It's Wednesday morning and your first consult is a limping dog. You nod...you've got this. Upon examination you cannot find any evidence of joint pain, muscle or bone pain. Not deterred, you radiograph shoulder to foot. Nothing of interest is visible.

What if the lameness is neurologic in origin, you ask yourself?

The most common causes of neurologic lameness in dogs are cervical disc herniation and nerve sheath tumors. Most dogs have neurologic deficits along with their lameness so it is worth a close look at the neurologic examination. Deficits could include reflex deficits, postural reaction deficits and/or pain.
Side note: Did you know that lameness from a neurologic cause is called a root signature sign?

Cervical Disc Herniation
Cervical disc herniation with resulting nerve root impingement occurs from type I or type II disc herniation. Many dogs have cervical pain along with the root signature sign, but not all. Cervical radiographs are non-diagnostic for cervical disc herniations and therefore not often recommended. MRI or CT/myelogram are the diagnostic tests of choice with MRI providing greater detail. Treatment may be medical or surgical. My recommendations for medical management vary by pet, but typically include a NSAID, gabapentin and a muscle relaxant. Additional management with opioids can also be included. Best rest is often recommended for the first 3 weeks. Surgical management is recommended for medically resistant dogs, or if the MRI or clinical signs are severe.

Nerve Sheath Tumor
Nerve sheath tumors are typically slow growing, locally invasive (eventually into the spinal canal) tumors. These are best diagnosed with MRI. Definitive treatment is surgical removal. If surgical removal is not pursued, supportive care with pain management (NSAID or prednisone +/- opioid), muscle relaxant and gabapentin are recommended. Acupuncture may provide additional pain relief. The slow growing nature of nerve sheath tumors means that clinical signs may be present for months before the pain or debilitation becomes life limiting.

Not sure if the patient you are seeing has neurologic disease? This is one of the main functions of a traveling neurologist (me!). Sorting between orthopedic and neurologic causes of lameness can be challenging, especially if you're not comfortable doing the neurologic examination. Please reach out, you're not alone! You can find me on email, or schedule directly online using my website.

Okay, now that we got that out of the way, enjoy that Wednesday morning lameness evaluation!

Happy St. Patty's Day everyone. I have two kids that do Irish dancing so we're really missing the festivities this year, but we look forward to celebrating next year.

Stay safe, stay kind, and I look forward to working with you soon!