We see it just about every week in practice: A hurt shoulder, hip, knee, elbow or ankle. Most joint injuries are sprains, thank goodness. Yet, dislocations, fractures or ligament tears that affect joints have a need to be surgically repaired within a reasonable amount of time. Dr. Phil Zeltzman, DVM, DACVS, CVJ recently wrote in our trade journal Veterinary Practice News that untreated joint damage like those mentioned above can really hurt pets when surgery is put off too long. These reasons included:
- Pain. Simply stated, although a pet with, let’s say a torn ACL of the knee, may have acute pain at first, chronic pain stays around. This will probably lead to a permanent limp and hesitance to ever try and put the affected leg down properly.
- Degenerative joint disease. This is a common sequel of non-surgical intervention. The aforementioned chronic disease tends to compound negatively this effect on the joint.
- Decreased range of motion. One may rationalize that this may not mean much to a couch-potato dog, but it sure will determine the activity level of an active family pet or a working dog.
- Muscle atrophy. After weeks of damage, anyone can see the muscle atrophy on the affected limb of a dog. It becomes easily visual after awhile, and this is muscle often never recovered back.
- Exercise intolerance. These pets seldom want to walk or run as they used to, because of chronic pain. Particularly in working dogs, this is critical. This also commonly leads to:
- Weight gain. A consequence of many of the above changes is decreased activity, which invariably causes weight gain. Unless the pet owner decreases the food intake to match the decrease in activity, weight gain is inevitable.
- Contralateral limb damage. We’ve seen it many times in practice. One limb is damaged, so the opposite limb must compensate to bear the load. The common result? Yet another joint damaged on the opposite leg. We can at least limit the damage to one leg if we can tackle the problem head-on in the beginning.
- Other injuries on the same leg. For example, meniscal tears on knees after the initial ACL rupture. The medial meniscus often times give way once the damage from the ACL tear sets in awhile.
- Distant problems. The changes in gait problems and posture can affect all three other limbs, as well as the spine. Weight shifting and compensation (as mentioned in #8) can indeed cause a cascade of other orthopedic events for years after the injury.
Now I know that just after injuries happen, we in general practice try to alleviate pain and inflammation initially. Optimally, surgical repair of joints in pets is optimal one to two weeks after initial injury. However, I always caution pet owners that putting off surgery to repair affected joints too long may not only cause the 10 things that Dr. Zeltzman mentioned, but my #11: That the pet may give up trying to use the affected limb for good because of the psychological acceptance that they cannot rehabilitate the limb anymore.
That’s a premise true in pets and people, amen?
Dr. Chris Duke