Clinical Case Presentation by Dr. Plinio Lidano (San Sepolcro Veterinary Clinic, Italy).
Equipped with Tendiboots™ Canine, Dr. Lidano uses this technology to detect gait abnormalities in dogs and monitor their progress. Discover how this tool integrates into a multimodal approach for managing tendinopathy through this clinical case.
Clinical Case Presentation
Kara is a 6-year-old spayed female Border Collie who practices agility one to two times a week. Additionally, she herds sheep twice a month. The owner reports that Kara has never shown signs of pain or lameness during training sessions or competitions.
On February 24, 2024, after an agility competition, Kara exhibited cold lameness in her right front limb during the evening.
However, the lameness had disappeared by the following day. The limb showed no pain upon palpation, and her gait was normal, allowing her to participate regularly in the second day of competition. The owner initially suspected it was a case of hyperlactatemia. Kara remained in good condition even by the evening of the second competition day.
Training continued until March 13, 2024, when Kara displayed severe lameness with weight-bearing suppression upon returning home after a session.
Veterinary investigation
Kara was first seen by a veterinarian on March 15, 2024.
Following a clinical examination and a series of X-rays, she was prescribed anti-inflammatory medication and rest due to a diagnosis of neck trauma sustained during training.
On March 22, 2024 after a week of rest, Kara had a follow-up visit with the same veterinarian.
The owner reported no clinical improvement. Kara was still showing cold lameness, which decreased as she walked.
The veterinarian recommended continuing the anti-inflammatory treatment and adding chondroitin-based supplements for joint support.
A second follow-up on April 12, 2024 prompted the veterinarian to perform a CT scan due to the lack of progress. A leishmaniasis test was also conducted, which returned negative.
A cortisone-based treatment began on April 18, 2024. During the treatment, the owner reported, for the first time, an improvement in the lameness, and Kara was almost walking normally.
Nevertheless, a few days after the end of the treatment, the lameness returned, sometimes in the right forelimb, sometimes in the left forelimb. A veterinary check-up in May revealed tendinitis and inflammation of the supraspinatus muscle. The veterinarian then prescribed shoulder injections.
Continuation of the Treatment
Dr. Lidano's veterinary clinic in San Sepolcro (Italy) continued Kara's treatment.
Kara’s owner had the foresight to record videos throughout the treatment process, starting from the onset of the lameness and including the various stages of the treatment.
Dr. Lidano then analyzed these videos in conjunction with Kara's medical file, which contained the results of the supplementary tests.
An initial observation of Kara’s locomotion was conducted during the first visit in the examination room, particularly focusing on her physical condition, movements, and weight distribution during her movements.
Later, a locomotion observation was carried out outside on a leash with the owner. The goal was to correlate the dog's physicality with the sport she practices to determine which parts of the body are most at risk for injuries. The angles were analyzed. The figure below shows the normal angles in a dog.
Dogs with a larger scapular angle tend to have more developed muscles around the shoulders, particularly the supraspinatus, infraspinatus, and triceps muscles, likely because these muscles support the shoulder joint when the dog is standing.
The veterinarian points out that the larger the scapular angle, the less dogs suffer from joint disorders, especially during landing with extended limbs. Tendinopathies are therefore commonly observed in the shoulders of athletic or highly active dogs.
During the clinical examination, each muscle is carefully palpated and mobilized.
The veterinarian specifically notes discomfort upon palpation and flexion at the level of the right shoulder. The locomotion is objectively assessed using various parameters measured with the Tendiboots™ Canine device. Radiographic and ultrasound exams are also performed on Kara.
Diagnosis and Treatment
Kara was diagnosed with bilateral tendinopathy of the supraspinatus muscle. A multimodal treatment was then initiated. This includes local platelet-rich plasma (PRP) injections, physiotherapy, dietary supplements, massage, laser therapy, and daily management with exercises. PRP, which particularly contains growth factors, is especially indicated for musculoskeletal injuries.
The two follow-up visits in the weeks following the start of the treatment showed an improvement in Kara’s gait, thanks to the use of Tendiboots™ canine, which allowed for a comparison with the previous results. The ultrasound examination confirmed this improvement.
The first figure below on the left shows the results obtained with Tendiboots™ Canine during Kara's first visit with Dr. Lidano.
The second figure on the right shows the results obtained after the follow-up visit a few weeks later. The ground impact parameter was balanced out during Kara's treatment (a 5.1 Newton difference between the front limbs at the start of treatment, and a 3.1 Newton difference between the front limbs during the follow-up visit).
To conclude this clinical case, this tool assists the veterinarian in managing a dog with a locomotor disorder, particularly in objectifying lameness and determining the key parameters to focus on. Tendiboots™ Canine also allows for objective follow-up by comparing the obtained parameters to check for improvement, and in doing so, adapting the treatment plan accordingly.
