Re: 8week old carpal hyperextension

[Guest guest]

I personally have used the splint from the vet at TOPS rehab in North Chicago.

I can't remember the name right now but I can email you it later. It is a

splint that is open at the toes and has three thermoplastic bars that can be

taken out. I had an agility dog that jumped from a tree, straight down and had

a horrible hyperextension of the hock. We put him in it for 16 weeks, four

week with all three bars, then four weeks with only one bar and then four weeks

with just the splint. We finally took it off him and one week later we noticed

him getting loose in the hock again so we put it on for another four weeks (just

the splint) and he has never had a problem since. He currently execises and

trains with the splint on with no bars and has not reinjuried at all. When we

took him to the ortho surgeon he was amazed because he thought the only thing we

could have done was arthodise the joint. But it was my 1.5 year old terrier I

wasn't about to do that without trying something else first. Good luck and if

you need the name let me know

le Welke LVT,CCRP

Michigan State University Advanced Rehab for Animals

East Lansing, MI 48827

>>> 07/04/07 11:49 AM >>>

Just wondering if anyone had an opinion on this one;

8 week old female pit bull with hyperextension injury of left carpus of two week

duration -a robert jones bandage had been applied at time of injury by another

vet no improvment noted when I removed the bandage. X-rays taken at time of

injury showed no fractures, palpation yesterday revealed no crepitus or pain on

palpation just lots of laxity. Wondering if I could get an opinion on some form

of coadaptation(have some low temp thermoplastics or splint that might be

adaptable for her at this age)-don't really want to lose muscle mass and

possibly cause abnormal stresses and resulting growth plate changes in this leg

and others due to compensation but also worried about ligaments and permanent

loss of carpal function and the resulting above. The only other thing I could

think of was ligaplex. Thanks for your thoughts. Clare DVM

[Guest guest]

Hi Clare,

Unusual injury for an 8 week old puppy. Usually you would get a salter

fracture. I would be very concerned about an impact injury that, if

enough to cause failure of the palmar fascia, would quite likely cause

a shearing injury to the distal ulnar growth plate, so be sure and

inform the owners of the possibility. I have used custom made hinged

carpal splints for a dog that was 100 lbs and had bilateral carpal

hyperextension due to iatrogenic cushings. It took several months to

get him used to them and some tweaking to get them right, but now he

jams with them on and can hardly walk more that 50 yards without them.

My experience with carpal hyperextension is that they are good for a

few days to weeks after being in a splint, but they start to sink down

after that and mal-articulate the carpus. If you were to arthrodese

the carpus on a dog of this age you would doom him to a life with a

short leg and likely multiple surgeries. I think best case scenario

would be to splint him with a hinged brace to maintain range of motion

and muscle mass and test it every few months without the splint to see

if there is any stability. If not then maintain it until maturity,

then determine if it is radiocarpal level or midcarpal level and then

do the appropriate arthrodesis. Dogs with middle

carpal/carpometacarpal arthrodesis will function normally if there is

not impingement of the plate on the distal dorsal radius.

I know there are other rehab people and surgeons out there with

experience on carpal injuries, SO WHAT DO YOU THINK ABOUT THE ABOVE

PLAN????

happy fourth of July.

Mark B. Parchman, DVM, CVA, DACVS

jason_clare@... wrote:

Just wondering if anyone had an opinion on this one;

8 week old female pit bull with hyperextension injury of left

carpus of two week duration -a robert jones bandage had been applied at

time of injury by another vet no improvment noted when I removed the

bandage. X-rays taken at time of injury showed no fractures, palpation

yesterday revealed no crepitus or pain on palpation just lots of

laxity. Wondering if I could get an opinion on some form of

coadaptation(have some low temp thermoplastics or splint that

might be adaptable for her at this age)-don't really want to lose

muscle mass and possibly cause abnormal stresses and resulting growth

plate changes in this leg and others due to compensation but also

worried about ligaments and permanent loss of carpal function and the

resulting above. The only other thing I could think of was ligaplex.

Thanks for your thoughts. Clare DVM

[Guest guest]

A second thought, does this dog have normal collagen and are you sure

it is traumatic??

