C10005711 / invoice 10000

REASON: LEFT thoracic limb lamenessREFERRING VETERINARIAN: Susan @ Vetwest Whitfords; primary  care veterinarian Marmion Vet CentreHISTORY: Intermittent LEFT forelimb lameness first noted around July last year after running on the beach. Initially mild and intermittent and sometimes associated with exercise. Owner suspected possible paw injury due to sand or uneven ground and signs temporarily improved. Lameness gradually became more frequent toward the end of the year. Local veterinarian performed radiographs and removed debris from the paw as a possible cause of discomfort. Radiographs reportedly showed no obvious abnormalities. After healing from the paw procedure and resuming activity, the lameness became more apparent again. Lameness appears to worsen with increased activity such as running and digging at the beach. Some days the lameness is more obvious than others. Dog has never been completely non-weightbearing. No known lameness as a puppy. Highly active lifestyle.Medications: Meloxicam prescribed by referring veterinarian.Imaging: Previous radiographs reportedly unremarkable.EXAMINATION:Gait: no obvious lameness in consultLEFT Thoracic Limb: Resistance and discomfort elicited during elbow manipulation, particularly with pronation/flexion. Paw lesion on digit 5 - erythematous erosion RIGHT Thoracic Limb: No significant abnormalities detected on examination.LEFT Pelvic Limb: No significant abnormalities detected on examination.RIGHT Pelvic Limb: No significant abnormalities detected on examination.ASSESSMENT: LEFT elbow pain with intermittent LEFT forelimb lameness. Radiographs unremarkable. Differential considerations discussed include fragmented coronoid process or other elbow pathology. Paw lesion may also represent a potential contributor to pain.PLAN: CT scan of the LEFT forelimb including the elbow and entire limb to further investigate the source of pain. CLIENT COMMUNICATION: Discussed that radiographs can miss certain elbow conditions. Fragmented coronoid process explained as a common cause of elbow pain in retriever breeds and may not be visible on radiographs but can be detected on CT. Explained that other soft tissue causes such as biceps tendon pathology can also cause forelimb lameness and may require further investigation if CT findings are unremarkable. The entire limb will be scanned to help localise the source of pain as manipulation of the elbow can also stress nearby structures such as the shoulder. Paw lesion discussed as a possible contributing source of pain if imaging does not identify elbow pathology. Insurance status discussed. Potential arthroscopic surgery discussed if a fragmented coronoid process is confirmed. SEDATIONPremedication: dexmedetomidine/butorphanolCOMPUTED TOMOGRAPHYRegion scanned: bilateral forelimbs; focused scan on elbows and shouldersImaging findings: no obvious lesions seen on imaging. Marked saliva staining around palmar aspect of LEFT manus; erythematous and erosive lesion seen as described. RECOMMENDATIONSNo obvious orthopaedic reason for lameness. Recommend primary care veterinarians continue care with focus on paw lesion - referral to dermatologist may be indicated.     Vital Signs