ORTHOPAEDIC CONDITIONS

Osteoarthritis is a form of chronic inflammation of the joint surrounding the cartilage. Cartilage is a flexible connective tissue that provides a smooth cushion against impact by coating the surfaces of the bones in the joint with synovial fluid. Osteoarthritis can be characterised by a progressive, permanent deterioration of the cartilage making the joint feel stiff and tender. It is one of the most common degenerative joint diseases mainly affecting the knees, hips, shoulders and elbows.
The condition can present itself either following trauma as a result of an accident, as a birth defect of one of the joints or from any wear and tear on the joints or cartilage. In some dogs the joints such as the kneecap, the elbow or the hip can develop abnormally, this is known as dysplasia. Obesity will also place extra stress or strain on the joints.

Spondylosis is a non-inflammatory, degenerative condition of the spinal column, whereby disks trigger projected bone growths also known as bone spurs to develop, limiting range of movement and flexibility as the bone spurs form a bridge from one vertebra to the next. It is the body’s way of stabilising the joints. The chest, upper vertebrae or the lower back are the areas most commonly affected.

Spondylosis is associated with the ageing process and as such is more common in older dogs. It usually develops due to natural wear and tear incurred over the years although it can also develop as a result of repetitive pressure on the same joints due to a certain exercise or activity. As a result of major trauma, the body will attempt to grow new bone, at this point bone spurs can also form. Dogs with a weakness of the abdominal muscles are very susceptible to this condition as the spinal column will overcompensate, causing increased stress and wear and tear. Dogs that have had multiple pregnancies, previous abdominal surgery including bitches who have been spayed and those with previous or current muscular strains in the trunk area may develop the condition.

Often there are no visible signs symptoms of the disease and it may go undetected for years until the bone growths can be felt along the spine.

A luxating patella is the most common knee joint abnormality in dogs. During the normal extension of the knee the patella (kneecap) glides up and down within the trochlea groove of the femur (thigh bone) that forms the front of the knee. A luxating patella occurs when the patella dislocates (luxates) out of this groove during extension meaning the knee cannot be extended properly. The kneecap can only return back to its normal position once the quadriceps muscles in the hind limb relax and lengthen. The patella most commonly moves inwards of the knee joint, when the quadriceps move in this direction it causes the thigh (femur) and shin (tibia) bones to deform in an outward bow shape.

The groove the patella should be sitting in develops abnormally and the limb deformities worsen. Over time as the patella moves in and out of the groove it will wear holes in the cartilage of the patella and in the ridge that it glides over when it dislocates. This can progress into osteoarthritis and lead to other stresses and strains upon the ligament and muscles within the knee joint.

A dislocated kneecap is usually the result of a genetic abnormality, being most common in toy breeds such as Yorkshire terriers or Chihuahuas, but it can also be the result of a trauma or a repetitive activity. The abnormalities of the bones and muscles of the hind limbs will usually develop early on in life although it can develop later on in some dogs. There a 4 grades to a luxating patella;

• Grade 1 – The patella luxates and returns to normal
• Grade 2 – The patella luxates when the knee is flexed and it remains this way until it is extended and straightened
• Grade 3 – The patella remains luxated for most of the time and although it can be manually replaced it will soon dislocate again
• Grade 4 – The patella remains permanently luxated and misaligned, not sitting in the trochlea groove at all

When the knee is out of its correct position no pain or discomfort will be felt but as it slides out of the ridges of the femur this is when it becomes painful.

Hip dysplasia is one of the most common skeletal diseases occurring when the hip joints develop abnormally. The hip joint should consist of a rounded ball and deep socket which it sits in. In hip dysplasia the socket is too shallow and the ball is often misshapen. The malformation causes uneven contact and loss of stability within the joint leading to deformities and potentially partial dislocation of the hip. Dogs are not born with the condition it is normally seen in large, fast growing and young dogs from the age of 6 months. The disease is considered to be genetic with external factors such as diet, rapid weight gain, obesity or inappropriate exercise putting extra strain on the hip joints determining whether those dogs with the gene will go on to develop the disease. It is usual for both hind limbs of the dog with the gene to be affected.

