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Hawksmoor News

July 2016 Case Study – Noodle

noodle1Name:            Noodle

Age:               13 1/2 Years Old

Breed:            Jack Russell Terrier

Condition:       Bilateral Cruciate Ligament Rupture – Right Hind Repaired and Left Hind Conservative Management.

Noodle has been attending the centre for Aquatic Treadmill Hydrotherapy following diagnosis of Bilateral Cruciate Ligament Rupture with a repair procedure to the right hind and conservative management of the left hind limb with some associated lumbar regional muscular pain.

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The cruciate ligament is located in the stifle or knee joint in the dog’s hind limbs and a rupture of this ligament is extremely common in a variety of different breeds for a variety of different reasons.

The anterior or cranial cruciate ligament located at the front part of the joint is the ligament most prone to rupture, whereas the posterior or caudal ligament rupture is very uncommon.

The cranial cruciate ligament (CrCL) in dogs is the same as the “anterior” cruciate ligament (ACL) in humans. It is a band of tough fibrous tissue that attaches the femur (thigh bone) to the tibia (shin bone), preventing the tibia from shifting forward relative to the femur. It also helps to prevent the stifle (knee) joint from over-extending or rotating.

In the vast majority of dogs, the cranial cruciate ligament (CrCL) ruptures as a result of long-term degeneration, whereby the fibres within the ligament weaken over time. We do not know the precise cause of this, but genetic factors are probably most important, with certain breeds being predisposed (including Labradors, Rottweilers, Boxers, West Highland White Terriers and Newfoundlands). Supporting evidence for a genetic cause was primarily obtained by assessment of family lines, coupled with the knowledge that many animals will rupture the CrCL in both knees, often relatively early in life. Other factors such as obesity, individual conformation, hormonal imbalance and certain inflammatory conditions of the joint may also play a role.

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The above diagram (taken from Fitzpatrick Referrals Website) shows what is happening inside a joint when the Cruciate Ligament is damaged.

Noodle have a repair of the right hind rupture but then conservative management was advised for the left hind.

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Noodle waiting to start her hydrotherapy session in the reception area.

Noodle started to attend the centre for Hydrotherapy in June 2015. On this initial session Noodle was fully assessed including health check, gait analysis, muscle mass measurements and a full discussion with the owner regarding at home care, exercise and daily routine.

 

The muscle mass measurements on the initial session were as follows:

 

Limb Measurement
Left Fore 15cm
Right Fore 13cm
Left Hind 28cm
Right Hind 25cm

 

These measurements along with the gait analysis revealed that the right hind limb was weaker and the range of motion in this limb was also reduced.

There was also pain response elicited in the lumbar spinal region which the Veterinary Surgeon had noted in the clinical notes.

The gait analysis also revealed that Noodle was reluctant to turn in circles and appeared very stiff through both hind limbs with reduced flexion in the stifles particularly in the right hind limb.

Following this assessment it was decided that Noodle was best suited to Aquatic Treadmill Therapy, so she was health checked, showered to the top of her legs and fitted with a harness and lead attached. She was then taken into the treadmill with the hydrotherapist in with her.

The water level was filled to 10 inches which was high enough to support her weight and reduce the pressure on the stifle joints and the speed was started at 0.4 mph. On this first session, Noodle managed 2 sets of 1 minute each with a rest between.

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Noodle in the treadmill waiting for the water to fill to start her session.

During this first session, Noodle exhibited reduced extension and flexion in both hind limbs, particularly through the stifle joints and a wide stance through the fore limbs but generally a good range of motion was seen through both fore limbs.

 

Following on from this session, Noodle has been attending the centre once per week and progressed well.

Her muscle mass has become even as highlighted in the below tables.

 

July 2015:-

 

Limb Measurement
Left Fore 20cm
Right Fore 20cm
Left Hind 28cm
Right Hind 27cm

 

 

 

 

August 2015:-

 

Limb Measurement
Left Fore 20cm
Right Fore 20cm
Left Hind 28cm
Right Hind 28cm

 

November 2015:-

 

Limb Measurement
Left Fore 18cm
Right Fore 18cm
Left Hind 26cm
Right Hind 27cm

 

January 2016:-

 

Limb Measurement
Left Fore 18cm
Right Fore 18cm
Left Hind 25cm
Right Hind 25.5cm

 

February 2016:-

 

Limb Measurement
Left Fore 20cm
Right Fore 19cm
Left Hind 26cm
Right Hind 26.5cm

 

July 2016:-

 

Limb Measurement
Left Fore 17cm
Right Fore 17cm
Left Hind 26cm
Right Hind 26cm

 

These measurements demonstrate that Noodle is now even on her fore limbs and hind limbs and no lameness has been noted for quite some time now.

The water level has steadily been reduced and she now walks in 4 inches of water. The speed also steadily increased and she now walks at a speed of 0.8mph.

Noodle manages 3 sets of 4 minutes each which she copes really well with.

The incline is also used for Noodle at a 20% height and she walks on this for 2 minutes of each set, which again she copes extremely well with.

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Noodle is extremely focused during her sessions and is only encouraged by her owner at the front of the treadmill and the thought of a yummy gravy bone when she has finished all 3 sets.

This girlie really does not act or look like an ageing lady of nearly 14 years – she is in fantastic condition and thoroughly enjoys her sessions at the centre. Overall we are very pleased with Noodle as is her owner and she will continue to attend the centre weekly for her treadmill sessions.

Well done NuNu you are a pleasure to treat and we all really love seeing you and hope you continue to do well!

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Noodle relaxing at home after her session.