MBP

jason_clare@... wrote:

Just wondering if anyone had an opinion on this one;

8 week old female pit bull with hyperextension injury of left

carpus of two week duration -a robert jones bandage had been applied at

time of injury by another vet no improvment noted when I removed the

bandage. X-rays taken at time of injury showed no fractures, palpation

yesterday revealed no crepitus or pain on palpation just lots of

laxity. Wondering if I could get an opinion on some form of

coadaptation(have some low temp thermoplastics or splint that

might be adaptable for her at this age)-don't really want to lose

muscle mass and possibly cause abnormal stresses and resulting growth

plate changes in this leg and others due to compensation but also

worried about ligaments and permanent loss of carpal function and the

resulting above. The only other thing I could think of was ligaplex.

Thanks for your thoughts. Clare DVM

[Guest guest]

All other joints appear fine, per owner little girl stepped or jumped directly on foot of maybe 5 lb pup- i agree this is a strange injury for this age and it is difficult to see potential fractures in an immature carpus film but no significant pain or crepitus on orthopedic exam just laxity so going with hyperextension although strong potential for undiagnosed chip fractures. I think this one is going to be difficult to win, any way we treat it there will still be permanent changes. I also worry about fitting her with any brace at this age other than a custom. thanks

-------------- Original message --------------

A second thought, does this dog have normal collagen and are you sure it is traumatic??MBPjason_clarecomcast (DOT) net wrote:

Just wondering if anyone had an opinion on this one;

8 week old female pit bull with hyperextension injury of left carpus of two week duration -a robert jones bandage had been applied at time of injury by another vet no improvment noted when I removed the bandage. X-rays taken at time of injury showed no fractures, palpation yesterday revealed no crepitus or pain on palpation just lots of laxity. Wondering if I could get an opinion on some form of coadaptation(have some low temp thermoplastics or splint that might be adaptable for her at this age)-don't really want to lose muscle mass and possibly cause abnormal stresses and resulting growth plate changes in this leg and others due to compensation but also worried about ligaments and permanent loss of carpal function and the resulting above. The only other thing I could think of was ligaplex. Thanks for your thoughts. Clare DVM

[Guest guest]

Hey Clare, Marks plan sounds pretty good to me. Though having to make

a true hinged splint may be very difficult in such a young puppy.

I have never made a carpal reusable /removable splint for such a

young dog before but here are my ideas about it. I would use a

product called Breathoprene; you can get this from this link…

(http://www.sammonspreston.com/Supply/Product.asp?Leaf_Id=553271). It

has a loop backing on a 1/8 or 1/16 inch neoprene sheet. On such a

young puppy you may be able to get away with just that. If it dose

not provide enough support you can add a small strip of LTT. I may

try to cut a little elliptical hole in the breathoprene over the

accessory pad of the carpus as well as 1-2 small relief cuts on the

cranial portion, so that she does not have to overcome the material

to elicit flexion. The LTT, if needed, can be Velcro-ed to the

cranial portion of the splint, though only attached above the carpus.

This should allow her to flex and not hyperextend due to the stop you

have made with the LLT. The LLT may have to be formed greater then at

a normal 10 degrees( like a carpal arthrodesis plate) then a closed

cell padding material can be placed at the distal portion of the LLT

to absorb the impact during active extenion since the top of the foot

is not made to bear weight. I would recheck this dog at least once a

week because he will probably be growing and need adjustments fairy

often. If I have not explained this real well feel free to write or

call me. I am in the database.

Good luck, Robby

>

> Just wondering if anyone had an opinion on this one;

> 8 week old female pit bull with hyperextension injury of left

carpus of two week duration -a robert jones bandage had been applied

at time of injury by another vet no improvment noted when I removed

the bandage. X-rays taken at time of injury showed no fractures,

palpation yesterday revealed no crepitus or pain on palpation just

lots of laxity. Wondering if I could get an opinion on some form of

coadaptation(have some low temp thermoplastics or splint that might

be adaptable for her at this age)-don't really want to lose muscle

mass and possibly cause abnormal stresses and resulting growth plate

changes in this leg and others due to compensation but also worried

about ligaments and permanent loss of carpal function and the

resulting above. The only other thing I could think of was ligaplex.