There are degrees of hip dysplasia ranging from dogs that show no sign of limping or lameness to more severe cases. In the most severe cases all the ligaments of the joint are stretched allowing the ball of the femur to wobble or slip out completely. The cartilage around the joint will degenerate leading to bone rubbing onto bone. Arthritis will set in and over time the hip bone may change shape due to osteoarthritis. In severe cases surgery may be the only option but each case is different and many dogs have a good quality of life without the need for surgery.

Elbow dysplasia is the abnormal development if the elbow joint which is made up of three bones the humerus, radius and ulna. If these bones develop abnormally they will not fit together, the cartilage surrounding the joint will not grow properly and the joint will not function as it should. As with hip dysplasia elbow dysplasia is usually a factor of genetics together with external factors such as growth rate, diet and how active the dog is during its early development. These factors will all determine whether dogs with the gene will go on to develop the condition.  Larger dogs are more susceptible to the disease which have four classifications;

• Fragmented Coronoid process – this is the most common classification, occurring when a small fragment of bone irritates the joint destroying the cartilage which in turn could lead to arthritis
• United Anconeal process – a fragment of bone within the elbow grows separately or becomes detached from the ulna during development
• Osteochondritis Dessicans – a piece of cartilage from the condyle of the humerus bone grows abnormally and as a result is partially or fully detached from the surface of the bone causing pain and inflammation
• Medial Compartment disease – when the bones develop abnormally and do not join together properly the cartilage on both sides or throughout the medial (inside) part of the elbow joint will wear quicker exposing the bone underneath causing the area to be swollen and painful

Dogs suffering with elbow dysplasia will usually be diagnosed in the first few years. In severe cases surgery may be the only option but each case is different and many dogs have a good quality of life without the need for surgery.

There are two cruciate ligaments, the cranial and caudal which are tough, fibrous ligaments connecting the femur (thigh bone) to the tibia (shin bone). The cranial cruciate ligament sits inside the joint with the caudal cruciate ligament forming the shape of a cross, the knee joint (stifle). The purpose of the cruciate ligaments is to hold the knee firmly in place providing stability by preventing the tibia moving forward of the femur and to prevent the stifle from rotating or over extending. When the ligament is damaged or torn it is referred to as a sprain, there are four types;

• Grade 1 – part of the ligament is torn or strained causing internal haemorrhaging. The ligament will still work, although there will be swelling to the stifle and the dog will be in pain
• Grade 2 – the ligament is partially torn or stretched considerably. It will remain connected to the bones but will be unable to function properly leading to a loose and unstable joint. There will be significant swelling and pain in the stifle
• Grade 3 – this is a severe sprain with the worse kind of damage with the ligament being torn or completely severed from the two bones, meaning they are no longer connected. The joint is very unstable, moving and flexing considerably. This will lead to significant pain and swelling in the stifle. Surgery would be required to repair the damage
• Grade 4 – the ligament is completely ruptured and torn away from the bone taking small fragments of bone with it. The dog will be unable to weight bear on the limb as it will be in considerable pain. Surgery would be required to repair the damage

There are a number of causes of cruciate ligament damage, the main cause being long term degeneration. This can be due to general wear and tear, excessive braking during activity, slipping on floors and jumping all causing stress on the joint. Trauma following an accident, obesity and hormonal imbalances can also cause the condition. Some dogs are genetically predisposed to the condition.

Cruciate ligament damage can also lead to the progression of osteoarthritis resulting in permanent lameness and stiffness. As ligaments have a limited blood supply, a lengthy recovery period is required.

