go” and that definitely doesn’t fit.

I wish I had insisted that we get Lexi moving, running and turning to try to recreate the injury/limp.  Now we are sitting on a month of crate rest with no definite diagnosis.

But, I feel like right now there is no other option we can take.  I don’t think a second opinion would help, and we’re already seeing the best vets around (and several of them, at that!)  We have a re-check scheduled for the first week in September.  I’m hoping that that will give us one week to get her back into exercising and we can see if there’s any residual limp or any issues.  If not, we’ll cancel the appointment.  If so, we’re back to square one which means x-rays, possibly MRI, and any other diagnostic test we can think of.


  1. I dont think of luxating patella. They usually dont go non-weight bearing. They usually toe touch. And if it was , the vet would able to move it. I think Muscle injury. And as you probably know, the muscle only hurts when its exteneded a certain way unless its torn. But if it was torn there would have been swelling. So rest is the cure. I think Ive told you before, Miley's iliospoas injury, no agility for 6 months. If its a muscle injury, one month of rest wont do it and she will re injury it very easily. I wouldnt see an ortho vet for this. They usually cant dx it. (Sorry but its true. when the world team takes a vet with them its a rehab vet not an othro vet) I would go to a rehab vet. They are much better at dx and treating it. Laser and ultrasound work great on helping with healing.
    If you feel you need to do an MRI, I would come down here and see Dr. Gillis and let her Ultrasound it. Much cheaper and she can see right then and there what is going on. She does lots of agility dogs.
    I know this all just sucks. Esp. when things were really starting to come together. Sorry about that. But it will get better and you will run again.

  2. I agree with Diana, she gave me the same advice years ago, go see a rehab vet. Laser and accupuncture, PT and UWT worked really well for Oreo's injuries. It makes you feel better too, because at least you're doing something besides "rest".

    So sorry. Injuries suck.

  3. Thankfully I haven't needed a rehab vet but I totally trust Diana and Sara and agree with what they say. I'm sorry about Lexi's injury and hope you get answers and that she heals quickly!

  4. Diana has very good points, we don't have a rehab vet here but I now believe in acupuncture. Lexi's case is very similar to my Sonic and someone suggested that is patella as well but there is no confirm diagnosis. It is frustrating for you and Lexi. Finger crossed something work out for you.