Elbow fracture
Posted: Fri Sep 02, 2022 2:08 am
Chad is a 10Y 7M old, male neutered lab. He has historically been obese, weighing in at around 115 lbs. The owner has managed to get him down to 92 # since his elbow fracture. He is still heavy but so much better.
Chad presented for a Rehab consultation on 8-31-22 following R elbow fracture and surgery. Chad had an acute injury/fracture to his R elbow in early May 2022 after falling out of a two story window. Chad had surgery at a local veterinary clinic with a board certified surgeon for a comminuted right elbow fracture of right lateral condyle and Olecranon. Chad has not been doing any Rehab since the initial surgery. Chad had weekly modified RJ bandage change with weekly bandage changes for 10 weeks following surgery. Recheck radiographs were performed on 7-26-22 ( 12 weeks post-op) showed static implants, incomplete healing of the condylar fracture with minimal new bone growth, suspect loss of reduction of the olecranon fracture, sclerosis of subchondral bone with degenerative joint disease . Owner just started water walking last week for short duration (~ 5 min) but he gets tired quickly. He has gone 3 times this week. He is only walking several hundred feet at a time.
He currently has a grade 3/4 R TL lameness.
Orthopedic exam - bilateral TL antalgic gait with R TL being worse than L. Off weighting to back legs and off R TL in standing. He weight bears on the medial aspect of R TL paw causing rotation of MCP joints and digits. Digits and MCP joints are hypomobile in flexion and rotation. Central nails (3+4 ) worn with wear on dorsal surface, nails 2+5 too long. He has mild hyperextension of R carpal joint in standing with a Marked decreased ROM in flexion. The right Elbow joint has bony thickening and mild effusion present. He has discomfort and crepitus with ROM.
The right elbow has decreased ROM in flexion and markedly decreased ROM in extension ~ 110 degrees. He has decreased shoulder ROM in flexion and extension but comfortable through ROM. He has marked muscle atrophy of forearm extensor muscles and flexor muscles, carpal flexors tight. Marked atrophy of biceps m and triceps m and of supraspinatus m and infraspinatus m on R TL.
His L TL digits are splayed and flattened with hyperextension of MCP joints and hypomobility of MCP joints and digits in flexion and rotation. He has moderate hyperextension in standing of his L Carpal joint. Bony thickening with effusion on dorsal aspect is present and there is decreased ROM and crepitus in flexion.
He has a fair amount of compensatory neck and back tightness and soreness.
I am looking for ideas for Rehab and improving function of his R TL and overall comfort. I am concerned about the overall health of the elbow joint and the incomplete healing of the fractures. I am concerned that further engagement of the triceps may cause further distraction of the olecranon fracture.
The tools I have available at the clinic are my hands, acupuncture, laser, Piezowave, Assisi loop, e-stim.
I am ordering a Therapaw carpal support wrap to support his L carpal joint.
Are there any good support options for the elbow joint?
Any ideas would be wonderful.
Thank you so much
Wendy Robinson :
Chad presented for a Rehab consultation on 8-31-22 following R elbow fracture and surgery. Chad had an acute injury/fracture to his R elbow in early May 2022 after falling out of a two story window. Chad had surgery at a local veterinary clinic with a board certified surgeon for a comminuted right elbow fracture of right lateral condyle and Olecranon. Chad has not been doing any Rehab since the initial surgery. Chad had weekly modified RJ bandage change with weekly bandage changes for 10 weeks following surgery. Recheck radiographs were performed on 7-26-22 ( 12 weeks post-op) showed static implants, incomplete healing of the condylar fracture with minimal new bone growth, suspect loss of reduction of the olecranon fracture, sclerosis of subchondral bone with degenerative joint disease . Owner just started water walking last week for short duration (~ 5 min) but he gets tired quickly. He has gone 3 times this week. He is only walking several hundred feet at a time.
He currently has a grade 3/4 R TL lameness.
Orthopedic exam - bilateral TL antalgic gait with R TL being worse than L. Off weighting to back legs and off R TL in standing. He weight bears on the medial aspect of R TL paw causing rotation of MCP joints and digits. Digits and MCP joints are hypomobile in flexion and rotation. Central nails (3+4 ) worn with wear on dorsal surface, nails 2+5 too long. He has mild hyperextension of R carpal joint in standing with a Marked decreased ROM in flexion. The right Elbow joint has bony thickening and mild effusion present. He has discomfort and crepitus with ROM.
The right elbow has decreased ROM in flexion and markedly decreased ROM in extension ~ 110 degrees. He has decreased shoulder ROM in flexion and extension but comfortable through ROM. He has marked muscle atrophy of forearm extensor muscles and flexor muscles, carpal flexors tight. Marked atrophy of biceps m and triceps m and of supraspinatus m and infraspinatus m on R TL.
His L TL digits are splayed and flattened with hyperextension of MCP joints and hypomobility of MCP joints and digits in flexion and rotation. He has moderate hyperextension in standing of his L Carpal joint. Bony thickening with effusion on dorsal aspect is present and there is decreased ROM and crepitus in flexion.
He has a fair amount of compensatory neck and back tightness and soreness.
I am looking for ideas for Rehab and improving function of his R TL and overall comfort. I am concerned about the overall health of the elbow joint and the incomplete healing of the fractures. I am concerned that further engagement of the triceps may cause further distraction of the olecranon fracture.
The tools I have available at the clinic are my hands, acupuncture, laser, Piezowave, Assisi loop, e-stim.
I am ordering a Therapaw carpal support wrap to support his L carpal joint.
Are there any good support options for the elbow joint?
Any ideas would be wonderful.
Thank you so much
Wendy Robinson :