Hello everybody. My name's James. I am an orthopaedic surgeon working at Fitzpatrick Referrals, and today we're going to learn about musculoskeletal disorders in working dogs.

So if you're presented with a working dog for a musculoskeletal disorder, for a consultation before they've even entered your consult room, I suspect that you're starting to create a differential diagnosis list in your head. So how do you do this? What do you consider?

So for me, there are 3 criteria that I tend to think about and consider. The first of which is what job does that dog do? As this will give us an idea of what movements they make and subsequently the tissues that could get overworked and injured.

And this is particularly important for repetitive chronic injuries. Another factor that I'll consider is the breed. Dogs have been bred for certain characteristics, and this means certain breeds are better suited and therefore more often used for certain types of work.

And different breeds are susceptible to different musculoskeletal disorders. And the final consideration is to still keep an open mind. At the end of the day, they are dogs and could get any condition that any dog could get.

So don't try and solely pattern recognise and try and give all working dogs a sexy sports medicine diagnosis. Just because er they are a working dog doesn't mean that they have to have a specific diagnosis or a specific condition. The diagnosis could be anything.

But despite saying that, not saying to pattern recognise, we'll spend the rest of this lecture purely doing pattern recognition. Now there are many different jobs that working dogs perform, and I'll focus on these common for so that we can give the talk some structure, but there will be a lot of overlap. So we'll run through dogs who are working in law enforcement, we'll look at farm dogs as well as then sort of scent dogs, so detection, search and rescue, as well as service dogs.

So dogs that work for the police or military are often shepherds, Belgian Malais. And for these dogs, a lot of their work is all or nothing. They can be contained for long periods of time, say within a vehicle, being sort of stationary, relatively confined, and then suddenly released into action.

And this gives them no chance to have a warm up. And as with any athlete, this can predispose to an acute muscle strain. Now, acute muscle strains can be minor and often go unnoticed, maybe resolving within a few days, or they can be more severe with significant swelling and bruising to the skin from an underlying hematoma.

As we can see in these two patients, significant bruising to the skin and a notable swelling on the inside of this limb. And for some of these more severe injuries with this sort of significant changes, these can take much longer to heal, as you say, weeks or sometimes months. Now, tearing of muscle fibres can either occur acutely, as we previously mentioned, this might be a sudden tear as the dog runs out from the car, or it can be from a repetitive chronic tear that's from tissue overuse.

And it's also noteworthy that muscles are more likely to be injured during an eccentric contraction. So an eccentric contraction is when the muscle is becoming longer and it's lengthening but still contracting. So example would be if you were doing bicep curls, as you lift that weight from down by your side up towards your shoulder, your bicep muscle is contracting and the muscle is becoming shorter.

And that's called a concentric contraction. Now if you want to lower that muscle back down again, you still contract your biceps muscle, but the biceps gets longer as the weight and your hand moves from your shoulder down to your side. And that's what we call an eccentric contraction.

And it's this type of contraction when the muscle is more likely to sustain an injury. Now there are different severities of muscle strain, and there are different grading schemes. The most common grading schemes tend to use 3 different grades, and this is what you'll most commonly find in the veterinary literature.

But some other grading schemes can be much more complex, like this is an example from the, the British Olympic team for human athletes, and this involves various, other descriptions and changes such as changes seen on MRI imaging to help them with their grading of the muscle strain. But if we go back to our sort of more commonly used three different types of grade, then a grade 1, this is whereby the muscle archi architecture remains intact. So there isn't really any sort of tearing as such of the muscle.

And only a small amount of the muscle is involved. You maybe get some focal edoema or haemorrhage. Nothing quite as severe as shown on the previous slide.

And these will typically resolve within a week. So these will be something that in general practise. You'll see very often, perhaps people bring their their dog in worried that they've gone lame.

They'll have some rest, maybe some analgesia. Within a few days or a week they suddenly seem to have resolved and and be OK. Often a exact diagnosis is never found, but it's probably a, a grade one muscle strain.