Thanks for your thoughts. Clare DVM

>

[Guest guest]

so basically a circumductive support sling with a stiffening rod or ltt in this situation? wouldn't it work better to put the support on the caudal aspect to aid carpal flexion and prevent the hyperextension rather than the cranial? could I almost do layers of ltt -make the support adjustable and remove layers as progresses to decrease support and enhance ligament usage? thanks for the input, that breathoprene's pretty cool! Clare

-------------- Original message --------------

Hey Clare, Marks plan sounds pretty good to me. Though having to make a true hinged splint may be very difficult in such a young puppy. I have never made a carpal reusable /removable splint for such a young dog before but here are my ideas about it. I would use a product called Breathoprene; you can get this from this link… (http://www.sammonspreston.com/Supply/Product.asp?Leaf_Id=553271). It has a loop backing on a 1/8 or 1/16 inch neoprene sheet. On such a young puppy you may be able to get away with just that. If it dose not provide enough support you can add a small strip of LTT. I may try to cut a little elliptical hole in the breathoprene over the accessory pad of the carpus as well as 1-2 small relief cuts on the cranial portion, so that she does not have to overcome the material to elicit flexion. The LTT, if needed, can be Vel

cro-ed to the cranial portion of the splint, though only attached above the carpus. This should allow her to flex and not hyperextend due to the stop you have made with the LLT. The LLT may have to be formed greater then at a normal 10 degrees( like a carpal arthrodesis plate) then a closed cell padding material can be placed at the distal portion of the LLT to absorb the impact during active extenion since the top of the foot is not made to bear weight. I would recheck this dog at least once a week because he will probably be growing and need adjustments fairy often. If I have not explained this real well feel free to write or call me. I am in the database. Good luck, Robby>> Just wondering if anyone had an opinion on this one;> 8 week old female pit bull with hyperextension injury of left carp

us of two week duration -a robert jones bandage had been applied at time of injury by another vet no improvment noted when I removed the bandage. X-rays taken at time of injury showed no fractures, palpation yesterday revealed no crepitus or pain on palpation just lots of laxity. Wondering if I could get an opinion on some form of coadaptation(have some low temp thermoplastics or splint that might be adaptable for her at this age)-don't really want to lose muscle mass and possibly cause abnormal stresses and resulting growth plate changes in this leg and others due to compensation but also worried about ligaments and permanent loss of carpal function and the resulting above. The only other thing I could think of was ligaplex. Thanks for your thoughts. Clare DVM>

[Guest guest]

Sorry I have a hard time explaining these sometimes. So yes,

basically a circumductive support sling made from the breathoprene

with a stiffening rod (more like a strip) made of an LLT. I am

assuming that this dog is pretty small</= 12lbs, as she reaches >/=

30lbs this type of splint may not work anymore (forces are too great)

The breathoprene will aid in some support and allow for some flexion

but probably not enough to keep her from hyper-extending. That is

where the LLT comes into function as a " stop support " . First you make

a rectangular piece of LTT contoured to the anterior surface of the

affected limb, with nice round corners. I think it should start just

distal to the MP joints and run as proximal as you can to the elbow.

This will help distribute the forces. Normal static weight bearing

angle of the carpus, as you probably know, is about 10 degrees. So if

you make a bend in the LLT to about ~20 degrees you will have enough

room for a closed cell foam pad that will be placed at the distal

portion of the LLT. This will allow the dog to still flex and extend

but hyperextension should not occur during weight bearing movement.

In others words the LLT does not flex or bend during walking it stays

static. So, one of your LTT splint will be attached to anything below

the carpus. During the swing phase of the dogs gait she should still

be able to flex her carpus, and then during stance phase pressure

will be distributed from the bottom of her paw then to the top of her

knuckles stopped by the LTT part of the splint. PS to keep the rigid

LTT in place I would put a Velcro hook on the inside, this will stick

nicely to the breathoprene, then a Velcro hook on the outside to

receive 360 degree loop straps to hold the whole thing together. All

this should minimize any slippage or movement of the splint. I know

all this sounds complicated so if it still does not make since to you

I can draw a picture of it and Fax it to you, if you think that will

help.

