Ask The Vet: Long Term Limp
Question:
My mom has a pitbull that is 11 years old. 3 weeks ago he started limping and trying to avoid walking on his right front paw. When he is standing still, he curls the toes under instead of standing normally on the pads. When he pushes down, while walking that is when the limp occurs. The vet gave him anti inflammatory pills which he takes every other day. The vet really doesnt want to deal with him, cause he hates being touched and inspected he completely freaks out. I wrapped the wrist in a ace bandage two days ago and within three hours the entire paw swelled up. He now has been walking mainly on three paws. What are the options for injury? Sprain wrist, displaced wrist, can toes of a dog break. I cant find a specific area of swelling, I searched throughtout the paw and I dont see any infection like something got stuck in the paw? The vet doesnt want to deal with x rays. Can you lead me in some directions of what the injury may be, or what we should really do.
Answer:
Sounds like a problem! First, don't wrap the leg ---it is very common for owner-applied (and sometimes vet-applied) bandages to compromise the circulation and cause a swollen foot. Plus you don't know whether there is an injury, much less where it is, so where's the right place to wrap? Dogs have 4 legs, they only really need 3 to walk around (somehow we make do with 2, to their constant amazement). If the leg bugs him enough he'd just stop using it.
The first question is whether the problem is musculoskeletal or neurologic. Standing knuckled over like that can be a sign of neurologic disfunction, which could be from a peripheral nerve injury or a spinal injury (like a bulging disc above the 3rd thoracic, though usually it would affect both legs). If it isn't neurologic, it could be a pulled muscle or a tendon injury, less likely ligamentous in the front leg, or possibly an injured joint (shoulder, elbow, wrist, foot, toes).
Also, given the age of the dog, it could also be some sort of tumor affecting the nerves or muscles in the leg or, less likely, in the spinal cord.
I'm pretty limited in distance-diagnosis, so I can't do much more than tell you all the assorted things it might be. If it's just musculoskeletal, he'd be painful somewhere, and if he's better with you or your mom than he is with the vet, you can try working his assorted joints each through their normal range of motion (one joint at a time without moving the other joints); if you find an injured one he should resist and tell you if it hurts. Try it out on the uninjured leg first.
I don't know what kind of anti-inflammatories your vet gave you ---NSAIDs, like rimadyl, etogesic, metacam, deramaxx, aspirin... or corticosteroids, like prednisone, prednisolone, or dexamethasone. NSAIDs have anti-inflammatory and pain-killing effects, while corticosteroids are anti-inflammatory but have no pain reduction effects, and can temporarily reduce the size of tumors as well. Musculoskeletal issues generally improve with NSAIDs and a bit of tincture of time, but neurologic and cancer related issues wouldn't really respond. If he's on corticosteroids and improves, we don't know if it's inflammatory, cancer, or neurologic (problems with slipped discs and "pinched" spinal nerves have an inflammatory component, and can respond to corticosteroid treatment).
3 weeks is time enough for a muscular injury to be improving, assuming you've been keeping him from running around and reinjuring himself. It's also enough time that a foreign body would have created an obvious infection, in the absence of antibiotic treatment. A fracture somewhere would be still causing problems, but fractures are pretty painful, and a dog doesn't tend to knuckle over with a fracture, they usually try to pick up the foot and keep it off the ground. So if things aren't getting better, given the length of time this has been going on and the age of the dog, I think it would be a good idea to get a bit more aggressive about finding a diagnosis. The dog will have to be sedated, probably anesthetized for the exam, and it would probably be a good idea to do radiographs, but if we can't isolate an area of sensitivity, that's a bunch of films to look at the whole leg and the neck/upper thorax. But sometimes once the dog is down, we can find out a lot just by palpating. If there's a lump somewhere, get at least a fine needle aspirate, or better still, a biopsy (FNAs don't always give an answer, and biopsies generally do... since it's so hard to examine the dog, don't mess around, make sure you get enough the first time to get an answer.).
Good luck!
Have a question for the Veterinarian? Use our Ask The Vet Form here.
This post was generously contributed by Dr. Stanley of House Call Of The Wild.
