Hyperextension Of Carpal Joint

[dressagegirl]

Hi I am new to this forum but was just wondering if anyone has had a dog with a hyperextension injury of the carpal joint and treated it successfully without surgery?

I have a German Short Haired Pointer who was trying to jump over our fence (influenced by the full moon and rabbits and foxed I think) and then landed awkwardly and has hyperextended his front left carpal/wrist.

Vets are quoting me about $4000 for surgical fix or if I don't want to do that they are saying that amputation is the only other option. I would like to try non invasive treatment first.

Please has anyone got any good stories to tell me about these types of injuries.

Thanks in advance

Emma

[Nekhbet]

I read 'conservative' treatment is to rest for 3 months with the limbs splinted for 2. I think that would be your only option to try instead of surgery as if the ligament is completely torn apart there is no way to fix it without surgery. What level of surgery would be required? Complete fusion or just the bottom two.

I think these injuries are more common in competitive/agility dogs because of the pressure they put on their joints.

[Garry]

Hi I am new to this forum but was just wondering if anyone has had a dog with a hyperextension injury of the carpal joint and treated it successfully without surgery?

I have a German Short Haired Pointer who was trying to jump over our fence (influenced by the full moon and rabbits and foxed I think) and then landed awkwardly and has hyperextended his front left carpal/wrist.

Vets are quoting me about $4000 for surgical fix or if I don't want to do that they are saying that amputation is the only other option. I would like to try non invasive treatment first.

Please has anyone got any good stories to tell me about these types of injuries.

Thanks in advance

Emma

[Garry]

Hi I am new to this forum but was just wondering if anyone has had a dog with a hyperextension injury of the carpal joint and treated it successfully without surgery?

I have a German Short Haired Pointer who was trying to jump over our fence (influenced by the full moon and rabbits and foxed I think) and then landed awkwardly and has hyperextended his front left carpal/wrist.

Vets are quoting me about $4000 for surgical fix or if I don't want to do that they are saying that amputation is the only other option. I would like to try non invasive treatment first.

Please has anyone got any good stories to tell me about these types of injuries.

Thanks in advance

Emma

l have treated some dogs with this problem, & the latest 2 are now back to normal, Where are you located, Garry

[dressagegirl]

Thanks everyone. They want to fuse the whole joint at a cost of $4000.

Garry I am in NSW and have just been given the name and number of an accupuncturist (sp?) out Bringelly way that has had success with these injuries as long as the tendon isn't snapped.

We are booking the dog in today or tomorrow for a consult with him.

Glad to hear though that there may be light at the end of the conservative treatment tunnel so to speak.

Keep the good news stories coming.

[Charles Kuntz]

Hi, Charles Kuntz here. I have to say that I have tried conservative management for several of these with little success. I have done about 35 pancarpal arthrodeses (complete fusions) with about 85% success rate. The big determining factor is if there is disruption of the flexor apparatus with increased mobility of the joint in extension or if there is just inflammation and pain. If it is the latter, then conservative management should be OK. If there is hyperextension of the joint, then you probably are going to have to do a fusion. I can see acupuncture helping with pain, but not much else.

Good luck. Please let me know if I can be of any further assistance.

Charles

[dressagegirl]

Hi Charles

We are hoping that the palmer tendon (?) hasn't snapped. If it has there is no hope and we will have to look at the operation. But if it hasn't then the accupuncturist said that we can help quiet a bit and he has rehabilitated several dogs with this injury.

We are quiet prepared to keep the leg splinted for 3 months or more and undertake physio etc. It would have to be cheaper than the $4000 quoted by the specialist.

Perhaps if we have to get the operation done I might have to ring around some reputable vets and get a better price???? But I don't know is the $4000 a standard cost of is this a little pricey for the operation involved?

We where told by the accupuncturist to ensure that the splinted leg had a carpal joint flexion of 10 degrees until we could come and see him - it didn't so we took the bandaging off etc so that we could re bandage it. The dog was very reluctant to give us any flextion in the carpal joint so I am hoping beyond hope that this is a good sign that would indicate that if he had snapped the tendon we could flex the joint forward and back without any resistance???? but that might just be me grasping at straws

Would love more input from anyone. Thanks to those that have contributed already.

