Tail-pull injuries, or sacrocaudal luxation, in cats can be challenging, as no definitive prognostic indicators exist. Varying degrees of trauma may occur, and the luxation may not be immediately apparent if other injuries (eg, trauma from traffic accident) necessarily take precedence for patient stabilization. Paraparesis is often transient; the most severe sequelae are anal sphincter and bladder dysfunction. Clinical findings may include reduced hopping reaction and paw placement and reduced withdrawal reflexes in the pelvic limbs, although the limbs may appear normal. Perineal reflex may be reduced or absent. Tail nociception should be evaluated by closing forceps across the bones of the tail, preferably at its base, without applying traction. The caudal lumbar spine, sacrum, and sacrocaudal junction should be palpated gently to assess for malalignment or signs of discomfort. Bladder size and turgidity should be evaluated with abdominal palpation. Plain radiography, history, and clinical signs are often sufficient for diagnosis. Return of urinary continence, which may take weeks, is the most important long-term prognostic factor. Conservative management includes cage rest and analgesia, but amputation is indicated with a degloving wound or permanent loss of sensory and motor function. Urinary incontinence is best managed with regular manual expression of the bladder (q12–24h), but a cystotomy tube may be placed if owners find this difficult.
Although tail-pull injuries may not be common, veterinarians need to be aware of their overall prognosis, management, and treatment. This article provides an anatomic overview of these injuries, focusing on examination and neurologic findings for localizing the lesion and estimating return to function. The following interesting take-away concepts were covered: up to 84% of cases had concurrent injury (eg, pelvic fractures, abdominal trauma), testing for tail nociception has most prognostic value when performed at the tail base, and timing of return to function is 13 days on average.—Justine A. Lee, DVM, DACVECC