Forelimb Lameness

When Seth the Greyhound came in to see me, it was obvious that she was limping: her head nodded down every time she put weight on her left front leg. But her right back leg also seemed to be moving unevenly. So which leg was causing the problem?

This sort of lameness dilemma can be difficult to solve just by watching an animal. My conclusion was simple: the source of her pain was her right front leg. I then had to work out which part of her right front leg was causing her to limp.

Humans Lameness VS Animals Lameness

When a human is lame or walking with a limp, the problem is usually caused by a problem with one of their two legs. With pets, the possibilities are doubled: instead of just two legs, animals have four. The forelegs are the equivalent of the human arms. The forelegs carry 60% of the weight of an animal’s body, so they are under significant daily pressure. It’s no wonder than many lamenesses of pets affect the forelegs rather than the hind legs.

Sources Of Lameness

There are five main areas in the foreleg that can be the source of lameness:

• The shoulder
• The elbow
• The wrist (called the “carpus” in animals)
• The equivalent of the hand bones (called the “metacarpus)
• The animal version of “fingers” (known as the “digits”)

To find out which part of Seth’s right foreleg was causing problems, I had to poke, twist, and tweak each separate part of the limb.

When I did this, I discovered where Seth was sore: it was the equivalent of her little finger, known in dogs as “digit number five”, colloquially described as her outermost toe. When I squeezed and poked this, Seth whined and pulled away from me.

I could tell by feeling the toe that it wasn’t fractured, but there were still several possible causes. She had only been lame for one day, so it seemed likely that she might have just sprained it.

I gave Seth a simple initial treatment: a five day course of pain relieving anti-inflammatory medication, combined with strict rest. She made a prompt recovery, and two weeks later, she was rushing around, with her normal graceful, smooth gait, as if she’d never been injured.

Causes Of Forelimb Lameness

There are many possible causes of forelimb lamenesses.

1) Sprain

• The simple “sprain” is the most common, with the digits, elbow, or shoulder most commonly affected. Rest and time, combined with pain relief, are usually enough to solve these cases, although sometimes a supportive dressing is needed to limit the movement of the affected joint until it’s fully healed.

2) Dislocations

• Dislocations – when one side of the joint becomes disconnected from the other side – are also seen occasionally: the shoulder and elbow are the most commonly affected. Obviously, the lameness is sudden and dramatic: a rapid visit to the vet is needed, and with luck, the joint can be popped back into place under general anaesthesia.

3) Fractures

• Fractures also cause dramatic lameness, and although a classical case of a broken leg has an obvious “hanging free” appearance, there are many types of fractures that are more subtle. A visit to the vet for detailed x-rays is always needed, and the treatment approach depends on the details of the broken bone. These days, the recommended treatment for fractures generally includes metal implants or external frameworks, with expensive surgery. People who have dogs with broken legs are always extremely grateful if they have had the foresight to have their pets insured.

4) Bone Tumours

• Bone tumours are another cause of forelimb lameness. In most cases, the lameness starts off as a mild limp, but it gets steadily worse with time, over days or weeks. An x-ray is needed to make the diagnosis, and in rare cases, a bone biopsy may need to taken to confirm what’s happening. Surgery to remove the tumour is always needed, and this usually means amputating the limb. Sadly, in most cases, even this is not enough to achieve a long term cure, because bone tumours tend to be malignant, spreading to elsewhere in the body.

5) Arthritis

• Perhaps the most common cause of forelimb lameness in pets is arthritis, or as it’s known these days, “degenerative joint disease”. This often follows developmental problems in a young growing dog: the joint surface of the elbow or shoulder can develop uneven patches that go on to be a focus for arthritis as the dog grows older. Treatment of such cases involves a patchwork of medication, physiotherapy, and lifestyle management: a dog with advanced arthritis may need a ramp to get into a car, rather than being able to jump up as normal.

Total elbow replacement, which involves replacing the natural elbow with a man-made version, has become an option in recent years as a form of treatment for advanced elbow disease.

The final part of the forelimb to mention from a lameness perspective is the feet: dogs walk everywhere in their bare feet, so they are prone to standing on sharp or irritating objects. A careful inspection of every toe is an important part of any lameness investigation, and the underside of the foot should be carefully examined for injuries or inflammation. Generalised skin disease can cause dermatitis that includes the feet, and this can be a common cause of lameness.

Lameness In Cats

Forelimb lameness is common in cats: the most common cause is cat bite injuries since cats use their forelegs to defend themselves (and to attack) in fights. A swollen foot is often a sign of a cat bite, and small scabs are often felt at the site of tooth penetration. Cats can also suffer from arthritis of the forelimb joints: difficulty jumping up or down, or stiffness when walking are the most common signs.

Treatment for Arthritis

1. Weight control: if an animal is obese, the extra weight pressurises the joints, causing further damage and increased pain. The most effective treatment for many dogs with painful hips is simple weight reduction. If an owner is not sure whether or not their pet needs to lose weight, they should ask their local vet.
2. Moderate exercise. A balance of exercise is needed for dogs with painful hips. Too much exercises causes ongoing damage and inflammation to the hip joints. Not enough exercise can cause the joints to stiffen up, and the muscles around the joints can become weaker. The optimal amount of exercise varies with each case, but on average, around 20 minutes twice daily suits in most cases.
3. Medication. A range of different treatments are available for painful hip
   • Non steroidal anti-inflammatory drugs (NSAIDS). Vets stock a wide range of these, from “Rimadyl” to “Metacam” and others. These have been proven to be the most effective form of pain relief for most dogs with arthritis, but like any drug, there are potential side effects, including gastric irritation, as well as the possibility of liver or kidney complications. That said, a daily dose of NSAIDS gives many dogs significant months and years of extra life: without the medication, many dogs would be euthanased because of the poor mobility and pain caused by arthritic hips.
   • “Cartrophen” (Sodium pentosan polysulfate) is an injection that is typically given once a week for a four week course, and this can be repeated every six months. This is a disease modifying osteoarthritis drug that helps maintain joint health, including preserving joint cartilage that is damaged by the arthritic process.
   • “Nutraceutical” products containing glucosamine and chondroitin sulphate, such as “Arthri-Aid”, are often recommended for the treatment of arthritis: some people believe that they make a significant long term positive effect.

4. Other treatments. Hydrotherapy and acupuncture are also often recommended to help animals with arthritis of the hips.