fourleg.com

Hi Laurie,
 
  I try to refrain from using your e-mail or website to answer all of my rehab questions, but I have tried to investigate this situation to no avail.

  Tomorrow a surgeon is sending me a 6 year-old Rotteweiler that has a radiocarpal bone luxation/subluxation after jumping repeatedly from a high place.  He very briefly talked to me about the case and thinks that I can provide a carpal brace and rehab in hopes of preventing the need for arthrodesis.  He would arthrodese this dog if it were smaller right off the bat, but would like to see if a non-surgical route would be satisfactory in this large breed dog.   

  Now, his tech spoke to the tech in rehab and said that he wants to board the dog here for 10 days for rehab.  And by 3rd person, it got back to us that the owner was wanting to leave the dog yesterday for the boarding and "intensive three times a day rehab sessions that the surgeon wants."   She's my first appointment tomorrow, and I need to have some direction on this case.  I can't imagine that the surgeon wants 3x/day sessions, and really, I don't understand the boarding part of this.  I am off today, but will speak to him tomorrow about the case.

  What is typically done with a radiocarpal bone luxation?  If a brace is needed, do we need to go with something as rigid like Ace Ortho provides, or something a little less rigid like Therapaw can provide? 

  What in the way of rehab is needed for this if it is being braced?  Do we take the brace off intermittently for ROM, LASER, or other?

  Thanks so much for your help that I so desperately need,

W.

Hi W.

So, here's your plan:
You want to assess carpal bone mobility and will likely have to mobilize the radial (and possibly ulnar) carpal bone(s) cranially (think of getting them out of the way in order to flex the carpus).  You can e-stim the carpal / digit flexors, and you can do a little laser for pain relief.  I think a Therapaw Carpoflex with a thermoplastic splint is in order.  
But here's the thing...

This is acute - there is swelling and inflammation - good.  You want / need that stuff to get sticky and hold the bones together - in the right position. 
You DON'T want to laser it daily.  You DON'T want to exercise it extensively.  You want pain management but not a total cessation of inflammation (i.e. pain med, not NSAID).
You want to maintain the position of the carpal bone, & use the splint to hold the joint in place.  
Give that 4 weeks, and then you can allow for exercise... while gradually reducing the 'firmness of your splint' (i.e. remove the thermoplastic, then remove the velcro support straps, then remove the padding, then remove the splint... all in sequential order. When you try a higher intensity of exercise (i.e. trotting), then add an element from what she can do at an easy walk).
I'd treat this dog once a week - check and mob carpals, laser, some e-stim, ROM (other joints + carpal flexion)... (yes with brace off for this)  :)
Otherwise the brace is ON whenever the dog us using the leg.  If the dog is not supervised, then she needs to be crated / not walking around freely.

Boarding makes no sense.  Intensive rehab makes no sense.
You can't speed up 'tightening' and 'allowing for fibrosis' in order for this joint to solidify.
Sounds like you have educating moments ahead of you!!!  

Intensive rehab doesn’t make sense, unless you own a magic wand... in which case only ONE intensive magic wand session will be required!!

I hope this helps!

Laurie