Carpal Laxity, FHO, & ACL tears

[lehughes]

Case # 3. Oscar

Oscar presented for possible surgery to correct bilateral ACL tears and a right FHO, as well as marked carpal hyperextension.

For the ligament laxity, I was debating DogLeggs carpal support. Once we can strengthen these ligaments (I AM HOPING), then floor exercises, hydrotherapy, laser therapy, and acupuncture. Is this a good carpal support device?

Approximately 5 yrs ago, Oscar started limping in the back end and at that time, it was intermittent in nature. Now, limping has progressed to persistent and severe limping per o. O also has noticed the front legs are “bowing” out and feel his right hip is most bothersome for him of all his legs. Mr feels Oscar has a lower stance in the wrist joints and is reluctant to get up and move in general. They attribute this to his arthritis. He has been treated with LONG term prednisone and these no longer help him.
-Diagnostics: Radiographs 10/2019 – bilateral hip dysplasia (rt>lt), cortical changes proximal lt tibia, distal femoral varus/prox tibial valgus bilaterally; Radiographs 2/20 – bilateral stifle OA; UA 2/10/20 – 2+ proteinuria, USG 1026, microalbuminuria (25); IM consult Dr. Perez CSAH 2/21/20

ORTHO: BCS 5/5. Ambulatory x4 but immediately lays down when asked to walk. Pet walks willingly toward owner.
Thoracic limbs: Bilateral carpal valgus with angular limb changes in both forelimbs. No appreciable pain in the carpi or elbows bilaterally. Mild – moderate carpal hyperextension in both wrists (o appreciated this once pointed out and feels it has been progressive over 2 months), Pet is weight shifting forward.
Hind limbs: Bilateral grade II lameness pelvic limbs. Pet is weight shifting forwards to the thoracic limbs. Both thighs atrophied. Patellas central and stable. Bilateral + cranial drawer, thrust and medial buttress (rt>lt). Pet resists hip extension (rt>lt) and abduction bilaterally but is relatively stoic for hip exam. Implants are palpable in the stifle LR, no pain associated with palpation of these.
--
Jessica Dreyfuss, DVM

Video Links (PS Cut and paste into a URL bar) - https://youtu.be/Uz5JvcUE7V8
& https://youtu.be/-wI0GrOnVSw

[lehughes]

Okay... so this is a case where you would benefit from creating a problem list and then ranking the importance of dealing with each.

i.e
#1. Hip dysplasia with reduced range and limping / pain.
#2. Carpal hyperextension likely made worse by offloading from problem 1.
#3. Stifle OA

So you have to work on the hip and carpals at the same time. I'd spend time IN CLINIC on pain management for the hips (laser, dry needle, myofascial release, shockwave, etc to the deep gluteals) and exercises to strengthen glutes.

Carpal braces (MAYBE for the short term). I prefer Therapaw carpoflex over Dogleggs. I doubt the dog will 'like them'... especially if bilateral. So your biggest job will be to get the owner to buy into using them for the short term (maybe 2 months) to correct the weight loading imbalances / strengthen the glutes, etc.

He'd be a good candidate for UWT if available, or swimming as a second choice.

Okay... that's off the top of my head! Hope it helps!

Cheers,

Laurie