Species: dog
Breed: French Bulldog
Sex: f, neutered
Weight: 15.2 kg
Birth date: 2027-12-27 00:00:00
Primary diagnosis: Suspected partial cranial cruciate ligament rupture right, medial patella dislocation on both sides (right grade 2, left grade 1)
Situation: pre surgery
Medical history: Ruby was presented to the emergency service of our clinic on 3 July 2024 due to acute lameness at the back right. Ruby ran into the garden in the afternoon and then came back on 3 legs. The right hind limb was completely relieved when she walked. On palpation, the owner could not detect any pain. Ruby was then taken to a private vet who could not find any pain and injected her with Meloxicam. Once home, Ruby was somewhat lethargic and showed little interest in her food. As her general condition did not improve, Ruby was taken to our clinic. Since the 02.07.2024 evening, Ruby has also had a bit of mushy diarrhoea. In 2019, a triple pelvic osteotomy was performed due to bilateral hip dysplasia. At our clinic analgesia with Methadon and Paracetamol was started and the following day (04.07) x-rays were taken X-rays report: Stifle right: Increased soft tissue opacity of the femortibial joint, Suspected mild subchondral lucencies in the intercondylar fossa, Equivocal cranial subluxation of the tibia, Medial bowing of the proximal tibia; Pelvis: Status after chronic triple pelvic osteotomy, Mild muscle atrophy left gluteal muscles, Moderate anterversion of the femoral neck, right femur. The dog went home the same day.
Medication: The day of presentation at the private vet (03.07): Meloxicam. 03.07: Methadon 0,1 mg/kg IV q4h, Paracetamol 10 mg/kg IV TID, Omeprazol 1 mg/kg IV BID, Cisaprid 0.5 mg/kg rectally TID, Gabapentin 10 mg/kg PO TID if needed, Trazodone 5 mg/kg PO TID if needed. 04.07: Methadon & Paracetamol & Omeprazol & Cisaprid & Gabapentin & Trazodone same as on 03.07. Before presentation on 10.07: Gabapentin 10 mg/kg PO TID, Carprofen 4 mg/kg PO SID. 10.07: Omeprazol 1 mg/kg PO BID, Cisaprid 0.5 mg/kg PO TID, Gabapentin 10 mg/kg PO TID, Trazodone 5 mg/kg PO TID. 11.07: Omeprazol & Cisaprid & Gabapentin & Trazodone same as on 10.07 (nothing given before filming).
Orthopedic exam: Gait: Lameness grade 5/5 right hindlimb. Posture: relieved right hindlimb, leg positioned caudolaterally. Orienting palpation: slight muscle atrophy quadriceps muscle right, moderate joint effusion knee right, medial buttress on both sides L>R. Specific palpation: medial patellar luxation on both sides (grade 2 on the right and grade 1 on the left), right tibial compression test positive but drawer test negative, dolence on manipulation of the right knee. Examination under sedation: drawer test still negative, tibial compression positive.
Neurologic exam: Mentation: alert. Behavior: normal. Posture: Holding right pelvic limb. Gait: right pelvic limb lameness 4/5. Cranial nerves: normal. Postural reactions: proprioceptive positioning mild delayed on left pelvic limb and delayed on right pelvic limb; hopping, hemiwalking, wheelbarrowing, extensor postural thrust were normal. Spinal reflexes: withdrawal right pelvic strongly reduced, cutaneous trunci reflex normal. Sensibility: not painful on thoracolumbar area, anamnestic painful on knee. Neuroanatomical localization: Right knee +/- T3-L3 vs L4-S1 (due to reduced postural reactions and withdrawal).
Pain type: acute, orthopedic, somatic
Pain origin: hind legs
Pain duration: More than 7 days
Estimated pain severity: 20