Painful Synostosis

[lehughes]

I have three cases I would love your help and other rehab brains on!

1. Shamrock -
Shamrock, 9 mo MN lab puppy, presented to Heroes Animal Hospital for bilateral forelimb lameness. There is an area of synostosis on the R forelimb that is repeatedly painful. I would love to consider an orthotic for this kid - BUT he is a labrador and very very excited and wiggly. This is my first case of synostosis so I would love thoughts!

He was adopted at 10 wks age and was not very active per owners– radiographs at that time showed numerous healing metatarsal fractures on both forelimbs (left MT 2-5, right ?). Due to the status of healing at that point, he was managed conservatively. O have been careful about his activity due to persistent lameness and treat him with intermittent anti-inflammatory medication. They are here for a consultation for lifestyle management. O relates that even on the anti-inflammatories, he STILL demonstrates lameness daily.

Currently, o notice favoring of both front legs every morning that lasts ~30 mins. This recurs after any resting/lying periods. He is able to rough house/play and doesn’t develop lameness consistently after activity, even rough play or running to the pool. O have not allowed him to freely run for concern of affecting his lameness.

-Diagnostics: Radiographs of the feet show a synostosis of the proximal MT region of digits 3-4 left side. On the right pes, P2-3 of digit #3 is deviated but this is not apparent clinically.
-Medical History: Vaccine reaction
-Diet: Purina one – recently switched off grain free
-Exercise: Swims daily at home, runs ~15 feet then jumps into pool, plays with sibling – pug, short walks, no fetch/running, jumps on furniture
-Current medication: Vetprofen for 1 week (third course); Benadryl daily (itches after swimming); Cod Liver SID (o d/c)
PE: LF: Splaying of digit #2 when standing that is more pronounced with ambulating; dec carpal flexion LF vs RF with subjective moderate discomfort at the full extent of flexion that is possible; subjective, mild discomfort with deep and firm pressure over the palmar aspect of the synostosis region. No overt shoulder or elbow discomfort.

Jessica Dreyfuss,DVM

[lehughes]

Oh my goodness! I'm not sure what to say! I've not seen this either.

I guess I'd go with pain management / inflammation management (laser, PEMF) and perhaps CBD. Definitely, joint supplements.

Beyond that, I'm not sure! Yes some exercise is okay... but not disease altering. I'm not sure that manual therapy will make a difference either. You could test drive some nice grade 2 - 3 mobilizations to SEE if it changes anything.
I don't THINK that a carpal brace would help for the metatarsal issue, however, you could test it by wrapping the carpus with vet wrap to see if it helps. Alternately, maybe you could try something like a Back on Track Carpal brace (they don't do much but retain body heat... and that might provide some comfort to the metatarsal region.

Oh boy! I hope this helps a bit. But I think with something like this it will be some trial and error.
Best of luck!!!

Laurie

[Kay Webb]

I've got a friend with Morton's neuroma and that just made me wonder whether there might be some nerve pinching or entrapment going on where the metacarpals are squashing/ fusing together. I'm not sure what would help but maybe gabapentin, laser or TENS proximally if tolerated. Ill have to get out the anatomy books and look at the exact course of the nerves in canine but in the human foot it looks possible.