More progressive then would be a grade 2 strain, and in these we do have some partial tearing. And this can result in reduced strength of that muscular tenderness unit. But the muscle has not completely torn, so some of it will still be intact.

Now these will take longer to heal and sometimes may not completely heal. And the lameness can go on for much longer duration. And particularly if these aren't given time to heal, there is a risk of re-injury.

So that same muscle that doesn't heal completely can become much more susceptible to becoming injured again. Now a grade 3 is where we have a complete tear or or very significant tear, and this is whereby we'll have a complete loss of function of the muscle because the two ends no longer join up. And for a situation like this, surgery would commonly be indicated to repair those ends together.

So this would be an example of a complete tear to a muscular tenderness unit with the stifle joint in extension, you should not be able to flex the hock to this degree. So this shows us that within that gastronemius common calcineal musculo tenderness unit, there has been a complete tear. Now muscle injuries could happen to any muscle, but they're more commonly seen and more commonly described in particular muscles.

And as I say, often these are ones that are at risk of an eccentric contraction. So the Iliosois would be such an example. Whereby if you have a a muscle tear or injury, you can, these can be quite painful, particularly when you're palpating them and when you stretch the muscle.

So to stretch the ileosois, you would want to extend the hip joint and internally rotate the femur because of the muscles attachment to the lesser tracanter of the femur, doing this type of manoeuvre will put that muscle under maximum stretch. And if dogs do have a. Injury, they can often be really quite painful when you're doing that test, so just watch out, they don't turn around to try to get you because it can be, can be particularly sore for them.

And on radiographs and CTs sometimes it can be possible to see physiohyte formation at that lesser trachanter. So this is a CT scan of a more sort of normal side. The slice taken shows that there's no real sort of new bone here, but on the affected side we can see this, this remodelling, and on the radiograph you can just make out the lesser tracanter on this normal side, whereas on the affected side, we've got this new bone formation at the insertions.

This is anhesophyte formation. Now the rest of the muscle and soft tissues you wouldn't be able to see on radiographs or on a CT but you could detect them on MRI or ultrasound. And if you do have this entheophyte formation, this would typically indicate that this is more of a chronic injury that's been going on for a while to cause this mineralization to form.

So you wouldn't expect to see this with an acute injury, but this would occur with a more chronic, particularly if it's a repetitive injury to that muscular tenderness attachment. Another example, that you maybe find, you can come across and, and you'll maybe read a bit more about in the literature is the, the Sartorius. This is another hip flexor muscle.

And as dogs are running or jumping, their pelvic limbs will be extending behind them as they propel themselves forward. And then if they are suddenly contracting those hip flexures, hip flexor muscles, then that's whereby they can become predisposed to an injury. Again, these saltorious injuries, if the muscle is swollen and painful, it's often relatively easy to palpate on the cranial aspect of the, of the limb.

Now, in this example, we can see there's actually marked mineralization within the muscle. This is something that you wouldn't normally see. This, this would be very uncommon, but it just hacked as a nice little way of showing anatomy and showing where the sartorius muscle is located.

And this is where you would palpate that muscle. And then there's a muscle condition that I think we all hate, and that's the gracillus contracture. This can be easy to diagnose, but very challenging, almost impossible to treat.

So if you watch the Left limb of this shepherd, we'll see a little flick of the hook, and there it is, that little flick. Takes the next stride and flick is that internal rotation of the ears relative to the rest of the limb. And this is because that muscle has contracted, it limits the amount or limits the range of movement present within the joint, and therefore, the muscle reaches its maximum length and it then prevents normal movement and you have this characteristic flick.

So these can be very easy to spot and if you were to go and palpate that muscle, you'll feel it will be very firmer, often like there's a a a fist within the muscle, this kind of swelling. Now, treatment, as I say, presents us with a real challenge. Subjectively, early physiotherapy may help to slow the progression down and if you do diagnose such a case, this is what I would recommend that you do.

