crooked carpus post ulnar osteotomy

[lehughes]

Hi Laurie

I have another strange question, if you don't mind me asking.

I have been working with the Guide Dog Association on a litter of Golden Retrievers. Six of the litter underwent bilateral ulna osteotomies following routine X-rays at 4 months of age. They were confined to strict rest for 6 weeks post-surgery. About 6 weeks later, they all started rotating their carpals out laterally. I first saw them at the beginning of June when they were 7 months old as the referring vet requested that they have physio to build up their chests, bring their elbows out and hopefully straighten their paws. They also had low gluteal muscle tone.

I could not find any literature to guide me on building up their chests (but I don't have access to any of the scientific databases such as PubMed or ScienceDirect). I put together an exercise programme (attached) which involved a lot of side stepping as well as core exercises.

Most of them have improved and their paws straightened out somewhat, but one puppy Gus (who was the worst of the litter) has gotten worse and looks to me to also have some carpal hyperextension now. Photo 1 was in June, Photo 2 last week.

Have you ever seen anything similar post ulna osteotomy and would you have any helpful hints or ideas as to what I could do with him? Or even comments or criticisms of the exercise programme I gave them?

Thanks as always for always being so happy to help and for your ongoing great efforts to keep us informed and improve our knowledge.

Kind regards
K.

EXERCISES:
Strengthening Exercise Programme for the G Litter

The aim is to build up the chest so that the elbows are moved slightly more away from the body to bring the paws in straight.
Choose 2 – 4 exercises per session. Muscles need 48 hours to recover so alternate the chest, core and hindlimb exercises on different days. Have one rest day per week. Start with 3 sets of 5 repetitions for each exercise and monitor how the dog is coping. Muscles should preferably be overloaded to build strength, so stop any exercise when the dog is battling or reluctant to perform. If the dog is managing the exercises with ease, increase the number of sets and reps accordingly, working up to 6 sets of 12 repetitions. Balance exercises should be a 10 minute session, starting with a minute or two at a time and monitoring when to progress. Work up to 10 – 15 minutes sessions.

Exercises to strengthen the chest: Abductors and Adductors
• Balancing on a cushion, mattress (any slightly unstable surface).
• Side stepping (Progress to side stepping over poles; up and down hills, on unstable surface and L to R).
• Forelimbs raised, step sideways in both directions. You could do this on a step for example.
• As above with forelimbs on an unstable surface such as a mattress or cushion.
• Forelimbs raised on a paw pad. Use a treat and your body to get the dog to pivot with their back legs in both directions.
• Hindlimbs raised on a paw pad. Use a treat and your body to get the dog to pivot with their forelimbs in both directions.
• Once they understand the exercise above, using an unstable surface (e.g. a large pillow or cushion), get them to pivot around the ends of the cushion, then step sideways along the pillow and pivot around the other end, stepping sideways again to the other end. Do this in both directions.
• Obstacle walking (Lure the puppy to walk over various low-lying objects to slowly step over).
• Figure 8 (Place two objects on the floor, about the puppy’s body length apart and do figures of 8. Progress to reducing the distance between the objects)
• Weaving (Place four objects on the floor, about the puppy’s body length apart and weave in and out of the objects. Progress to reducing the distance between the objects)
• Walking in a circle, starting with a large radius and gradually reducing it. Both directions.
• Cookie stretches (Stand behind; place cookie in front of the nose, moved to point of shoulder then along body to the hip and to the foot.) Progress to stretches with forelimbs on an unstable surface.
• Wave: (Holding the foot higher than the head for more than 5 seconds. This can be taught by making sticky tape into a roll, placing the sticky side on the eyebrow and reward when the dog lifts its paw to rub it off.)
• Paw. Give paw and progress to giving paw to the side on both sides.
• High 9: Once the dog knows how to give paw, randomly place your hand on one of 9 spots (3 at head level, chest level and carpus, one on each side and in the centre).

Core:
• Rolling
• Sit to stand on unstable surface
• Down to stand unstable surface
• Abdominal crunch
• Diagonal leg lifts (one forelimb placed on a block; diagonal hindlimb placed on similar sized block)
• Forelegs raised, hindlegs on the floor and vice versa
• Back extension
• All 4 legs on unstable surface
• Balancing on paw pad
• Balancing on an unstable surface
• Push ups on an unstable surface
• Cookie stretches (Stand behind; place cookie in front of the nose, moved to point of shoulder then along body to the hip and to the foot.)
• Theraband / bandage around the abdomen when walking

[lehughes]

Well now, this is an interesting question. I do have thoughts!

So,

1. An ulnar osteotomy doesn’t always fix the problem. In fact, I have never seen it TOTALLY fix the problem. I even saw one dog that had 3 surgeries on each leg, and the vet had managed to convince the owner that the dog would be 100% if she just did one more. (I talked the owner out of the 4th surgery). He was a disaster. The first dog I saw with this was a Newfoundland dog and she had the same outward turn of the carpus afterwards and as she grew. The breeder placed her in a pet home. So this is not a matter of ‘physio should fix this'… but rather these dogs can’t be 100%!!

2. It’s true that once the pup develops more of a chest that the elbows get pushed out a bit. However, strengthening exercises can’t do that. IF it’s possible through exercise (which I’m a bit doubtful that it can), it would be cardiovascular and involve lung expansion. (This is what my Borzoi breeder believes - again, I’m not convinced, but it makes a wee bit more sense than strengthening - maybe.) So, lower weight bearing activities that are very cardiovascular would be good (i.e. swimming, UWT, & maybe uphill walking… but of course 'coming back down' has to accompany going 'up', but down requires greater loading on the front legs, which might not be great).

PS
Everyone has access to Pubmed - it’s Public. - https://pubmed.ncbi.nlm.nih.gov/
And my favourite ‘free’ resource for accessing papers is Sci-hub. The url changes regularly, so I just google 'sci hub’ and pick one of the websites that come up. You just need to cut and paste the DOI number into the search.

Hope this helps somewhat! Unfortunately, no-one can make this dog perfect!


Laurie