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Cold Shoulder

Diagnosing and treating forelimb injuries in Molossers
Unfortunately, forelimb problems are common in our large Molosser breeds. And even more unfortunately, due to the size and the movement of many of the Molossers, it is sometimes hard to assess which side the forelimb or front leg the lameness is on, and where it is coming from – the shoulder, elbow, wrist, toes or a combination of them. 
 
Here’s a very common scenario: Lameness or a limp is seen in the dog, and he is taken to the veterinarian. Everyone holds their breath to make sure the elbows are not dysplastic, no tumor is present, and the shoulder is clear from osteochondritis dissecans (OCD). When the radiographs come back clear, everyone is thrilled – but the dog is still lame.
 
Soft-tissue problems involving muscles, tendons and ligaments do not appear on an X-ray, but may still be a major source of lameness. They are frustrating for many reasons – they are not clear cut and initially seem like they come and go.  
 
A soft-tissue problem will present with an intermittent and subtle lameness. Sometimes it is more prevalent after lying down, and sometimes it is prevalent after activity. Sometimes it only appears with certain activities. For example, if it is a left shoulder problem, the lameness or hitch may be seen while the dog is running around the show ring and turning in to the left shoulder. Initially the issue may be very subtle and may only be noticed by someone who really understands movement or is able to detect problems. I have seen many dogs in the show ring – right up to Best in Show – demonstrate a subtle lameness that I would bet is soft tissue that goes undetected.  
 
Forelimb lameness is typically characterized by a head bob, or an upward movement of the head when the forelimb strikes. The lameness has to be pretty significant to cause a large head bob. A more common scenario is a slight jerking or rolling motion when the affected forelimb hits the ground. In the large breeds, it is sometimes difficult to determine which forelimb is causing the problem because the dog rolls the weight quickly off the affected forelimb to the other one. So it may take a few minutes of examining the dog to determine which limb is the problem.
 
The forelimb is attached to the rest of the dog’s body by many muscles at the shoulder. Unlike our arms, dogs support their weight with the forelimbs, so the dog’s muscles need to provide stability to the area and help the dog advance. If one of those muscles becomes injured, it compromises the stability and movement of the forelimb. And it does not take much to cause a minor injury to one of these muscles in a Molosser. A quick run around the backyard and a step in a hole could do it. Jumping off the couch or bed and stepping wrong could do it. A slip on ice or a slippery floor could do it.
 
What typically happens is a dog slips once and aggravates the area, but then the repetitive continued motions aggravate the area even more. For example, he may have injured his forelimb jumping off the bed, but then continually aggravates it when the motion is repeated. Once the muscle or tendon is inflamed, it will remain inflamed until the problem is resolved. If inflammation exists, the body reacts and protects the area by reducing the amount of activity that exists. Muscle atrophy or weakness begin to develop. Once this process begins, the forelimb problem presents with inflammation, pain and muscle weakness. The weaker the area becomes, the more stress on the joints and the more discomfort. Range of motion in the shoulder also begins to decrease, so the dog’s reach and drive are diminished.
 
Treatment for a soft-tissue problem needs to include a program to decrease the inflammation and pain, and to increase the muscle loss and the range of motion. And a definitive diagnosis needs to be made. Additional diagnostics, such as an ultrasound or MRI, may be necessary to determine the exact cause of the lameness. It is essential to understand that a dog who is exhibiting lameness is experiencing pain. Until the pain and inflammation are addressed, the lameness will continue and perhaps even worsen, and appropriate strengthening cannot be performed.
 
Pharmaceutical interventions may be necessary, and your veterinarian will assist with those. These may include an anti-inflammatory, pain medication and a muscle relaxant. Proper supplements should be part of the Molosser’s well-balanced diet. NitroCoQ10, glucosamine/chondroiton, and essential fatty acids are my favorites.
 
The rehabilitation portion of a forelimb problem will consist of reducing the pain through various modalities, range-of-motion exercises and strengthening. It is always challenging working with the Molosser breeds purely due to their size, but is so much fun!
 
The first thing that needs to be addressed is the stability of the area. Ball work is one of my favorite exercises. The Molosser stands on a large ball. (Yes, they can hold up to 400 pounds!) Just standing or lying on the ball helps with the dog’s core strength as well as the strength of the large shoulder muscles, which are essential in assisting in the stabilization of the area. This is a great exercise for a forelimb problem, as well as the prevention of a problem and cross conditioning. Typically, a session on the ball begins with about five to 10 minutes; I encourage owners to perform it daily initially and then decrease it to three times per week. The challenging part is teaching your Molosser to get up, but once they get on it – they love it! There is more information on the Get on the Ball Two DVD available from our website. 
 
Treadmill walking on a land treadmill or an underwater treadmill is a wonderful exercise to strengthen the forelimbs while controlling the amount of stress placed on the area. Walking in water reduces the stress placed on the joints. Many conditioning and canine rehabilitation centers have underwater treadmills. Most Molossers take a few minutes to become accustomed to the underwater treadmill, but then do very well. It serves as cardiac and pulmonary conditioning, too.
 
A land treadmill is very useful, as long as the belt is long enough for the large Molosser and allows for full reach and extension of the body. The belt should be at least five and a half feet long or longer, if possible. We use the professional Fit Fur Life treadmill in our clinic and we have not had any problems with even the largest of breeds. Treadmill walking may also take some getting used to, and I usually recommend two people to start. One person holds the harness and the other leads the dog with bait. The goal is a slow trot to a fast walk, with good extension. An initial 10-minute session is usually enough to begin with and then incremental increases can be made.
 
Lameness in the forelimb, however minor it may appear, needs to be addressed as quickly as possible. The sooner the cause of the lameness is determined, the faster the treatment and recovery can begin. It is sometimes challenging in the large breed, but with a skilled practitioner, the problem should be solved quickly and efficiently.
 

About the Author

Dr. Debbie Gross Saunders is a certified canine rehabilitation practitioner, conditioning expert and Bullmastiff fancier. She owns Wizard of Paws Physical Rehabilitation for Animals in Connecticut and specializes in working and performance dogs. She speaks nationally and internationally on the rehabilitation and conditioning of dogs. She has recently launched her new supplement line, Dr. Saunders Select, to naturally improve the health of dogs. She has published numerous DVDs, books and articles on the conditioning of performance and working dogs, and had enjoyed assisting many dogs obtain their championships and other performance titles. Contact her through her web site, www.wizardofpaws.net.  
 
 
 

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