fourleg.com

I need help with a case.

Bear is a 7 year old intact male lab.
He had surgery to repair a left subscapularis tear in January. The surgeon placed him in a velpeau sling for 8 weeks post-op. I met him after removal of the sling. I've only seen him twice.
On exam, he is non-weight bearing on the left front leg because he is unable to place his foot on the ground. He lacks extension in the elbow and carpus, and these two joints have a firm end feel on extension. His toes also feel stiff. He has severe muscle atrophy and trigger points in biceps, triceps, infraspinatus, and supraspinatus

I'm concerned that his decreased ROM is due to joint capsule and muscle, so:
I've done some joint mobilizations - this is not what I am most confident with, and I find the carpus easier to deal with than the elbow.
I've treated the trigger points with dry needling, an acupuncture point stimulator, and massage.
I used NMES on the atrophied muscles, although tonight he didn't tolerate it and hid under a chair.

Any suggestions to improve range of motion are greatly appreciated.
Thank you,
Lisa

Hey Lisa,

Great question!

So, I find that dogs with contractures / shortenings tend to improve the fastest with active therapies. In other words, make them move that leg and reach and stretch it out.
You can do your part of stretching, mobs and dry needling, but the difference maker is going to be getting this dog to use the leg, to weight bear, to 'try'!!! If he uses it, he'll stretch out the toes and carpus better than you ever could!!

And in the beginning, ANYTHING will do! Here's what's coming to mind:
Crawling under (chairs, poles, whatever) to follow a treat
Slowly following a cooking while weaving around obstacles (straight line of objects or figure of 8 around 2 objects.
Walking down hill or down stairs. (Up is okay, it's just down works on weight bearing and extension)
Backwards walking on a treadmill
Simply standing and taking treats with the rear legs elevated on a step or stool and the front feet on the floor.
Progress to doing a push up - lure the dog forwards and down to take a treat - while the rear legs are elevated.
Any balancing using balance equipment. Simply having to balance can activate muscles. If you can, progress to it being a 3-leg stand.
Swimming or UWT if you have access, actually could be good here as well - really, as much to work the brain blockage about using the limb as much as actually using the limb!!
Walking over obstacles - slowly, and with the obstacles spaces at different intervals - so as to get the dog to accept weight on the affected limb at least a % of each step / obstacle.

This should be enough to get you started. And don't forget to test exercises 'in clinic' before sending the owner off with them as part of a home program!

Cheers,

Laurie

Thank you for your suggestions, Laurie.
I had him crawl under last week. I tried figure 8s, but he did them three-legged. I will try some of the other suggestions and let you know how he does.

Thank you,
Lisa

Update:

Bear's carpal extension has improved by 10 degrees. His elbow extension has improved by 5 degrees.
He can toe touch, but he still can't get his paw pads to the floor, so he can't weight bear.

He is doing well in the underwater treadmill. He reaches with the affected limb about 80% of the time while in the water.
He reaches with the limb when going up and down stairs, if I make him go slowly.
I've placed an inflatable ring underneath my wobble board, and he will use the limb (very briefly) for balance.
He reaches when he crawls under.
All the other exercises I've tried, he does on three legs. Will keep trying.

But also trying not to be disappointed or frustrated with his progress.
Do we need to worry about a time line for improvement?

Thank you,
Lisa