Re: help treating possible congenital condition

December 9, 2011

Wow!

You may want to contact Diane Shelton at the Comparative Neuromuscular Lab at UC

San Diego. In the interim you can use custom orthoses with dynamic hinging to

gradually extend the carpi to physiologic angle (at least 180). If he cannot

stand or walk on his own build him a cart so that he can " stand " on all fours

and get proper gravitational orientation, neuromuscular facilitation, and for

the mental stimulation of being up and around.

Patsy Mich

Patrice M. Mich DVM, MS, DABVP, DACVA

OrthoPets, Denver CO USA

>

> Hello!

> I was recently presented with a challenging case. I have an approx. 3

> month old mixed breed male puppy that presented with acute onset of severe

> weakness and severe muscle atrophy on all 4 limbs, worse on the forelimbs,

> to the point where the dog cannot walk or stand at all. He has good pain

> sensation and motor function. CP's are present but weak. The dog's

> carpal joints also became contracted in flexed position. According to the

> owner the puppy was fine up till around 2 months of age when the clinical

> signs started to develop. 1 littermate died at a very young age I believe,

> and his 2 other live litter mates have also developed similar problems

> according to this owner (they belong to someone else). The dog does not

> have vaccines, and there is no budget for blood work or any type of testing

> other than radiographs of the distal forelimbs and hind limbs. These are

> normal except for what seems to be disuse osteopenia. He cannot extend his

> carpus on his own at all in order to stand on his forelimbs. We're

> suspecting a congenital condition (muscular dystrophy?), but a proper work

> up cannot be done . he's currently on several nutritional supplements and

> we treated with clindamycin in case it was infectious (neospora?). The

> owner however has the time and commitment to do therapies at home to try to

> help the puppy.

>

> We started doing rehab on him with basically range of motion exercises on

> all joints, working on increasing carpal extension, electrical stimulation

> to atrophied muscles (triceps, carpal extensors mainly), swimming at home.

> Since the dog cannot extend carpus, we placed braces on the forelimbs to

> see if this helped maintaining the carpus extended and prevent further

> contracture. we've been trying this for about 3 weeks. I have seen mild

> improvement in the hind limb muscle strength, girth, etc. (although we

> still have a ways to go) tries to give steps with support , but I don't

> see any improvement in the forelimbs.

>

> Do you have any other suggestions for me as far as rehab things we can do

> to help this puppy? I'm not sure where to go from here. If he doesn't

> improve, what options do we have?

>

> I have attached two videos of him.

> Thanks!

> Alma Alicea-Garcés, DVM, CCRT

> San , Puerto Rico

>

December 12, 2011

My gut (since other diagnostics are not an option) says because of the

compromised delivery, the congenital contdition is some sort of cerebral palsy.

This also fits into the fact that the contractures did not develop until 2

months. With this diagnosis, contractures develop when the animal goes through

a growth spurt. The bones grow faster than the muscles with spastic tone can

stretch. A brace will help to prevent further contracture BUT you have to get

the paw in a neutral postition first. When I worked at the Shriner's Childrens

Hospital we used serial casting to do this. -on and I did

serial casting at Alameda East for a dog that had a congenital problem involving

a stunted one side of a growth plate. In humans, they wear the cast for 2

weeks. Then, the cast is removed and another is added, each time we cast in the

most corrected postition. You do this during growth time until the limb is in a

neutral postition. (serial casting does not work in a skeletally mature animal)

Once the limb is neutral, cast for a custom brace, then keep serial casting

while the brace is fabricated. Because dogs mature more quickly, we changed the

cast every 3-5 days, use your judgement, start with 3 and work up to 5.

As far as the strengthening, if this is truly cerebal palsy, the dog will not be

able to control the more distal parts of the limb. The dignosis has spastic

tone of the muscles and the dog will always be confined to a brace to maintain

the neutral postition. I would focus working on the strength of the more

proximal joints.

My guess!

Ben

Ben Blecha, CPO

www.AceOrthoSolutions.com