Surgery has been described to actually remove that muscle, but this only provides a benefit for a short period of time. Normally the remaining scar tissue or adjacent muscles start to fibrose and contract and within a few months you can end up in the same situation again. Now there is a a study that reported some promising results with some stem cells, whereby stem cells were injected into the affected muscle.

However, I have spoken with various colleagues who have tried this, and typically the results don't appear to be as good as what was reported in this publication, with most people seeing no improvement. So it might be something to consider, but the results that the vast majority of people get are not as good as what was reported in this, this study, and unfortunately does not appear to be at the moment, a particularly good treatment for this condition. So this is something that working dogs may be able to continue working with depending on what their role is, but it might be something that inhibits their ability to perform at a high level and therefore it may mean they need to be retired from the workforce.

Now, probably one of the most common problems that I see shepherds from the police force from is lumbosacral degenerative stenosis with neuro foraminal impingement of the L7 S1 nerve roots. So the last lumbar, the last disc in the lumbar sacral spine here, and then running next to it is branches of the sciatic nerve. And if we start to have protrusion of this disc and also hypertrophy of the ligaments above, so hypertrophy of the ligaments, protrusion of the disc and then mineralization can occur, and we can have compression of the nerve from new bone formations, spondylosis, or also from the disc protruding avaxia, so the disc protruding out to the side and putting pressure on the nerve.

Treatment of this can be conservative with rehabilitation, with systemic analgesia such as gabapentin or with epidural injections. Classically with epidural injections, steroids are used, so typically methylprednisolone. And there are a couple of different reports on how this can be administered.

One of the earlier studies in 2009, reported doing three injections a few weeks apart. But there are also studies that have shown having just a single epidural of methyl prednisolone can also provide a good result. And in humans, you would typically have a single injection, you wouldn't commonly have a, a course of them.

So there are different ways in which you could administer it either as a single injection or as a, a short course. For me personally, I tend to give one injection and then I'll touch base with the clients in a couple of weeks to see what kind of improvement they're seeing. If they're already seeing a very significant improvement with just the one injection, we'll maybe leave it at that.

If they report a mild improvement or maybe minimal improvement, then I'll consider giving a second dose. And there's also been a report out about using PRP or platelet rich plasma that might represent an alternative option. Now instead of medical management, can also consider surgical treatment.

This can either be with a laminectomy in order to increase decompression. And To reduce micro motion that may be contributing to bone and ligament proliferation, then you can consider a lumbosacral distraction fusion. This is whereby a spacer is placed between the bones, we have this metal conical spacer.

A screw is placed through a little groove within the spacer to stop it from rotating once it is in position. And then the bones are stabilised with this essentially like an internal external fixator. That will stabilise lumbosacral junction and prevent movement.

And in terms of working dogs, I would say it's around about 50/50 in terms of the police and military dogs as to whether they can go back to working again after they've had such a procedure. Now, thankfully, we don't come across gunshot and explosive injuries too often, but they can be sustained by working dogs in war zones. I suppose in in the UK, a gunshot injury is most likely to be accidental, such as a gun dog out on a weekend shoot.

And this Labrador unfortunately was caught with some shotgun shrapnel. Whilst out on a on a weekend shoot. Treatment to repair these fractures, and to fuse the.

Metatarsal phalangeal joints that were badly damaged. A particular type of external salletal fixit was used. And now this type of frame is called a pedal arch wire scaffold, PAWS or paws.

So the dog walks on its paws. Effectively, that means the dog walks on this circular frame and the toes are suspended off the ground so they're not weight bearing whilst the bones are healing. And then once the bones have healed, all of the frame is removed.

So we'll now move on to farm dogs. And farm dogs are commonly collies and Shelties. I don't know if you come across these teammate studies from New Zealand, but the authors put in an incredible amount of work.

