Common Injuries and Sports Medicine in Companion Animals

Question 1

What history questions should you ask for canine athletes

Answer 1

• Age at which they started training: Higher risk of injury with high impact/repetitive training before maturity
• Gonadectomy Status: Predisposed to orthopedic injury if neutered before reaching puberty
• Activity Level: How often and how long are they training
• Diet/Supplements

Question 2

Low impact activities

Answer 2

Rally and conformation

Question 3

Common injuries in Agility

Answer 3

Soft tissue injuries – shoulder, iliopsoas strains and CCL

Question 4

Common injuries in obedience

Answer 4

Shoulders – usually the left due to chronic uneven weight distribution, head always looks
to right at the owner

Question 5

Common injuries in Flyball

Answer 5

Chronic repetitive stress injuries – shoulder, carpus, iliopsoas, MSS, hip arthritis

Question 6

Common injuries Dock diving

Answer 6

Back pain and hips

Question 7

Common injuries in Feild trials/ hunt trials

Answer 7

Feet, carpus and shoulders, arthritis, carpal hyperextension

Question 8

Common injuries in working dogs

Answer 8

Mainly related to overuse and repetitive stress or trauma

Question 9

Common Conditions and Surgical Interventions (Hip)

Answer 9

• Femoral Head and Neck Ostectomy (FHO)
• Total Hip Replacement (THR)

Question 10

Common Conditions and Surgical Interventions (stifle)

Answer 10

• Extracapsular Suture Repair
• Tibial Plateau Leveling Osteotomy (TPLO)
• Tibial Tuberosity Advancement (TTA)
• Tibial Tuberosity Transposition (TTT)
• Patella Groove Replacement (PGR)

Question 11

Femoral Head and Neck Ostectomy (FHO)

Answer 11

Salvage procedure, excision arthroplasty – femoral head and neck are removed
* Creates a pseudoarthrosis (false joint) –
formed from fibrous tissue
* Treatment – severe OA, irreparable fracture
involving the joint, severe/recurrent joint
luxation, or congenital joint deformities
* Complications – incorrect ostectomy (bone-
on-bone contact)

Question 12

FHO Prognosis

Answer 12

• Good
• Patients can return to daily function, however normal gait and function are not achieved due to biomechanical changes
• Specifically hip extension remains limited – patient will be able to walk and trot mostly normal
• Functional shortening of the limb is expected and slight gait
  abnormality
• More difficult recovery process for larger patients

Question 13

FHO rehab considerations

Answer 13

Control Pain:
* Usually need NSAIDs longer than most post-
operative patients, during entire recovery period (up to 3 months)
* Consider Gabapentin

Maintain range of motion
* Need to start immediately to prevent too much fibrosis
* Active stretching exercises AROM, PROM, stretching

Question 14

When should you start rehab for an FHO

Answer 14

Immediately

Question 15

Total Hip Replacement (THR)

Answer 15

• Salvage procedure – femoral head is removed and replaced
  with a femoral prosthesis and the acetabulum is replaced
  with a prosthetic acetabular cup
• Eliminates the joint therefore eliminating joint-associated
  pain
• Treatment – severe OA
• Complications – luxation, infection, fracture, implant
  failure/loosening
• Prognosis: Very Good to Excellent

Question 16

Total Hip rehab considerations

Answer 16

Prevent post-surgical luxation and promote tissue regeneration

• Hip dislocation is the most common complication
• Extreme care should be used up to 3 months post-operative
• CAUTION with rehabilitation – no Abduction/Adduction, leg should ONLY move in a sagittal plane
• Owner education important – some surgeons do not even instruct owners to perform PROM at home bc of this

Question 17

What can’t you do in rehab with a total hip

Answer 17

no Abduction/Adduction, leg should ONLY move in a sagittal plane

Question 18

Luxation can happen up to _________ post of from a total hip

Answer 18

3 months

Question 19

THR-Rehab limb function

Answer 19

Week 2-10: Limb placement
* Early limb use can be encouraged with gentle weight shifting exercises
* Mandatory slow leash walks ONLY starting with 5 minutes

Week 10-12: begin limb strengthening
* Usually do not begin until recheck radiographs are taken and surgeon clears the patient for re-introduction

Question 20

Menisci

Answer 20

• Between condyles of femur and tibia
• Medial meniscus - connected to tibia and medial collateral ligament
• Lateral meniscus – connected to tibia, allowing for higher range of motion

Question 21

Cranial cruciate ligament

Answer 21

prevents “cranial drawer” or cranial displacement of tibia and internal rotation of tibia towards the femur

Question 22

Caudal cruciate ligament

Answer 22

prevents “caudal drawer” or caudal displacement of tibia toward femur

Question 23

Lateral Fabellar Suture (LFS)

Answer 23

• Extracapsular stabilization technique – use
  of heavy gauge synthetic suture is wrapped
  around the lateral Fabella and through a pre-drilled hole in the proximal tibia in a
  figure-8 pattern
• prevents cranial displacement of the tibia
• Scar tissue will eventually form over the joint for long-term stabilization

Prognosis is good

Question 24

Lateral Fabellar Suture (LFS) Rehab considerations

Answer 24

• Control Inflammation
• TENS and massage to reduce edema
• Control Pain
• Improve range of motion
• PROM should start on Day 1
• Therapeutic U/S

Question 25

Lateral Fabellar Suture (LFS) Rehab Limb ROM and Function

Answer 25

Day 1: begin PROM immediately Week 2: add in gentle passive stretching, UWTM intro * Avoid extreme flexion and extension Week 4-5: add in more active range of motion * Cavaletti poles * Continue to avoid extreme flexion and extension * No stair climbing until week 5-6

Question 26

When can LFS patients climb stairs?

Answer 26

not until week 5/6

Question 27

TPLO and TTA Rehabilitation

Answer 27

Both techniques are osteotomy procedures that alter the biomechanics of the joint in order to provide dynamic stabilization * Rehabilitation is similar to Extracapsular Repair with some precautions * Can begin UWTM as early as 2 weeks post-op

Question 28

TPLO and TTA Prognosis

Answer 28

* Good to excellent * Return to full function

Question 29

TPLO and TTA Rehab considerations

Answer 29

* Caution: Avoid TENS or Laser directly over the plate * Avoid extreme flexion/extension until Week 6 * Until Week 8-10: Avoid increased loading exercises until radiographs show appropriate bone healing and surgeon releases to increase activity * Patient should NOT be walking any longer than 20 minutes 2x/day until recheck radiographs

Question 30

Patella luxation repair

Answer 30

Tibial Tuberosity Transposition and trochlear wedge recession (TTT) * Surgical correction to deepen the patella groove and change the position of the tibia in order to correct the tracking of the patella ligament over the patella groove

Question 31

TTT: Prognosis

Answer 31

Prognosis: * Long-term success is varied * Depends on the severity of the grade * Often luxation reoccurs at a lesser severity Complications: * Implant loosening

Question 32

TTT – Rehab Considerations

Answer 32

Improve Range of Motion * Caution: sagittal plane only Week 2-4: heavier limb use can begin with caution * Avoid exercises that cause extreme flexion and extension, explosive activity, jumping, running, active play Week 6-8: * Gradually increase to higher impact activity * Stairs, inclines, weave poles