I hope you are doing well and that you are willing to give me your opinion on a case.
I will share the video the client made for me with you.
The case is a 9 yr FS Chocolate Lab that had a lateral suture for cruciate rupture first on the left in early 2017, then on the right in Sept or Oct 2017. Claw foot on the right was noted in Nov 2017 and diagnosis of Achilles rupture. Surgery (3 loop suture) was performed and a cast was placed. She reacted to the cast so changed to robert jones bandage for 6 weeks and now no support. I was contacted at this point because of her current level of lameness, atrophy and drop in the right hock.
I saw her on Friday night (2/16//18) and honestly I am not completely sure how to proceed (attempt rehab or back for surgery).
She has significant atrophy of the right hind
Thigh is 2 cm smaller on right than left
Hock is swollen 3.5 cm larger on the right than the left and measurement across the insertion is 1 cm greater on the right than the left. She is weight shifting forward and has tightness in the triceps, latissimus dorsi and both iliopsoas muscles. I suspect she is atrophied on both hind from previous ACL surgery on the left.
I can feel the suture and suture knots in the tendon and it feels like everything is still intact. My concerns are though that when she weight bears her toes curl under a bit (similar to claw foot position) when she is not weight bearing the toes rest in a normal position.. She still has significant scarring and irritation from the dermal reaction to the tape so she is not in a brace of any kind.
My thoughts at this point are short walks flat surface, passive range of motion of the hock and try to get her into an underwater treadmill if possible. Then progress to assisted sit to stands and having her wear a boot for 1-3 minutes on the opposite forelimb.
I am a bit nervous about a brace because of the reaction she has had to tape and cast material. Plus owners are a bit tapped out financially. I have looked at a neoprene type brace but not sure that will give us support she needs. Also she did not react well to gel for E stim and the beep of my laser scares her so I have to desensitize and countercondition slowly to that.
Any advice is as always greatly appreciated. i am sharing videos of her walking with you so you can get an idea of how she moves.
My main question is do you think rehab is appropriate at this point or should I be sending her back to the surgeon (last appt surgeon talked amputation or euthanasia so owners are not excited about this option to say the least
)Thanks again
LR