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Hawksmoor News

October 2015 Case Study – Manu

manu1Name:              Manu

Age:                  2 Years

Breed:              British Bulldog

Condition:       Ruptured Cranial Cruciate Ligament in the Right Hind and Tibial Plateau Levelling Osteotomy (TPLO).

 

Manu is a 2 year old British Bulldog who was referred for Hydrotherapy following Tibial Plateau Levelling Osteotomy to his right hind limb and subsequent post operative infection.

Due to the infection that Manu suffered following surgery he had not used the limb effectively and so had lost some of the muscle mass in this limb and the range of motion had also become quite restricted.

 

A Tibial Plateau Levelling Osteotomy (TPLO) surgery is performed following a Cranial Cruciate Ligament Injury. The Cruciate ligament prevents forward and backward sliding of the Femur on the Tibia, also known as a draw motion. When the cruciate ligament is ruptured or completely torn the cranial draw is present and in the majority of cases surgical intervention is required in order to reduce this movement and secure the joint.

Cranial Cruciate ligament rupture is one of the most common orthopaedic injury to occur in dogs. Affected dogs can be any age, any size and any breed but there are a few that are more prone to the injury such as Labradors, Rottweilers, Boxers, Newfoundland’s and West Highland White Terriers.

This diagram shows where the cruciate ligament is situated. (Anterior is the same as the Cranial cruciate ligament).

This diagram shows where the cruciate ligament is situated.
(Anterior is the same as the Cranial cruciate ligament).

 

Tibial Plateau Levelling Osteotomy involves changing the angle of the top of the shin bone (the tibial plateau) by cutting the bone, rotating it and stabilising it in a new position with a plate and screws. TPLO surgery aims to make the tibial plateau perpendicular to the long axis of the bone and, in doing so, to prevent the shin bone moving forwards. The stifle thus feels stable for the dog when weight bearing, despite the fact that the ligament has been ruptured and not directly repaired.

This diagram shows a diagram of the TPLO surgery.

This diagram shows a diagram of the TPLO surgery.

 

Unfortunately for Manu he suffered with quite a bad post operative infection and the plate in his leg needed to be replaced so his recovery period was extended. Manu first started attending the centre for Hydrotherapy on 15th September 2015 where he was fully assessed including a full gait analysis, muscle mass measurements and a full discussion with the owner regarding at home care & rehabilitation plan for him.

Muscle mass measurements on this first session were as follows

 

Limb Measurement
Left Fore 31cm
Right Fore 31cm
Left Hind 46cm
Right Hind 42cm

 

Manu had a difference of 4cm in his hind limbs and this was also obvious when his limbs were palpated during the assessment. During the gait analysis it was revealed that Manu was off loading into the left hind limb and he was extending the right hind limb at a stand in order to reduce the weight bearing through the right hind limb. The flexion through the right hind stifle joint was also very reduced and he was taking most of his weight through the fore limbs to again reduce the pressure through the hind limbs.

After Manu was assessed it was decided that the Aquatic Treadmill was the most appropriate treatment for him so that we could target his stifle joint with the water level, assist with re training his gait pattern whilst also encouraging correct loading through the affected limb and so appropriate muscle mass building. Manu took to the treadmill well and with his owner providing the yummy chicken he does a great job through his sessions.

This is Manu in the treadmill during one of his sessions being encouraged by his mum.

This is Manu in the treadmill during one of his sessions being encouraged by his mum.

Initially the water level was started at 11 inches and the speed started at 0.1-0.2 miles per hour, the first session Manu managed to complete 2 sets of 45 seconds each. This was hard work for Manu and his owner reports he was really tired after this first session.

Following on from this first session he has progressed well through his sessions and the water level has now been reduced to 9 inches in order to try and increase the flexion through the stifle joints and the speed increased to 0.9 miles per hour.

On the most recent session he managed to walk for 3 sets of 3 minutes each with a good rest between. His fitness levels have advanced well also and his pulse & respiratory rate remains very stable throughout his sessions. The owner reports he also recovers quicker after his sessions.

Manu was re-measured on his 10th session and these were as follows

 

Limb Measurement
Left Fore 31cm
Right Fore 31cm
Left Hind 45cm
Right Hind 44cm

 

These measurements indicated that the muscle mass in the right hind limb had increased by 2cm and the left hind reduced by 1cm. This indicates that his is now weight bearing more evenly on the hind limbs which was also noted when he was re assessed during a gait analysis. The flexion through the right hind limb had also increased but we still have a little way to go. The owner also reports that Manu is managing more exercise at home and enjoying playing with the family again.

Luckily for us, Manu is continuing to attend the centre! Manu is an absolute pleasure to treat and enjoys all the fuss and attention he gets during his session. He is always keen to come in and if we could just get him to stand still to be washed and dried he would be the perfect patient.

Well done Manu, keep up the fantastic work!

manu5