They collected data over 4 years from 641 farm dogs, and they found that the joints most likely to be affected by swelling or a reduction in motion were the carpus and the stifle. And the joint that seemed to be most commonly painful was was the hip. So with regards to the, the carpus, the carpus can suffer hyperextension injuries, and these can either be an acute trauma.

Typically this tends to be a dog landing from a height, and all of their weight going onto the thoracic limbs as they try to brace themselves for their landing and they hyperextend. So previously treated a dog who. Sustained this injury whilst being out in a a battle zone and came jumping over part of a building, and there was a large fall to the other side and, and the dog ended up with a a hyperextension injury.

But in regards to our, our farm dogs. Our Shetland sheepdogs and rough collies, these appear to have a degenerative condition that can lead to collapse. So with hyperextension injury as we can see here, we can have this extreme, very flat-footed collapse whereby the dog is walking on the palmar surface of the paw.

In this example here we can see again this increased degree of extension. And you can see this on radiographs if you perform a stress view, so you might be a little bit faint, but you can maybe just make out here these little ropes. One is on the anti braum and there's another rope that's on the pore, and by tensioning these, we can take a lateral view and have an increased degree of extension seen.

This can be particularly useful if you're trying to work out at what level of the carpal joint the injury has occurred at as this might create more opening of that joint space. And I'll just drop back actually, you might have noticed this dog on the, the bottom right corner here has got this really affected limb, but the other limb is in a bandage. And that's because this dog was bilaterally affected.

So the right leg has just undergone surgery, but the left still has the problem that will require fixing. Now treatment usually involves a pancarpal arthrodesis. This is usually performed with internal fixation, so plates and screws.

And you can either unzip and open everything up, or you can do it in more of a Mepo approach. So for example, through 3 smaller skin incisions, keeping some of the skin intact. Therefore feel that this reduces the amount of postoperative swelling.

And if you did have a problem with incision healing, it may be just one of the three incisions rather than worrying about the whole thing opening up. And promisingly, 83% of farm dogs can return to work with a pancarpal arthrodesis, with 50% being able to perform all duties and a further 33% performing most of them. Now another limb disorder that these breeds can be predisposed to is luxation of the superficial digital flexor tendon.

Now feeling this sort of popping sensation you can see in the video when you diagnose one of these is really, really satisfying, particularly if these cases have sort of come in and been referred via neurology for an unusual skipping gait, and on the radiograph you noticed a, a subtle thickening in this area, and then when you go and examine the patient, you have this obvious luxation of the tendon over the calcaneus. And if we open them up, we'll find some torn retinaculum, and this is the little groove on the back of the calcaneus that the tendon runs in. And I've found that just by imbrating their retinaculum, this can often be suff sufficient at curing the problem.

Some people have described deepening this groove, but in most situations that's not required. And then I tend to pop a little support on for a few weeks afterwards just to limit some motion whilst that tissue is healing. Also these farm dogs, they might get their foot caught in a cattle grid or stood on by a sheep, and they can sustain fractures to the metacarpals, to the digits, or to the little sesamoid bones as well.

And then from the bottom of the limb to the top. Border collies are also predisposed to shoulder osteochondrosis. So this is whereby on the radiographs we might see a flattening or a concavity to the humeral head.

If we were to look inside with the arthroscope, we can then see this little crater or this cartilage erosion. And if you do look inside and you see that the flap has gone, always be wary that it could have moved and ended up down in the region where the biceps is, and this could cause impingement. And we can see this is a mineralized flap that has been removed.

Now in terms of treatments, we can remove the flap, and that will often result in a significant improvement to the lameness. And in order to try to encourage some fibrocartilage forming, you could perform micropicking to the exposed area. This is where you would create some little small holes within the subchondrial bone to try to encourage bleeding in order to bring some.

Substances that can cause healing up to the surface that may form a fibrocartilage. Or if you have a particularly large defect, you may want to resurface that area. And resurfacing could either be done with a graft.

