The Hidden Causes of Front Leg Pain

The Hidden Causes of Front Leg Pain
By Dr. Ed Mapes
Stonebridge Animal Hospital
McKinney, Tx

Front leg pain and lameness in dogs can be difficult to diagnose and treat. A variety of problems causes the pain, and there are cases that the normal examination procedures, X-rays, and even ultrasound fail to provide a diagnosis.

If a thorough examination of the affected leg doesn’t reveal the source of discomfort, attention should next focus on the neck; ruptured or prolapsed discs in the cervical area can affect nerves emanating from the neck, resulting front leg symptoms. These dogs will often hold their heads still, resisting movement because of the discomfort. They can be seen looking to the side with their eyes while keeping the head immobile. There may also be abnormalities in the eyes that indicated nerve damage.

Regular radiographs usually don’t demonstrate the problem; digital rads have a better chance to give a diagnosis. These patients are often referred to the neurology specialist for myelograms or cat scans. Surgery is often recommended if disc disease or other spinal involvement is found.

Another problem that can be subtle and easily missed during examination is a problem that affects a tendon of the biceps muscle (bicipital tendinopathy). This tendon attaches the upper portion of the muscle to an area on the shoulder blade, or scapula (Figure 1). The tendon runs through a groove at the top of the humerus bone (the intertubercular groove) and attaches to a point at the front of the scapula (supraglenoid tubercle). This tendon can become painful, and is actually the cause of undiagnosed lameness often seen in medium to large breed adult dogs.

There are specific manipulations we do to diagnose bicipital tendinopathy, and these relatively simple tests can isolate the painful responses at the tendon; thus eliminating other causes of the discomfort and confirming the diagnosis

Figure 1:  The biceps tendon

Figure 1: The biceps tendon

 
 
Figure 1 the biceps tendon connects the biceps muscle to the scapula. Several problems cause inflammation and pain involving this tendon, which can be difficult to diagnose (the doctor must be looking for the problem) and causes chronic front leg pain when undiagnosed.

Oral anti-inflammatory medications are almost always ineffective with this disorder. There are several modalities of treatment, but at least 4-6 weeks of exercise restriction – giving the tendon time to heal, is always included in therapy. Routes of therapy can include:
 
 
 

  • Intramuscular injections of Adequan (polysulfated glycosaminoglycan) that is taken up by inflamed joints. It is most commonly used to treat arthritis or feline urinary bladder inflammation, but it has proven to be effective here as well.
  • Intra-articular injections of long-acting cortisosteroids reduce inflammation and pain, and improve the environment for healing.
  • Laser therapy this groundbreaking technology (MLS Harmony Therapy) combines two separate forms of lasers that have different effects on tissue. Pulsed Laser emissions have an immediate effect to control pain, inflammation, and swelling within a short period of time.  Continuous Laser emissions act fast on inflammation, stimulating blood and lymphatic circulation and inducing fast re-absorption of fluids. MLS Therapy combines and synchronizes emission of continuous and pulsed Laser emissions with different infrared wavelengths, so it derives benefits of both forms of laser therapy.
  • Stem cell implantation is a proven modality for treatment of tendons and ligaments, and these cases are ideal for this mode of therapy.
  • Surgically cutting the tendon or placing a screw through the tendon to stabilize it can be effective, but these techniques are usually used if other, less invasive approaches fail to produce adequate results.

If rest and anti-inflammatories do not alleviate the condition, I recommend either Adequan or intra-articular cortisone injections combined with a laser therapy regimen for best results that may avoid the necessity for surgery.

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