So I have a client with a 6 year old spayed female mixed breed dog. She weighs about 40 pounds. She presented to me for evaluation after being treated for 2 months with antibiotics for diskospondylitis in the C3-T1 region. According to the owner she has improved some on antibiotic therapy and is also on Rimadyl for pain and inflammation. She has severe atrophy of the supra and infra spinati muscles and very weak withdrawal, bilaterally. She is ambulatory but often knuckles over on both sides and seems to have to consciously replace her feet correctly. On evaluation she appears to have some flexor contraction and so I am suspicious that this knuckling over has both neurologic and orthopedic components. The owner is a human PT and so he wants to know everything he can do at home and that I could do to help. Additionally, he is asking about braces. I am super out of practice bc I do more general medicine these days so I thought I would run my plan by the experts and see what you guys think.
1. I am not so sure about how braces would help bc I am worried they would inhibit strengthening of the extensor muscles and tendons, but was thinking about splinting to help counteract the contracture, maybe at night? Not sure if this is the way to go at all - and not sure about where to find a splint (it really was the owner who is interested in this direction of treatment).
2. Acupuncture and Laser therapy along the affected spinal region and following the path of the radial nerve seems obvious.
3. Joint mob's and traction of both carpi, which he can easily do at home, seem obvious as well. Not really sure how long for treatment time - how much is too much?
4. Estim on supra and infraspinatus, triceps and biceps and extensor muscles - should I start with going for full muscle contractions while lying down? I know that to strengthen and build muscle it is best to do it while weight bearing. I haven't used this modality in a while, so how long to start out is one question I have. I imagine this would be an every other day treatment to give the muscles time to rest in between.
5. Exercises to encourage carpal extension, especially with a therapy ball seem like a good idea as well. I just don't want to overload this little dog and it's been a while since I created a full treatment plan, so how many exercises and treatments do you start out with?
6. Wish I had access to an underwater treadmill but I don't.
Thanks to anyone with any suggestions.
Dr. Kelly Hutchison
Carpal Flexor Contraction secondary to diskospondylitis C3-T1
Re: Carpal Flexor Contraction secondary to diskospondylitis C3-T1
Hi Kelly!
Fun case... and you're sure to be successful with the home program being taken on by the owner-PT!
So, I'll answer your questions by number:
1. For bracing... I'd go with something simple like a neoprene brace that one could add thermoplastics to IF needed. But really, some sort of neoprene wrap could help. I'd see how the dog looks with them on to decide if day time or night time use would be better. I really just like splints to be on when supervised. So at night (beside the owner - so they can hear if the dog is trying to chew them off), or during the day when supervised. I like the Therapaw CarpoFlex products. BUT... try bandaging first, just to see. Maybe a face cloth wrapped on with vetwrap to create a carpal support... see what you & the owner think before making a purchase.
2. Acup & Laser. Agreed 100% with your plan.
3. Joint Mobs & traction. Mobs are always done by 'feel' vs time. It doesn't sound like hypermobility is the problem. So you likely won't do 'too much' on this case anyways.
4. E-stim. I'd still do it in standing. When lying down, you are really just getting a bit of a circulatory pump action out of it... not muscle building. So do it in standing with weight shifting. On 'fresh' (i.e. 2 week old) TPLO cases, I use it on the Quads in standing with weight shifting or 3-leg stands. The first time, the dog will tire after 7 minutes. The next time (2 - 3 days later) they can make it 10 minutes. Go with how the dog looks and functions to decide your time. Aim for somewhere between 5 - 15 minutes / side.
5. You can try the therapy ball... but it's not quite as 'functional' of an exercise for this scenario. Simple weight bearing might be just as effective... and getting the carpal straightened out with stretches, mobs, & traction could be a better use of time. Any exercise that focuses on carpal mobility and forelimb strength would be good... digging might actually help (if it's an option).
You don't sound so rusty after all!!!
Cheers,
Laurie
Fun case... and you're sure to be successful with the home program being taken on by the owner-PT!
So, I'll answer your questions by number:
1. For bracing... I'd go with something simple like a neoprene brace that one could add thermoplastics to IF needed. But really, some sort of neoprene wrap could help. I'd see how the dog looks with them on to decide if day time or night time use would be better. I really just like splints to be on when supervised. So at night (beside the owner - so they can hear if the dog is trying to chew them off), or during the day when supervised. I like the Therapaw CarpoFlex products. BUT... try bandaging first, just to see. Maybe a face cloth wrapped on with vetwrap to create a carpal support... see what you & the owner think before making a purchase.
2. Acup & Laser. Agreed 100% with your plan.
3. Joint Mobs & traction. Mobs are always done by 'feel' vs time. It doesn't sound like hypermobility is the problem. So you likely won't do 'too much' on this case anyways.
4. E-stim. I'd still do it in standing. When lying down, you are really just getting a bit of a circulatory pump action out of it... not muscle building. So do it in standing with weight shifting. On 'fresh' (i.e. 2 week old) TPLO cases, I use it on the Quads in standing with weight shifting or 3-leg stands. The first time, the dog will tire after 7 minutes. The next time (2 - 3 days later) they can make it 10 minutes. Go with how the dog looks and functions to decide your time. Aim for somewhere between 5 - 15 minutes / side.
5. You can try the therapy ball... but it's not quite as 'functional' of an exercise for this scenario. Simple weight bearing might be just as effective... and getting the carpal straightened out with stretches, mobs, & traction could be a better use of time. Any exercise that focuses on carpal mobility and forelimb strength would be good... digging might actually help (if it's an option).
You don't sound so rusty after all!!!
Cheers,
Laurie
LAURIE EDGE-HUGHES
Re: Carpal Flexor Contraction secondary to diskospondylitis C3-T1
Thank you so much for your reply, Laurie. It helps my confidence a great deal.
Kelly
Kelly