Case Reports

Cassie - Immune Mediated Polyarthritis

Polly - Bilateral hind limb amputation

Claudia Perkowski

University of Illinois Urbana-Champaign

College of Veterinary Medicine (Class of 2022)

 

Patient Name: Polly

Signalment: 2 year old, spayed female, Jack Russell Terrier Mix

Polly

Clinical Problems:

Bilateral hind limb amputation distal to the hocks

 

Severe bilateral hind limb lameness (Grade 3-4/5) -especially painful after exercising (1-2/4 CSU)

 

Significantly reduced bilateral hock flexion with joints easily hyperextending due to the lack of tendons restricting that movement

 

Increased bilateral carpal extension

 

Decreased left stifle flexion and decreased right stifle extension

 

Restricted movement in mid-thoracic and lumbar spinal motion units

 

Mild myofascial back pain from T8-S3

 

Moderate thigh muscle atrophy with mild-to-moderate paraspinal muscle atrophy

 

Overweight (BCS: 6/9)

 

Rehabilitation Goals:

To have Polly’s hind limbs fitted for veterinary-orthotic prosthetics (V-OP) to improve her mobility. In the meantime, her wheelchair must be adjusted to a proper height for better ambulation. Reduce pain score from 1-2/4 to 1/4. Reduce thigh muscle atrophy from moderate to mild-to-moderate, ultimately aiming for bilateral muscle symmetry in both thighs. Increase hip extension with massage exercises. Strengthen core musculature and improve body awareness using proprioception re-education. Promote weight loss.

 

Modalities Used in Rehabilitation:

VSMT: T8P, L2P, pelvic traction, and TMJ traction

Assisi Loop

Homework exercises

 

Assessment:

Polly initially presented to Pawsitive Steps Rehabilitation and Sports Medicine after undergoing bilateral hind limb amputation due to severe degloving injuries while in the care of her previous owner. Due to her altered hindlimb conformation, Polly demonstrates severe bilateral hindlimb lameness that worsens with increased activity. Polly’s posture is kyphotic with a variable hindlimb stance, as she avoids placing weight on her stumps and prefers to sit off on a hip because she is unable to sit squarely. There is restricted movement in her stifles, mid-thoracic to lumbar spine, and hock flexion -likely contributing to her already limited ambulation. It was noted that the unequal hindlimb bone lengths and easily hyperextending hocks will prove to be a challenge in designing V-OP devices. Polly’s new owners have elected to have her fitted for V-OP devices to improve her mobility, lessen strain on her body, and reduce pain.

 

Homework:

1. Cookie Side Bends, hold for 5 seconds

  • 5 times twice daily

2. Proper Sit

  • 3 times twice daily

3. Belly Rubs for Hip Extension

4. Massage for 5-10 minutes

  • Back
  • Front limbs
  • Hind limbs

 

Plan:

In order to reach and maintain weight loss goals, reduce total food volume by 25% and avoid feeding table scraps to Polly.

 

Supplement with Omega Benefits from Veterinarian Recommended Solutions to support joint, skin, and brain health. Also supplement with Dasuquin Advanced from Nutramax to support joint health.

 

Begin basic massage and core strengthening exercises as part of the homework

 

Once the V-OP devices are created, Polly will require at least three follow-up visits to ensure the devices are fitting correctly and comfortably. Oftentimes these visits may warrant additional therapeutic exercises and/or modalities.

 

Polly will benefit from routine VSMT to maintain mobility and comfort

Polly

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