Robby

> >

> > Just wondering if anyone had an opinion on this one;

> > 8 week old female pit bull with hyperextension injury of left

> carpus of two week duration -a robert jones bandage had been

applied

> at time of injury by another vet no improvment noted when I removed

> the bandage. X-rays taken at time of injury showed no fractures,

> palpation yesterday revealed no crepitus or pain on palpation just

> lots of laxity. Wondering if I could get an opinion on some form of

> coadaptation(have some low temp thermoplastics or splint that might

> be adaptable for her at this age)-don't really want to lose muscle

> mass and possibly cause abnormal stresses and resulting growth

plate

> changes in this leg and others due to compensation but also worried

> about ligaments and permanent loss of carpal function and the

> resulting above. The only other thing I could think of was

ligaplex.

> Thanks for your thoughts. Clare DVM

> >

>

[Guest guest]

any updates on this dog for us? Just curious.

--__________________ Orenbuch www.evelynvet.com

-------------- Original message -------------- From: jason_clare@...

All other joints appear fine, per owner little girl stepped or jumped directly on foot of maybe 5 lb pup- i agree this is a strange injury for this age and it is difficult to see potential fractures in an immature carpus film but no significant pain or crepitus on orthopedic exam just laxity so going with hyperextension although strong potential for undiagnosed chip fractures. I think this one is going to be difficult to win, any way we treat it there will still be permanent changes. I also worry about fitting her with any brace at this age other than a custom. thanks

-------------- Original message -------------- From: "Mark B. Parchman" <mbparchmanbendbroadband>

A second thought, does this dog have normal collagen and are you sure it is traumatic??MBPjason_clarecomcast (DOT) net wrote:

Just wondering if anyone had an opinion on this one;

8 week old female pit bull with hyperextension injury of left carpus of two week duration -a robert jones bandage had been applied at time of injury by another vet no improvment noted when I removed the bandage. X-rays taken at time of injury showed no fractures, palpation yesterday revealed no crepitus or pain on palpation just lots of laxity. Wondering if I could get an opinion on some form of coadaptation(have some low temp thermoplastics or splint that might be adaptable for her at this age)-don't really want to lose muscle mass and possibly cause abnormal stresses and resulting growth plate changes in this leg and others due to compensation but also worried about ligaments and permanent loss of carpal function and the resulting above. The only other thing I could think of was ligaplex. Thanks for your thoughts. Clare DVM

[Guest guest]

miracle of miracles, this one didn't read the book! I left a message for the dog to return for re-evaluation following the weekend and the little bugger was almost walking completely normal on the foot, it was difficult to even tell which one was affected!! So I'm not fixing what ain't broke, I guess supporting it in the cast for a week was enough time to get some healing, the wonder of pups! thanks for the input and will continue to check on her and let you know if anything changes. Clare

-------------- Original message -------------- From: evelynvet@...

any updates on this dog for us? Just curious.

--__________________ Orenbuch www.evelynvet.com

-------------- Original message -------------- From: jason_clarecomcast (DOT) net

All other joints appear fine, per owner little girl stepped or jumped directly on foot of maybe 5 lb pup- i agree this is a strange injury for this age and it is difficult to see potential fractures in an immature carpus film but no significant pain or crepitus on orthopedic exam just laxity so going with hyperextension although strong potential for undiagnosed chip fractures. I think this one is going to be difficult to win, any way we treat it there will still be permanent changes. I also worry about fitting her with any brace at this age other than a custom. thanks

-------------- Original message -------------- From: "Mark B. Parchman" <mbparchmanbendbroadband>

A second thought, does this dog have normal collagen and are you sure it is traumatic??MBPjason_clarecomcast (DOT) net wrote:

Just wondering if anyone had an opinion on this one;

8 week old female pit bull with hyperextension injury of left carpus of two week duration -a robert jones bandage had been applied at time of injury by another vet no improvment noted when I removed the bandage. X-rays taken at time of injury showed no fractures, palpation yesterday revealed no crepitus or pain on palpation just lots of laxity. Wondering if I could get an opinion on some form of coadaptation(have some low temp thermoplastics or splint that might be adaptable for her at this age)-don't really want to lose muscle mass and possibly cause abnormal stresses and resulting growth plate changes in this leg and others due to compensation but also worried about ligaments and permanent loss of carpal function and the resulting above. The only other thing I could think of was ligaplex. Thanks for your thoughts. Clare DVM