Or you could use a synthetic implant such as the sinacart from Arthrex. So this imp implant has a titanium metal backing that has a honeycomb appearance that will allow the bone to ingrow. And then over the top of that is this plastic surface that is then ultra smooth to allow you to have a smooth surface.

So for smaller lesions, it may be fine without resurfacing, but for larger lesions, my preference would be to resurface them. For small lesions, if you are just removing the flap, that can also be done arthroscopically in order to minimise patient morbidity and provide a quicker recovery. So sticking with the shoulder, we can get problems with the biceps.

Now, biceps problems are often secondary to impingement of a mineralized supraspinatus muscle. So as we can see in our little anatomy diagram, the supraspinatus is running down over the shoulder and the tendon of insertion is very close to the origin of the biceps. And therefore if we had had an injury and we had some mineralization and swelling of this supraspinatus, it could lead to impingement of the biceps.

So this is a a cross section, a transverse image through the humerus with the articular surface towards the back. This is the greater tubercle and this is the little groove that the biceps would run in. So the biceps would be in this area and we can see this mineralization of the supraspinatus.

So if our biceps is in here, we can get impingement from this mineralization. And if we look inside arthroscopically, we can maybe then start to see some fraying, some inflammation, some tenosynovitis of the biceps. Additionally, we can have new bone forming within that biceps groove of the humerus.

So this is a, a series of slices through, so this would be our groove, and as we look through, we can sometimes get these little spurs of bone. Now you can imagine that the biceps tendon is in here, running up and down and it will be rubbing on this section of bone, causing it to become inflamed and painful. Potential treatment options for the biceps can include either trying to remove some of these bony spurs or the minimalization within the supraspinatus, but there is a risk that they may reoccur.

Therefore, another option would be to transect the biceps tendon and therefore allowing it to drop out of the way and therefore it will no longer become impinged. Either you can just transect the biceps and leave, leave it, or a tenodesis whereby it is reattached to the proximal humerus below this groove can also be performed. Now we can also get a condition that is sometimes referred to as medial shoulder syndrome.

Now this is a repetitive grade 2 strain injury to the subscapularis muscle, and a sprain injury to the medial gland or humeral ligament. They are the supporting structures on the medial side of the joint. And as we mentioned, sometimes we can get enthesophyte formation at the insertion of some of these soft tissues.

So we can imagine our medial collateral ligament running between the medial side of the glenoid to the humerus, and over the top of that will be the subscapularis muscle. If we were to look inside arthroscopically, this band here would be our ligament and the subscapularis is just in behind it. Again, we can see on this diagram are medial glomahumeral ligament.

Now with these cases, you will typically have pain on abduction of the shoulder, particularly when that shoulder is placed into extension. So to perform this test, you should put the shoulder into full extension and then attempt to abduct the humerus away from the body wall, keeping the scapula stabilised. This will put stress on the medial side of the joint and result in discomfort for the patient if they are suffering from this condition.

Now these injuries are very commonly described in agility dogs who are changing direction repetitively and very quickly, so you can imagine the dog going through the poles, wheezing in and out, doing this repetitively and having these repetitive injuries to the muscle, and if they are not allowed to chance to heal, then they can become more chronic. I've also seen quite a lot of dogs who would be the complete opposite to your agility or working dog. This would be some small chondrodystrophic breeds such as miniature dachshunds or shih-tzus who appear to suffer from this medial shoulder syndrome.

And I suspect we have these dogs who are up on the couch jumping down. They have short legs and a relatively heavy body, landing on the wooden or laminate or tiled floor that's very slippery, and their legs slipping out from underneath them, and therefore putting a huge strain on those adductor muscles on the inside of the shoulder. And these dogs often tend to be quite yappy dogs, often quite busy, wanting to see what's happening.

