Clean Run - September 2020 - 43

Occasionally, dogs present with skipping or mild hind leg lameness without any obvious abnormal
findings in the lumbar/back region or hind legs. Small breeds often go home with the diagnosis of
"skipping with unknown cause" or "Russell skip." It is under discussion if some of these dogs could
have something pathological underneath, driving this behavior.

Kix received rehabilitation therapy,
which included phonophoresis,
pulsed therapeutic ultrasound with
lidocaine, and glucocorticoids. After
resolution of the symptoms and inflammation within the sciatic nerve
and healing of the surrounding
muscles, he continued supportive
rehabilitation therapy consisting of
photobiomodulation, a home exercise plan, and manual therapy. He
was able to successfully return to
agility. The time from the diagnosis
to the full recovery was approximately three months.
Occasionally, dogs present with
skipping or mild hind leg lameness
without any obvious abnormal
findings in the lumbar/back region
or hind legs. Small breeds often
go home with the diagnosis of
"skipping with unknown cause" or
"Russell skip." It is under discussion
if some of these dogs could have
something pathological underneath, driving this behavior.
On leaving the pelvis, the sciatic
nerve runs close to the piriformis
muscle and gemelli muscles. It also
distally runs close to the internal
obturator muscle and deep to the
gluteal muscles. Due to this close
relation, if there are any strains, in-

flammation, or even chronic tightness to these deep gluteal muscle regions, it
is possible for the sciatic nerve to become irritated by direct compression. In
addition, chronic stretching of the nerve can also cause it to become inflamed
and sore. Chronic stretch is often seen secondary to other underlying injury,
such as off weighting/holding the leg in the air/off the ground or even during
long episodes of guarding the stifle or back. Since this syndrome can be seen
as a primary or compensatory issue, it is always important to check for any underlying issues when sciatic or gluteal pain is noted.
If there are no primary underlying issues identified with the dog, it is recommended to proceed to the musculoskeletal diagnostic ultrasound of the
sciatic area and the surrounding muscles to determine if the primary source
of injury.
Treatment of the sciatic area consists of therapeutic pulsed ultrasound with
phonophoresis. Phonophoresis means that with the help of the ultrasound,
we deliver drugs deep to the tissues through the skin. The drugs used in cases
of sciatic neuritis are dexamethasone and lidocaine, properly infused into an
ultrasound gel.
When there is an underlying condition involved, it is always important to remember to treat the sciatic nerve also. In the cases which it does not resolve
by itself after treating the underlying condition, it can become the main reason for a slow recovery. In those cases, finding a veterinarian skilled with musculoskeletal ultrasound and scanning of this area is important.
So, does the deep gluteal/piriformis syndrome exist in dogs?
Increasing numbers of dogs present with the issues and findings noted above;
the same findings seen with the Deep Gluteal Syndrome in humans. Treating
the sciatic pain and inflammation within the surrounding muscles results in
the resolution of the presenting performance issues/lameness. In addition,
the recovery and successful return to sport of these previously symptomatic
dogs continues to reassure sports medicine veterinarians that there is good
evidence supporting the translation of this human condition as an important,
underdiagnosed, similar condition in dogs. D

Dr. Tiiu Toijala studied veterinary medicine at the University of Helsinki in Finland and began veterinary work in 2002. She completed her thesis on dog rehabilitation after orthopedic surgery in 2004. Dr. Toijala is a Certified Canine Rehabilitation Therapist (CCRT) through the Canine Rehabilitation Institute
and is currently a Practice Path Resident through the American College of Veterinary Rehabilitation and Sports Medicine under the mentorship of Drs. Sherman and Debra Canapp at Veterinary Orthopedic & Sports Medicine Group. She is currently practicing at Urheilukoiraklinikka, Espoo, Finland. In her spare
time, Dr. Toijala enjoys sports, traveling, and competing in agility with her Border Collies. Dr. Toijala can be contacted via email at ttoijala@gmail.com.
Dr. Debra Canapp, a diplomate of the American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR), is currently the medical director and chief of the
rehabilitation and sports medicine diagnostic imaging department at Veterinary Orthopedic and Sports Medicine (VOSM) group in Annapolis Junction, Maryland. Her
exclusive area of interest, clinical work, lecturing, and research revolves around sports medicine and rehabilitation therapy, specifically canine sports-related injury, sport
rehabilitation, and performance. In addition to her current diplomate status in the ACVSMR, she served on the college›s board examination committee for two years
and has also completed advanced courses in acupuncture, orthopedics, and regenerative medicine therapy. Dr. Canapp is active in teaching rehabilitation medicine,
musculoskeletal ultrasound, and regenerative medicine to visiting veterinary students, rehabilitation therapy certification candidates, and veterinarians. She is also
co-founder of Canapp Sports Medicine, a virtual canine sports medicine platform.
September 20 | Clean Run

Clean Run - September 2020

Table of Contents for the Digital Edition of Clean Run - September 2020