Front Matter

Chapter 15 Evaluation and Rehabilitation Options for Orthopedic Disorders of the Pelvic Limb 399

Treatment rationale

Treatment should emphasize stretching of
the medial soft tissues and strengthening of
the lateral musculature in an effort to redirect
the pull on the patella.

Treatment goals

● Decrease pain
● Increase flexibility of the medial soft tissues
(medial quadriceps, medial hamstrings,
adductors, sartorius, iliopsoas)
● Increase strength of the lateral thigh
musculature
● Normalize gait
● Develop HEP.

Treatment by goal

Pain management

As for hip dysplasia.

Increase flexibility

● Passive stretch and STM of the sartorius,
medial quadriceps, medial hamstrings,

adductor, and iliopsoas with manual stabili-

zation of the patella

● Passive stretch and STM of the patellar

ligament and musculotendinous junction of

quadriceps, mobilizing tissues laterally.

Increase strength

● Lateral thigh musculature (e.g., side step-

ping on flat and elevated surfaces).

Home exercise program

The client is instructed in performing the

stretching and strengthening exercises.

Cranial cruciate ligament insufficiency

Disruption of the CCL is a very common canine

orthopedic injury. The mechanism of injury can

be either acute or chronic. Typically, CCL tears

are treated surgically; however, increasing

numbers of clients are opting for conservative

management due to health and financial con-

cerns. The success of conservative manage-

ment depends on the extent of the tear and

whether or not the meniscus is involved.

Case Study 15.2 Medial patellar maltracking with secondary muscle impairments

Signalment: 2-y.o. F/N Jack Russell Terrier; agility

competitor

Presenting complaint: Left pelvic limb (LPL) hiking

gait lameness; hesitant to jump into car or onto bed.

Evaluation: Physical exam WNL except for:

Special tests: Positive patellar stability test (grade

I–II medial laxity).

Gait: Intermittent skipping noted particularly with

clockwise and counter-clockwise walking and in

transitions from trot to canter.

Atrophy: Minimal to moderate at L quadriceps and

hamstrings; Gulick measurement: left thigh 24.5 cm;

right thigh 25 cm.

Flexibility: Moderate tightness of L semimembra-

nosus, gracilis, and sartorius.

Assessment: Patellar maltracking (medially) with

associated flexibility and strength issues. Treatment

will focus on stretching the medial stifle musculature

and strengthening the lateral musculature.

Problem list:

● Patellar maltracking

● Skipping gait

● Atrophy/weakness L thigh

● Tight L semimembranosus and gracilis.

Goal: Normal gait within 6 weeks.

Treatment:

(1) Manual therapy:

● Passive stretch with STM at semimembrano-

sus, gracilis, and adductors

● Passive stretch of the sartorius with manual

patellar stabilization

● STM with lateral strokes to the patellar liga-

ment and the musculotendinous junction of

the quadriceps.

(2) Therapeutic exercise: Progressive strengthening

exercises of the hip abductors such as side step-

ping in varying degrees of front-end elevation.

(3) HEP: Instruct client in treatment described

above.