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Hi Laurie,

I am a physiotherapist currently completing my Masters in Vet Physio with Liverpool University. I work part-time with at a Small Animal Specialist Hospital. I have a complex patient who is now 2 years post FCE which I inherited from a colleague. 12 months ago the dog became NWB lame on the left forelimb from a presumed accident (unwitnessed). We have tried several methods to encourage this dog to use the limb again with little success. The dog has developed a 40 degree loss of extension on the left carpus, which appears to be almost fixed. The SDFT/DDFT tendon complex is shortened but there are also carpal joint changes. I am at a cross-roads with this case and would like to discuss further with yourself if possible, as I feel there are a number of factors to consider in the long-term management of this case.
Do you think you would be able to help here? I can certainly send through a video and case history for you.
Any help would be greatly appreciated.

Kind regards,
K

Hi K.,

This does sound like a complicated case. Hard to say if I could be of benefit without being able to get my hands on the dog.
What / where was the damage a year ago when the dog was NWB? What was the diagnosis then?
What did the FCE affect? A front limb, hind limb(s)? What residual neurologic signs & symptoms are left?
How does the front limb assess now in regards to neuro function, as well as joint / muscle assessment throughout that limb?
The carpal & SDFT/DDFT might simply be there as a result of NWB / non-use. It’s the rest of the leg that will determine whether you ‘care’ about the carpus / digits.

To be honest, I don’t have time to dig through a whole file with 2 years of data… but if you can break it down and/or answer the questions above, then I might be able to give some thoughts to a case such as this.

Also, my words of advice would be “Don’t forget you’re a physio.” (I see this a lot where new-to-rehab physios forget they’re physio brains when they run into a complex case… because it can be so overwhelming.) So, sit back a moment and piece together, the problems, & the likely root of each problem. What would you expect to find with each ‘presumed’ diagnosis? What are the top 3 differential diagnoses you can come up with? How would you assess for each? Treat for each? What would you expect in regards to outcomes after treatment? Do you change your primary diagnosis / thought? This is actually the process that you will be made to go through in one of your second year classes when you have to present a case study. It’s a great way to turn on your physio brain… especially with a case like this.

Thinking along the lines of: What would cause sudden onset and 1year later un-resolved NWB? (I would throw brachial plexus lesion into your thinking as something to assess for - nerve function. Can you get a muscle contraction with e-stim of the triceps, carpal flexors / extensors? Reflexes? Sensation?) At this stage, you now also need to process, “What’s primary (aka the root of the issue), what’s secondary (i.e. because of being NWB for a year), and what’s residual (FCE related)"?

So, yes, I might be able to help… but I’m going to ask you to do a bit more of the ‘heavy lifting’… in regards to putting it together to present back to me.
(Sorry, sounding a bit like a teacher there, eh!?)


Okay, back to you!

Laurie