C10023328 / invoice 10000

REASON: RIGHT thoracic limb lamenessREFERRING VETERINARIAN: Tarryn @ Greencross Vets SubiacoHISTORY:Young dog presented following an episode approximately six weeks ago at dog daycare where he reportedly jumped off play equipment and landed awkwardly. Following the incident he developed an intermittent limp affecting the RIGHT forelimb. The lameness persisted intermittently for several weeks, often improving after a few days and then recurring. Over the past couple of weeks the owners have not clearly noticed the lameness. The dog remains very active with no reported issues jumping onto furniture or general activity. The referring veterinarian raised the possibility of forelimb orthopaedic disease and potential hip concerns, although the owners have not observed any hindlimb abnormalities.EXAMINATION:Gait: no lameness in consultLEFT Thoracic Limb: No specific abnormalities detected on palpation.RIGHT Thoracic Limb: Mild reluctance to manipulation of the shoulder compared with the contralateral side; no obvious instability or dislocation palpated.LEFT Pelvic Limb: Mild reluctance to hip extension.RIGHT Pelvic Limb: Mild reluctance to hip extension.ASSESSMENT:History of intermittent RIGHT thoracic limb lameness following a jumping injury. Mild discomfort noted on manipulation of the RIGHT shoulder. Exact source of lameness cannot be localised on physical examination.PLAN:CT scan of both forelimbs to evaluate the elbows, shoulders, and other forelimb joints. While under sedation/anaesthesia, hips will also be palpated and assessed.CLIENT COMMUNICATION:Discussed that physical examination findings are subtle and do not clearly localise the source of lameness. Advanced imaging was recommended due to the history of persistent lameness in a young dog. CT was recommended as it provides detailed evaluation of the forelimb joints and is more sensitive than radiographs when multiple joints may be involved. The patient will remain in hospital for the day for the CT scan and sedation, with discharge expected later in the afternoon once fully recovered. Insurance processing was discussed and will be completed prior to discharge where possible. Further treatment recommendations will depend on imaging findings and may range from conservative management to surgical intervention depending on the diagnosis.GENERAL ANAESTHESIAPremedication: dexmedetomidine/methadoneInduction: propofolMaintenance: isoflurane in oxygenCOMPUTED TOMOGRAPHYRegion scanned: bilateral forelimbs (focused scans on shoulders and elbows); bilateral hindlimbsImaging findings: no abnormalities seen in hindlimbs. RIGHT shoulder has hypoattenuating region in the caudal glenoid, only subtly larger than the contralateral side, which could be consistent with ununited caudal glenoid or damage to the labrum. Soft Ortolani positive RIGHT hip, negative LEFT hipPLANRecommend no specific treatment. Monitor both shoulder and hip and manage symptomatically if needed.     Vital Signs