My mom has a pitbull that is 11 years old. 3 weeks ago he started limping and trying to avoid walking on his right front paw. When he is standing still, he curls the toes under instead of standing normally on the pads. When he pushes down, while walking that is when the limp occurs. The vet gave him anti inflammatory pills which he takes every other day. The vet really doesnt want to deal with him, cause he hates being touched and inspected he completely freaks out. I wrapped the wrist in a ace bandage two days ago and within three hours the entire paw swelled up. He now has been walking mainly on three paws. What are the options for injury? Sprain wrist, displaced wrist, can toes of a dog break. I cant find a specific area of swelling, I searched throughtout the paw and I dont see any infection like something got stuck in the paw? The vet doesnt want to deal with x rays. Can you lead me in some directions of what the injury may be, or what we should really do.
Answer:
Sounds like a problem! First, don't wrap the leg ---it is very common for owner-applied (and sometimes vet-applied) bandages to compromise the circulation and cause a swollen foot. Plus you don't know whether there is an injury, much less where it is, so where's the right place to wrap? Dogs have 4 legs, they only really need 3 to walk around (somehow we make do with 2, to their constant amazement). If the leg bugs him enough he'd just stop using it.
The first question is whether the problem is musculoskeletal or neurologic. Standing knuckled over like that can be a sign of neurologic disfunction, which could be from a peripheral nerve injury or a spinal injury (like a bulging disc above the 3rd thoracic, though usually it would affect both legs). If it isn't neurologic, it could be a pulled muscle or a tendon injury, less likely ligamentous in the front leg, or possibly an injured joint (shoulder, elbow, wrist, foot, toes).
Also, given the age of the dog, it could also be some sort of tumor affecting the nerves or muscles in the leg or, less likely, in the spinal cord.
I'm pretty limited in distance-diagnosis, so I can't do much more than tell you all the assorted things it might be. If it's just musculoskeletal, he'd be painful somewhere, and if he's better with you or your mom than he is with the vet, you can try working his assorted joints each through their normal range of motion (one joint at a time without moving the other joints); if you find an injured one he should resist and tell you if it hurts. Try it out on the uninjured leg first.
I don't know what kind of anti-inflammatories your vet gave you ---NSAIDs, like rimadyl, etogesic, metacam, deramaxx, aspirin... or corticosteroids, like prednisone, prednisolone, or dexamethasone. NSAIDs have anti-inflammatory and pain-killing effects, while corticosteroids are anti-inflammatory but have no pain reduction effects, and can temporarily reduce the size of tumors as well. Musculoskeletal issues generally improve with NSAIDs and a bit of tincture of time, but neurologic and cancer related issues wouldn't really respond. If he's on corticosteroids and improves, we don't know if it's inflammatory, cancer, or neurologic (problems with slipped discs and "pinched" spinal nerves have an inflammatory component, and can respond to corticosteroid treatment).
3 weeks is time enough for a muscular injury to be improving, assuming you've been keeping him from running around and reinjuring himself. It's also enough time that a foreign body would have created an obvious infection, in the absence of antibiotic treatment. A fracture somewhere would be still causing problems, but fractures are pretty painful, and a dog doesn't tend to knuckle over with a fracture, they usually try to pick up the foot and keep it off the ground. So if things aren't getting better, given the length of time this has been going on and the age of the dog, I think it would be a good idea to get a bit more aggressive about finding a diagnosis. The dog will have to be sedated, probably anesthetized for the exam, and it would probably be a good idea to do radiographs, but if we can't isolate an area of sensitivity, that's a bunch of films to look at the whole leg and the neck/upper thorax. But sometimes once the dog is down, we can find out a lot just by palpating. If there's a lump somewhere, get at least a fine needle aspirate, or better still, a biopsy (FNAs don't always give an answer, and biopsies generally do... since it's so hard to examine the dog, don't mess around, make sure you get enough the first time to get an answer.).
Good luck!
Have a question for the Veterinarian? Use our Ask The Vet Form here.
This post was generously contributed by Dr. Stanley of House Call Of The Wild.