Discussion related to the musculoskeletal system - injuries, post-op, lameness, extremity issues (joint, muscle, tenon, fascia...), axial skeleton issues, etc., as it relates to canine rehabilitation.
8 months old ME standard Poodle. Came to see us because he has been increasingly worried of walking down the stairs and owner was worried something was wrong. Owner says he easily lies down and are less playful than the other puppies in the litter (he's been like that ever since they got him at 8 w). On examination it is obvious that he tends to stand and walk on his tip toes and sometimes his carpal joints will "collaps" forwards when he is standing or walking. But he can also walk and stand normally sometimes. When he lies down he externally rotates his carpi.
Quite a wriggly little one, so not so easy to assess when awake, but orthopeadic and neurologic examination were unremarkable except for perhaps a very slight reaction upon elbow extension and flexion on the right. He was sedated so we could do x-rays of elbows and carpal joints (which was also unremarkable). When testing the carpal movement under sedation it is obvious that carpal extension is normal when the elbow is fully extended. As the elbow flexes the carpus flexes a lot more than it should normally do. It feels like there is a connection between the triceps and flexor carpi ulnaris (if that makes any sense at all ). I've attached a couple of pictures of how he tends to lie. I've also got a video of the carpal movement, but I wasn't able to attach that one. I'll try to e-mail it directly to you Laurie so you could have a look at it, and if possible post it here Any ideas what could cause this, and any suggestions for treatment - surgical or otherwise...? I tried to post on the vetrehab page, but didn't really get any input that was helpful...
Thanks for this question. I did get your video, but it didn't seem alarming to me. There is a natural correlation with elbow flexion & carpal flexion as well as elbow extension & carpal extension - just the hardwiring and orientation of certain muscles (and related to deep digital flexor muscle and the extensor carpi ulnaris... I believe... I read a paper about it over 10 years ago... Not sure where I put it!!)
Anyways, I have some thoughts & suggestions:
1) Is there more valgus at the carpus when you place the arm (i.e. elbow straight) in a straight position? In other words, is there a chance that you are seeing a premature closure of the ulnar physes?
2) If that is not the issue, then also check for a medial shoulder hypermobility. The way he lies can only be accomplished by a great deal of medial glide / translation at the shoulder. The 'turn of leg' you are seeing comes from higher up, not the carpus specifically. Perhaps he is just lax there and needs some strengthening for this (i.e. theraband pulls laterally while lifting one front leg off the ground - do both sides. Loop & pull on the theraband when it's around the standing leg.)
3) This could very well just be a phase of growth. Many large breed dogs look 'hideous' (according to breeders) at this age. Their rear limbs and front limbs don't match. Their chests haven't filled out or dropped. And they're just not muscled enough to hold themselves properly.
4) And on the flip side of that, poor conformation could be at play... but I'd never say that to an owner... I'd just say it's mostly likely a stage of growth. (And that is likely the truth!)
5) You may just need to support those forelimbs to keep them from buckling over. I just did a great Bracing course. So I would try simply wrapping the carpal joints in Vet wrap, and after a layer, do a couple of figure 8's / criss-crosses over the front of the carpal joint (in order to hold a slightly extended position). See if this works, if yes, then you can have the owner to continue to do this as the dog grows and gets used to using his limbs properly. OR, you can get a custom splint made (or modify one) that will provide support to the front of the carpal joint.
And I know you said he was examined for both orthopaedic & neurologic disorders, but keep in the back of your head the premature closure of the ulnar physes, medial shoulder hypermobility, and even Wobbler's. I'll throw in there eyesight, just from the perspective of the issues going down stairs.
My thoughts off the top of my head anyways! Please keep us posted!
Thought I'd give a little update on this one. Thank you for the help Laurie. I read your replay as soon as you postet it, but didn't have the time to reply and then forgot about it
I agree that the video didn't look to disturbing, but I still feel (having tested the same in a lot of dogs after I had this one) that the feeling is much harder and less elastic when the carpus flexes with simultanous elbow flexion in this one than what I've found in other dogs. I checked the shoulders and couldn't really find a hypermobility, but I felt that there was less resistance to motion than what is normal without (if that makes sense). He did also have triggerpoints in his triceps which we've treated.
In the end I ended up doing a bit of everything; thera-band exercise for the shoulders, stretching of the triceps and carpal flexors as homeexcercises, and treating the muscles and spinal dysfunctions during the sessions in the clinic. For some reason he has improved a lot only during the last few weeks. It could very well be that it was, as you said, only a stage of growth. When I saw him yesterday he placed his limbs normally about 95% of the time. Owners says he mostly looks normal at home, and it is only when he sits the wrists tend to sometimes collaps forwards. He sists very well when he wants something though, so we've added sitting practice as part of the homeexcersises. He is also behaving more normally for his age - being happy and active and more willing to go for walks. He also seems less anxious about the stairs.
So thanks again for your help. I must say I thought it was to extreme to be only a stage of growth, but I'm happy to say that it seems like I was wrong
I had myself serious carpal issues a few months ago, which all boiled down to elbow and neck issues as a cause. I am now looking way more at radio ulnar mobility and elbow mechanics as cause of carpal issues.I still did strengthening carpal exercises but it made m look at carpal dysfunctions again as a symptom not the root
On the human side, we are very used to looking at all contributing factors to joint / soft tissue issues. I think it makes it that much more important to 'touch and treat' every part of part of the dog that might be associated. (Finding additional causes & compensations). A good reminder for sure!
). I've attached a couple of pictures of how he tends to lie. I've also got a video of the carpal movement, but I wasn't able to attach that one. I'll try to e-mail it directly to you Laurie so you could have a look at it, and if possible post it here 
Any ideas what could cause this, and any suggestions for treatment - surgical or otherwise...? I tried to post on the vetrehab page, but didn't really get any input that was helpful...