If surgery is required, one of the following techniques may be performed:

Tibial Plateau-Levelling Osteotomy (TPLO)

TPLO is a surgery performed on dogs following a cruciate ligament rupture. The section of the tibia connected to the stifle (knee) is cut and rotated and screwed in place to change its angle preventing the femur from sliding down the tibia when the dog weight bears on its stifle. The damaged ligament is removed and after some months, healed tissue will stabilise the stifle. The procedure basically alters the mechanical forces upon the stifle making the cruciate ligament unnecessary. Following TPLO surgery recovery is fairly quick taking around 2 to 3 months, although the dog should be able to weight bear and walk after a few weeks. In some cases of TPLO the limb has functioned better as bone heals more efficiently than ligaments and there are signs that osteoarthritis progresses at a much slower rate.

Cranial cruciate ligament surgery CCL

CCL is the most conventional surgery performed for a cruciate ligament rupture, replacing the damaged or torn ligament with an artificial ligament or graft. This type of surgery is not always successful in larger dogs with degenerative ruptures, being unable to provide long term strength or stability. Most cruciate ligament injuries are caused by degenerative wear and tear or through lots of twisting and sudden stopping associated with certain exercises or activities. The femur slips down the front of the tibia trapping the ligaments behind the patella (kneecap)

Benefits of post-surgery massage

Broken bones can be caused by any trauma or injury, such as a car accident, a heavy impact or the dog could have brittle bones. Conditions such as cancer can also cause a dog’s bones to break or fracture. There are a variety of bone fractures from a hairline crack to a complete break:

• A closed Fracture is the most common, with the bone breaking but remaining intact in the skin although there may be damage to the surrounding tissue
• An open (compound) fracture is more complicated in that part of the bone may be protruding through the skin. As this is an open wound with external bleeding, emergency surgery is required to prevent injury
• A transverse fracture occurs when a bone breaks in a horizontal line
• A spiral fracture occurs as a result of a twist of the affected area whereby the fracture extends down the axis of the bone in a spiral pattern. This type of fracture will usually be treated with a splint or a cast
• A comminuted fracture occurs when the bone breaks into many pieces as a result of great force maybe from a road traffic collision. This fracture will take longer to heal as there are so many fragments of bone. With this type of fracture the dog will be unable to weight bear and the limb may dangle and appear swollen. Surgery is required due to the amount of shattered fragments which cannot be healed with a cast.
• An impact (buckled) fracture occurs when two bones are forced into each other buckling due to the impact. The area will appear shorter following this type of fracture
• A greenstick fracture gets its name from the similarities to how the branch of a tree is bent and breaks but remains attached to the tree. A slight crack can be seen in the bone. This type of fracture usually occurs in young dogs with elastic bones which could result in the shortening of the affected limb potentially leading to a deformity. Pain will develop as a result of this injury.
• An oblique fracture occurs when the breakage runs diagonally along the axis of the bone causing a slanted fracture, curved in shape.

Benefits of massage

Massage should never be performed directly on or around the affected area following surgery.

Endochondral ossification is the normal process by which the bones develop in a majority of cartilage whilst in the foetus. Osteochondrosis is a term used which refers to the abnormal development of the cartilage at the end of a bone in a joint. When the diseased cartilage becomes inflamed and separates from the bone the resulting condition is referred to as Osteochondritis Dessicans. The excessive cartilage is absorbed and the process of endochondral ossification stops although the cartilage still continues to grow which results on thick areas of cartilage that is not very strong unlike bone which is dense and strong. Over a period of time part of the cartilage can separate from the bone which creates a flap which can irritate the joint and its surrounding tissue. The disease is most commonly found in the shoulder joint although it also affects the stifle (knee) elbow or hip.

Osteochondritis Dessicans commonly occurs in medium to large breeds usually between the ages of 6 to 9 months. It is thought that if a dog grows too rapidly the cartilage can outstrip its own blood supply which leads to abnormal development of the cartilage. It is believed that deficiencies in diet can also lead to the disease as can an excessive level of calcium.