How do vets diagnose tendon/ligament injuries

PoopyDog

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#1
Hi, i am new here... well signed up a while back but only returning and posting today! :eek:

This may sound like a strange question, but how are tendon, ligament or muscle injuries diagnosed by a vet normally? My girl has a persistent limp in her front leg, we have had 3 opinions, 2 sets of x-rays and the last vet says it is a tendon or ligament problem in her foot/ankle. But these don't show on the x-ray and really what the problem is, is just a guess and the treatments up to now seem to be trial and error and not working. All that has been done for sure is eliminate what it is not.

So, I am going to look for a 4th opinion, or go back to the last vet... but want to be able to ask specifically for the test if the office has the necessary equipment or what i should be expecting... if that makes sense.

Thanks
 

garett

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#2
The best way to diagnose it is by trial and error. To rule out what it is not first.

A pretty good indicator of whether there may or may not be a problem has to do with range of motion. Vets will move / rotate / manipulate areas to get a better feel of what the problem is. Then they will have them walk and observe them to see if it can give them any more clues as to the nature of the injury.

The reason the vets are saying it may be a tendon or ligament problem is because the X-rays are not showing any structural damage to the bones. Everything should be working normally, unless there is soft tissue trauma / tendon / ligament damage.

Having worked for a Veterinarian that specialized in TPLO's and other soft tissue injuries that required surgery, I can confidently say that we were never 100% sure exactly what to expect once we opened them up.

The standard procedure is trial and error, and I am not aware of any definitive tests that would provide you with immediate answers.
 

garett

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The problem with ultrasound is that there is a very steep learning curve. They would need to perform and interpret 50 or so odd ultrasounds a day to be good at what they do, and even then I've seen ultrasound specialists fail to even correctly count the number of puppies a bitch is carrying.

You really need to find someone that is excellent with ultrasound.

The vet would need to call in a specialist that deals only with ultrasounds to get a better idea of what you are dealing with, but even then I'm not so sure if it would be definitive. Everything is still left up to interpretation.

It might be worth it in your case, but I'm not quite sure if it would work for the region you would be targeting.
 

ACooper

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#5
Can you tell us a little more about your girl?

How old is she?

When did these problems start?

Was there an injury at some point and the limp has never went away?

Is it always limping on the same leg?

There are many, many, members here who might have been through the same thing you are going through and be able to make suggestions on where to look/what to do at the vet.

Oh, and WELCOME :)
 

adojrts

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#6
If it were me I would one or all of the these options.

1- seek a vet that is also a chiropractor.
2- go to a Vet University
3- go to a race horse vet, they'll do an ultrasound and probably know what they are looking at.

If you have done x-rays and nothing is showing, pin pointing a lameness shouldn't be all that hard but sadly so many vets can't see it.
Try this, run you hands under cold water, pat them dry and then slowly run them over the limb, you should be able to find the heat. Heat = problem area.
Also compare it to the other leg and go back and forth between the two areas.

The days are quickly coming with more and more vets that are specializing in sport dogs and lameness. I have two vets, one is for regular work and the other one is far away that specializes in lameness for sport dogs, bonus that she is also a chiropractor and can do acupuncture too.
 

PoopyDog

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#7
Thank you for your replies and welcome.  I was thinking ultrasound too but my vet does not have one. *** I just read this before posting and realized it is really really long! Thank you to anyone who gets through it***

So… a bit of back ground. She is about 2.5 years old, best guess lab/Doberman cross. I got her as a stray and the vet estimated she was 4 months. She was skinny and scared but a lovely girl. Anyway in about May this year (at around 2 years old) I noticed that after a walk or when she was tired she would start to limp slightly on her right front leg. It would go away after resting. I don’t have a yard and so we walk frequently and I always keep a very close eye on her. At no time do I remember her injuring herself so that she would cry out, although when playing with her doggie friends she does play very rough and tumble. I also did not see any swelling on her leg at any time and when I touch it and feel around there was no place that would cause her to react to my touch.

I took her to the vets and he did an x-ray. The x-ray showed a slight line in the bone about 2 inches below her elbow. He suspected that this was a small crack, gave me an anti-inflammatory/painkiller liquid medicine and ordered 3-4 weeks rest. We rested and the limp went away, however as soon as I started to reduce and eliminate the liquid medicine the limp returned (still on light exercise) and in fact from then until now she limps constantly and always the same leg. She still puts her weight on it, wants to run, play. Have seen no change in energy level and otherwise shows no signs of ill health.

I became frustrated with that vet as when I went back for follow up after the limp returned he did another x-ray. There was no sign of a crack and he asked me where it was, I said can’t we look at the old film but apparently he only keeps them a couple weeks and throws them out! I should mention I live in Spain, in a rural area, I am actually Canadian so know that things are done very very different here!

So, I was annoyed. Went to a new vet (excellent) who did a full series of x-rays on both front legs to check all joints and bones. Everything comes up clear. Her joints are good, no sign of trouble. He has manipulated and examined the leg in detail and has determined it is in the ankle area (not sure the correct word on a dog). He has instructed me to walk her on the beach on the soft sand, let her swim when possible (I don’t have a pool, there aren’t any lakes and she doesn’t like the sea). He has also given me an anti-inflammatory cream that is for humans to put on the area 3 times/day. The 2 problems I have with the cream - the smell is very strong and she pitches a fit and it is toxic/poisonous to ingest so I have to watch her to make sure there is no licking. It is a nightmare and I am lucky to get the cream on more then once per day – I have to work and sleep and the slightest whiff and she retreats to her crate - so the amount of ‘watching’ time is limited.

I understand that there is some trial and error to this as obviously she cannot tell me what she feels, but I am seeing no improvement at all and really we don’t know what the actual problem is other then he says it is ligament or tendon problem. Hence me wondering how an actual accurate diagnosis can be achieved.

The Vet university suggestion is a good one. I have done a quick search and the closest one to me is about a 6 hour drive away. I will do a bit more research and try and find a vet with an ultrasound or any that also do chiropractor or acupuncture

So, this ended up being ridiculously long and I apologize – as it is also a bit of a rant… I appreciate any suggestions. We had started agility at the beginning of the year but obviously until this is sorted out that is on hold. I just want my girl healthy again!
 

BostonBanker

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#8
go to a race horse vet, they'll do an ultrasound and probably know what they are looking at.
I'm thinking this might be a good idea - it seems that horse lameness vets are quite a ways ahead of the dog vets. Another idea would be to try to find one who can do the scan for heat. I think it is thermography? With horses, they can do a whole body scan and find any sources of heat (and thus inflammation) in the body.
 

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