Guest guest Posted June 6, 2011 Report Share Posted June 6, 2011 Hi All, I have a difficult case of quadracepts contracture. Harley, 7 yr FS lab X, HBC in 12/08, femural fracture was plated but refractured two weeks later (don't know details), replated and IM pin and ex fix added for 6 wks. Four weeks after ex fix removal the dog was found to have no movement in the stifle. That's when our PT first saw her. She was in rehab for 13 mo (with our PT, not me). She had ultrasound, laser, stretching, moist heat, land exercises, acupuncture and eventually underwater treadmill work. She seemed to improve, getting some available motion in the stifle but she would not actively flex or extend the joint much on her own. She would occasionally seem to use the leg a bit. She did gain some muscle mass and (according to her record) a perceived pelvic malalignment improved. About a year ago the owner stopped bringing the dog for rehab as our PT felt she could not get any more improvement. She has continued with acupuncture (done by a different vet). It seems that after acupuncture she is better for a day or two but quickly relapses. Now the owner is interested in stem cell therapy, but we don't see that there is an indication for this. I just saw the dog (briefly) -- she was sedated for radiographs and under sedation I cannot flex or extend the stifle at all. Tarsus has some but reduced flexion, likewise hip flexion and extension is reduced. The quads are rock hard. Anything to advise this owener? Is surgery to release the contracture a good idea? Do we need to be doing something different in rehab -- something more aggresive, some different technique, or more frequently, or do you think if we tried for a year then more is unlikely to help? Thanks Pam Mueller PhD DVM CCRT pending Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 12, 2011 Report Share Posted June 12, 2011 There have been some cases where surgery has helped, but it does have a high rate of complications. Sometimes they have to re-create the ligament with fiber tape or remove a portion of the femoral diaphysis, other times fascial and muscle release is enough. As long as the client understands the potential that it would not help, surgery is the only likely way to regain flexion of the stifle. It sounds like they would be willing to do intensive rehab following surgical release (and I would ONLY recommend surgery if they will do the rehab). Otherwise, working on the hip has been successful in my hands (and others). I ignore the stifle completely and focus on the digits and hip. Currently, there aren't any orthotics/splints that have been consistently successful in resolving the contracture and I don't anticipate there ever will be one based on the disease process and severe fibrosis. However, I did utilize a splint in a case where we surgically released the contracture (clinically the same as quad contracture, but it was from a post op cruciate that was splinted in extension for 4 weeks.....don't ask). The splint prevented him from lying with his leg in extension, which had become a habit prior to surgery. My magic number has seemed to be standing angle of the stifle (130-135). If they can't flex more than that, I have not been able to regain flexion without surgical intervention. Hope this helps, Marti Drum DVM, PhD, CCRP, CERP Clinical Assistant Professor Small Animal Physical Rehabilitation University of Tennessee C247 Veterinary Teaching Hospital Knoxville, TN 37996 (o) (f) mdrum@... " The most exciting phrase to hear in science, the one that heralds the most discoveries, is not 'Eureka!' (I found it!), but 'That's funny...' " -Isaac Asimov > > Hi All, > I have a difficult case of quadracepts contracture. > > Harley, 7 yr FS lab X, HBC in 12/08, femural fracture was plated but > refractured two weeks later (don't know details), replated and IM pin and ex > fix added for 6 wks. Four weeks after ex fix removal the dog was found to > have no movement in the stifle. That's when our PT first saw her. She was in > rehab for 13 mo (with our PT, not me). She had ultrasound, laser, > stretching, moist heat, land exercises, acupuncture and eventually > underwater treadmill work. She seemed to improve, getting some available > motion in the stifle but she would not actively flex or extend the joint > much on her own. She would occasionally seem to use the leg a bit. She did > gain some muscle mass and (according to her record) a perceived pelvic > malalignment improved. About a year ago the owner stopped bringing the dog > for rehab as our PT felt she could not get any more improvement. She has > continued with acupuncture (done by a different vet). It seems that after > acupuncture she is better for a day or two but quickly relapses. > > Now the owner is interested in stem cell therapy, but we don't see that > there is an indication for this. I just saw the dog (briefly) -- she was > sedated for radiographs and under sedation I cannot flex or extend the > stifle at all. Tarsus has some but reduced flexion, likewise hip flexion and > extension is reduced. The quads are rock hard. > > Anything to advise this owener? > Is surgery to release the contracture a good idea? > Do we need to be doing something different in rehab -- something more > aggresive, some different technique, or more frequently, or do you think if > we tried for a year then more is unlikely to help? > > Thanks > Pam Mueller PhD DVM CCRT pending > Quote Link to comment Share on other sites More sharing options...
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