Rhodesian Ridgeback carpal hyperflexion/supination

[Nicole]

Hi there

I have a special case, maybe someone did see anything similar. It is a 6 year old spayed rhodesian ridgeback female, grown at a pig farm, adopted with 9 month from the actual owner.
She got x-ray of her hips just to know if she has clean hips for canicross. They found that the left femur was about 2cm shorter (guessing she had a fracture as puppy )
In 2017 she had a biceps avulsion on the left side and the surgeons did cut the rest of the biceps tendon of. Since then she did not walk normal but managed to get along with it.

She was always staying quit straight with the forelimbs, but over time developed more and more like a carpal hyperflexion with Kind of supination....

At the moment she has a right forelimb lamness, after running into the leash/collar. I could find restriction of the whole shoulderblade, and pain and some restriction in the os carpi accessory. No swelling. Mm.extensor carpi radialis and flexor carpi ulnaris are sound, no pain in flexibility test. She shows also pain in both digits ll left and right food. Carpal flexion was slightly restricted on the right side.
Radiographs are attached (I see changes in both digits ll, and on the caudal Part of os carpi accessory, as well as on the insertion of m.ext.carpi radialis)
(I treated here chiropractic, I can give the listings if needed)

Do you have any Idea why she shows this posture? Is this common in this breed? Wichtig exercise could help avoid this? Did anybody have a similar case?

Appreciat any advice

[David Lane]

To clarify: can she extend the carpus but chooses not to at stance, or is the carpus physically contracted into that position? During the course of working up the shoulder, what imaging was done on the elbow and how long ago?

[Nicole]

There is no imaging of the ellbows...she shows only slight discomfort in ellbows.
She chooses to stand like this, sometimes it is better. But also in walking she tends to do it (on both sides). Sometimes it looks almost normal,so the carpus is not fixed like this. ( by the way how would you call this position?)

Would you recommend to check the elbows with imaging?

Thank you

[Nicole]

More pics of standing

[lehughes]

Hi Nicole,

Okay... so I'm going to back up a bit. I have found with some active sporting dogs (hunting dogs) where an issue on one side caused an offloading to the other side that led to orthopaedic issues there. In my head, the issues could have started from the biceps tenotomy (along with maybe other issues on that side???? maybe), causing increased loading of the right front - especially if doing canicross or if the dog does any kind of jumping (landing in particular). So, this might lead to a breakdown of the RF foot and increased stress on the carpus. Thus leading to SDFT tears (I think the toes 2,3, & maybe 4 look 'long' compared to the left), which could change biomechanics of the foot, maybe pain at the sesamoids, as well as arthritis at the carpus. I'm looking at the carpus wondering if it is more of a deviation that occurred first, and which the dog 'learned' to move with the joint slightly flexed.

All in all the whole foot & carpus looks like a compensation to me. Compensation for a multitude of things that have likely transpired one by one...and you are just seeing the current stage of the foot/carpus now.

Okay - so what to do.
1. Look at the rest of the dog for imbalances in movement / strength and flexibility.
2. Check the left front for any areas of pain OR weakness (i.e. something that needs to strengthen).
3. Check MCL & LCL at the carpus and each PIP / DIP.
4. Palpate the sesamoids
5. Assess / Stretch SDFT and DDFT - differences from side to side?
5. Try wrapping the carpus as a test to see if a soft orthosis would help - so perhaps some foam or neoprene, or cotton batting wrapped with vet wrap. Does it help or hinder? Maybe even have the owner test for a week. If it helps then order a carpal brace. (I like Therapaw for cases like this.)

To be honest, you can't fix this foot. The owner should have come a LONG time ago before it got this bad. At this point, you treat the other issues, secondary or primary (soft tissue elsewhere), you treat for the developing OA in the carpus and toes, treat any soft tissue pain you find, support the carpus as needed. If the sesamoids are tender, then a bootie with padding inside might be beneficial.

In my eyes, it's a fit dog already, there won't be an exercise that can improve this. If anything, some version of activity modification might be needed.

I hope this helps in some way.

Laurie

[David Lane]

Especially if there is elbow pain, consider adding carpal flexor enthesopathy to the rule out list (with or without FMCP or other elbow issues). Offloading the carpus could be to take tension off the tendon of origin, and chronically doing so can then screw up the feet. If the original biceps issue was repetitive stress, then protecting the elbow may have contributed to that as well.

[Nicole]

Thank you both a lot for your help and thoughts...
Maybe all began at the beginning, I don,'t think the foreign owner looked well for the dog, maybe compensation started with the fracture of femur allready.... the actual owner said, the carpi looked allready like this (maybe a bit better) since she got the dog...
So I try to find out your points...I recommend to check the ellbows as well.
She was much better after my last treatment, but now worsen again. Gonna see her today.
Thanks a lot
Greetings Nicole