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I have seen 2 patients recentley with what's been termed Hyperextension Syndrome?

The first case is an 18 wk old Yorkie mix approx 7lbs. Obtained through Rescue-unknown Hx
Was seen by Neurologist-with no sig findings or recommendations. Stifles and Tarsus fixed in extension. Circumducts both hips to ambulate. X-ray shows L hip luxated, R hip sub luxated
Able to place in supported stand, feet turned out
I started some soft tissue work and standing exercises-with some improvement in Tarsal and Stifle flexion.
Question: am I wasting this Owner's money or is their potentially ground to be gained in overcoming the Hyperextension and getting this dog somewhat Functional
Is this a congenital issue or related to injury-once you see it is it permanent and whatever we do is going to revert back to Hyperextension and are we just improving tissue health.

Here is a google link to a video clip of the puppy walking and to 2 photos of stance.
Video:
https://drive.google.com/open?id=1CQrBF ... vQIxF7f3M4
Photos:
https://drive.google.com/file/d/1aNOS94 ... sp=sharing
https://drive.google.com/file/d/16WvCbo ... sp=sharing

Hey Ann-Margret,

Interesting case indeed!

Okay, so firstly, what you are seeing, I believe, is compensations for the hip luxations and a gait adaptation. To call this Hyperextension Syndrome is about as crappy a 'diagnosis' as 'Fibromyalgia'. It's merely a label, that in this case describes what is seen versus a pathoanatomical diagnosis. (Which... like a fibromyalgia diagnosis, does nothing to address the route of the problem.)

So, I would say that especially since you have made some progress in stifle and tarsal flexion, that more gains can be made. If you think of it as compensations / adaptations for the hips, and not a 'syndrome', then indeed, you should be able to improve upon this!

So, if the hips are luxated - craniodorsal I presume - then it would throw the legs into external rotation, thus forward movement of the limb and propulsion forward are not done by normal mechanisms. (Try turning your feet out / externally rotating your hips and walk. Do you need to bend your knees or ankles this way? No. And so for the last 10 weeks or more, neither has this puppy... hence the compensations.)

I might actually push for bilateral FHOs in order to see bigger improvements / lasting gains. Now, that being said, it's riskier in a puppy, as the chance for boney exostosis at the surgical site is much higher. (I've seen a couple of cases, and it's heart breaking!) Now, that being said, these hips are already luxated... so maybe it wouldn't be as much of an issue (i.e. the boney regrowth would be dorsal to the hip joint IF it occurred.)

However, you could work on sit to stands, hill walking, ROM and the soft tissue work to try to improve / change use of the legs.

And, I think giving the owner options helps to take the burden of decision off of you.
1. Try rehab in order to change use of legs, gain flexion, build muscle, retrain gait. (See what you get.)
2. FHO as an option. Either now or after a trial of rehab. And followed by rehab.
3. While not ideal. A dog this size could live with this kind of deformity for the rest of it's life, if the owners weren't bothered by it and the little one didn't seem in pain.

I hope this helps. Please keep us posted!

Cheers,

Laurie