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Second Aloha Laurie,

Second case:

2) Gracie, 3-4 yr old FS Hound Mix. Adopted when she was 1 yr of age
with angular limb deformity. Xrays were taken a while ago that showed
a significant radial bowing, as well as the beginnings of “step” at
the elbow joint. Initial surgical intervention with corrective closing
radial wedge osteotomy was discussed, but the owner elected not to
pursue.

Despite the degree of abnormalities, Gracie is quite functional: she
goes on 2-4 mile hikes often, plays at the beach weekly, and enjoys
daily walks. She is currently on Adequan, solid nutraceutical plans,
and receives maintenance acupuncture/laser.

Over the past 4-6 weeks, I have observed mild biceps, deltoid, and
supraspinatus atrophy, as well as mild biceps tendonopathy. She is
also developing moderate skin thickening/irritation from where the
deformed part of her medial paw rubs against the ground.

Based on these new findings, we initiated more targeted exercises for
shoulder strengthening; however, I was wondering if you had
suggestions for a custom carpal brace, which may help protect the paw
and potentially facilitate more weight-bearing throughout the limb?

Pics of each patient are attached.

Thanks for all you do!

J

Hey again!

So... just to cover bases. Whenever I hear deltoid & supraspinatus atrophy, the alarm bells go off in my head to put Nerve Sheath Tumour into the list of differentials. I would be remiss if I didn’t pass that along.

Now, let’s assume it’s as the result of decreased use… which is a bit odd to have in combination with a biceps tendinopathy… and so I bring back the Tumour thoughts.

Okay… and again, back to the shoulder. I honestly wouldn’t worry about trying to combat the atrophy if it’s there from non-use. And I’d focus on modalities for the biceps as compared to exercise. That part of the limb is most likely secondary to her funky lower limb.

So, if we focus on the lower limb. 1) I’d look at the development of the callus or ‘pad extension’ as a positive. She needs that. With the limb deformity, she needs a roughened surface that can put up with weight bearing. I’d treat around the side (the skin irritation), with laser… and wish that callus good luck! Alternately, you look at manually creating some kind of bootie…but that may just be asking for that foot to get more manky and musty!
Ohhh… and if you can drum into their head about keeping the toe nails short… that would likely be great!

Which takes us to the carpus. This may be the joint that has the greatest impact on the rest of the limb. Oi! This one is not so cut and dry.
Again, I’d try wrapping the carpus to see if it helps or hinder the joint.
And in this case, I’d send these pictures and a video of gait, off to Ben at Hero to see what he thinks. To me, this is either a ‘bigger case’, requiring something radically customized… or a ‘leave it alone’ kind of a thing.

That’s what I’ve got on this…

Hope that helps…

Mahalo,
Laurie