So you can imagine that somebody walking past the window of the house or the doorbell rings and the dog is jumping down and running off barking, doing this over and over again, and therefore maybe predisposing themselves to injuries on the inside of their shoulder. These, these strain injuries typically would be managed conservatively, so often physiotherapy, potentially using a, a shoulder hobble system, and this will prevent the limb from abducting whilst the tissue is healing. And you can also combine that with regenerative medicine, such as platelet rich plasma and also consider the use of shockwave to try to stimulate healing.

Often if you have these chronic repetitive grade 2 injuries, the, Body almost starts to shut down, we, we have these tendinopathies or tendinosis whereby there's actually no active inflammation going on. And without inflammation, tissues can't heal. So with regenerative medicine or shockwave therapy, we're actually trying to reinitiate a healing process.

And then, unlike the previously described medial shoulder syndrome, which is whereby everything is stable, we can have medial shoulder instability. So this would then be our grade 3 type of muscle tenderness injury. So we can see the more normal side in this patient, a more normal degree of abduction, and in this side, the affected side, there is a much greater degree of abduction.

And this can be measured using a a goniometer. There are some studies out there that describe normal and abnormal angles. There can, however, be quite a lot of variability between individual dogs and between breeds, particularly if patients have had a, a lameness that's resulted in muscle atrophy, often you'll get an increased degree of abduction just from that, that muscle loss.

So I wouldn't rely too much on the quoted figures, but compare maybe one side to the the other. And you really wanna be able to see quite a, a dramatic change to sort of confirm the diagnosis. So it seems like it's kind of borderline, it might be that there is actually not instability, but some increased laxity due to, another reason.

And in these cases, if you do have instability, often these guys are more heading towards the, the surgical table and having a replacement of a ligament such as in its situation, a tightrope has been placed, would be a ligament running from the glenoid to the humerus and anchored by these buttons. So again, these will be a grade 3 injury, complete tear, instability, marked increase in abduction, and therefore we're often aiming for a surgical repair of these injuries. So, detection, search and rescue dogs can often be spaniels.

And other than being crazy and full of energy, what's the next thing that comes to your mind when you think about spaniels? Humeal intracondylar fissures. And why do we now tend to refer to them as a a HIF rather than IOHC or incomplete ossification of the humour condyle.

And that's because, yes, in some dogs, it might be that there's a true incomplete ossification. So in this patient, we can still see that this physis is opened, but the fisy between the condyles has closed. On this side it is still open.

We can see that here on the radiograph. But in some books we have seen that there is no fissure present when they are young. The condyle has completely healed, but a fissure has then formed.

And we can see some dogs who by there's a partial fissure present, and if you were to do sequential CT imaging, you can actually see those fissures progress. So for example in this dog, we can see that there's some sclerosis to the back of the humerus, and then over time, when a CT scan was repeated, we can then see this fissure that's forming. It hasn't gone all the way across yet, but the sclerosis is progressing.

Likewise on this frontal view, we can see there is no fissure at this time when the scan was performed, but at a later date, the fissure has formed. And if you were to look at these arthroscopically, you can see the fissure forming here at the back of the humeral condyle. And in every case that I've seen, the fishes always appear to start quarterly.

They never seem to start cranially and go back, they always seem to start quarterly. So this has led many surgeons in the, particularly in the UK now, to think that these are actually stress fractures, caused by increased pressure between the anineal process of the ulnar and the caudal aspect of the humerus. Either this anineus hitting the back of the humerus like an axe or it trying to prize the humerus apart because it doesn't fit perfectly and trying to wedge it open.

So these cases, typically the fissure, if it is causing lameness or if there appears to be a significant risk of fracture occurring, then these will be repaired with a transcondylar screw in order to stabilise that fissure. And if you do believe the theory that there's incongruity of the elbow, you could also consider trying to improve the elbow fit or taking pressure off between the ulna and the humerus by performing an an ulnar osteotomy. Now some of our search and rescue dogs might be dogs that are performing search and rescue in water.

And therefore this might predispose them to acute caudal myopathy or limber tail cos swimming appears to be a predisposing factor, although any type of vigorous exercise can result in this condition. So we'll finish off with our service dogs, and service dogs typically tend to be Labradors, and these dogs perform an array of different jobs and roles and are an absolute huge help to hundreds and thousands of people for the incredible work they do to to improve their day to day lives. Now, Labradors are predisposed to hip dysplasia and elbow dysplasia.

But frequently these working dogs will come from good breeding lines with good hip and elbow scores, and often these conditions can be diagnosed from a very young age, meaning that those dogs who have these problems may not go on to a working career. So if you were seeing a working dog, it's probably unlikely it's gonna need treatment for something like hip dysplasia. So probably unlikely to be looking to perform a DPO or a a hip replacement.

However, if you do have a dog that has a thoracic limb lameness, and the client says to you that this dog had a perfect elbow score when it was younger, it's parents had a perfect elbow score, the lameness is definitely not due to its elbow, and it doesn't matter how much they try and convince you, it might still be the dog's elbow. This is a dog who had its elbows scored when it was younger and it had a perfect score of 0, but we can see now that there is fissure and fragmentation to the medial coronoid process, there is evidence of osteophytosis affecting the joint. So although it maybe reduces the chance of these conditions forming by having these breeding programmes and scoring systems, it doesn't mean that the condition won't occur at all.

And if we were to look inside this dog's elbow with us. Proscopy and there is some wearing of the superficial cartilage on the medial conno process and the opposing surface of the medial aspect of the humeral condyle along with synovitis within the joint. And I said to keep an open mind, so common things are common.

Degeneration of the cranial cruciate ligament, stifle instability, and subsequent meniscule injuries are gonna be common in all dogs. So, we can see in the video that we have this torn cranial cruciate ligament. The caudal cruciate ligament is intact just behind it.

In the radiograph we can see that there is evidence of an effusion within the joint. There's degeneration with paraarticular osteophytosis noted around the femoral trochlear and also at the insertion of the cranial cruciate ligaments at the cranial aspect of the tibial plateau. There's also some around the caudal aspect of the joint as well.

And I know a significant finding on the radiograph is that the tibia is hugely subluxated cranially relative to the femur. So the femoral condyles, the centre point of the femoral condyles should be over the centre of the plateau, so there's this huge displacement. And it's always important to check the meniscus if we have a rupture or degeneration to that cranial cruciate ligament.

So I say we'll have some instability as the ligament is tearing, and then if the ligament tears fully, we have this abnormal motion, and we can have tearing to the meniscus. So with our examination, we can do our. Cranial tibial thrust test.

So by holding the stifle in a fixed position, flexing the hock, we can see thrusting where the tibial tuberosity is moving cranial relative to the femur. And for this condition, we obviously have a range of treatment options. Surgeon can choose which option they feel is gonna be best for them and that individual patient.

For me, I prefer a TPLO, small approach, a very large strong plate, and then you can get these dogs back into an active recovery straight away. Hopefully therefore minimising the downtime and getting these dogs back to working quickly. So why is all of this important?

Why are musculoskeletal disorders in working dogs important? And it's because it can end their careers. Of dogs withdrawn from the guide dogs, most were due to musculoskeletal conditions, with 28% due to arthritis.

And 20% of military dogs can pick up an injury on their first deployment. Again back to some of these teammate studies from New Zealand, remember the large studies looking at the farm dogs, they found that dogs being lame at trot doubled the risk of the farm dog being lost from the workforce. So by understanding what musculoskeletal disorders working dogs can develop, this not only allows us to improve our treatment and rehabilitation, but can also allow us to focus on prehabilitation.

With exercises and conditioning programmes that may be able to prevent injury and keep these amazing dogs doing amazing things. Thank you very much for listening. I hope you enjoy today's presentation.