Emma

[Charles Kuntz]

Hi, We have to make sure that we are talking about the same directions here. Flexion of the carpus is the direction where the toes touch the arm, in the natural direction that dogs fold their carpi. This is the direction that you want the bandage to go, in 10 degrees. This will hopefully put the ruptured structures in closer contact with each other in hopes that they will heal. The other direction is "extension" or "dorsiflexion" (confusing, I know) and is the direction the carpus goes when a dog is standing squarely on both front feet. This is the direction that the carpus was stretched that caused the injury in the first place. You would not want to bandage the carpus ten degrees in that direction because that will make it harder for the tissues to heal (and is understandably painful). The best way to tell if there is instability is to take anaethetised radiographs and compare one side with the other with equal amounts of pressure.

Regarding the cost of the surgery, $3,400 to $4,000 is about right given the extent of hardware needed to repair the injury and the surgical time required. Usually a soft bandage is placed at the time of surgery, then a cast is placed at 5-7 days out. This has to be reassessed and changed as necessary for 8 weeks and a radiograph is taken at that time. You want to find out if these rechecks are included in the initial cost or not.

Hope this helps.

Charles

[dressagegirl]

Ahh this helps me greatly Charles.

[Garry]

Good luck with the acupunture & the bandage. l wonder if the acupunturist will use an injection of pentosan 100 into the joint also, really good for tendons & joints, regards Garry

[Diva]

Perhaps if we have to get the operation done I might have to ring around some reputable vets and get a better price???? But I don't know is the $4000 a standard cost of is this a little pricey for the operation involved?

One of my dogs had a carpal arthrodesis op, it was for a different sort of injury than the one you described but just to give feedback on cost, I think the op and pre-op blood tests and x-rays etc was about $3,500. She subsequently needed another to remove the metal plate, another $1,500 or so.

[dressagegirl]

Diva that would of been a lengthy recovery both times.

Took naught German Short Haired Pointer off yesterday to the accupuncturist and he has had a look at the limb and diagnosed it as not being the main ligament (palmer ligament ? ) but all the tendons etc below the carpal joint and running into the paw?

We have it now splinted and pointing backwards at a 10 degree angle and he will receive accupuncture etc every week for the next six weeks and we will see what happens.

Fingers crossed everyone that this helps my naughty fence jumping boy...... needless to say that when he is better he will not be allowed to sleep outside again (especially if there is a full moon).... he will now be locked away at night to stop any other nocturnal yearnings he has for high jumping.

Emma

[Charles Kuntz]

What does he expect to achieve with acupuncture and what evidence does he have that it will have the desired effect? As far as I know, acupuncture has been shown to provide pain relief, improve liver recovery after toxic injury and to improve neurological recovery after spinal cord injury. It has been shown to reduce requirements for anaesthesia and to provide sedation. To my knowledge, it has not been shown to improve recovery after tendinous or ligamentous injury.

I am a big believer in "evidence-based medicine" which means that we, as medical practitioners, make treatment recommendations based on what has been shown to be effective in scientific studies. Otherwise, we must be clear that what we are doing has no basis in the scientific literature.

Charles

[Diva]

:D Diva that would of been a lengthy recovery both times.

Yes it was. Sadly the outcome has been poor and she remains lame and in pain.

Good luck with your boy, you have all my best wishes.

[Garry]

Diva that would of been a lengthy recovery both times.

Yes it was. Sadly the outcome has been poor and she remains lame and in pain.

Good luck with your boy, you have all my best wishes.

l feel that Charles is a bit critical of the accupunturist, but in saying that there is good & not so good people doing this. Having a top surgeon operate on my arm & putting a plate in that nearly severed the nerve (couldn't open my fist) i know that after removing the plate all the physio etc never changed a thing until i had accupunture, but after the first treatment i felt a difference in the hand. Three visits later with a little more movement in the hand i was told it was now ok. The little movement then progressed to FULL use of my hand. No coming back for more money etc the job was done in 4 visits. Also today started treating a dog with hyperextension of the cruciate ligament, & by the way i'm not an accupunturist.

[Charles Kuntz]

I have nothing against acupuncture or any other alternative modalities. I am not saying that acupuncture doesn't work- in fact, I believe that in certain instances, it works very well. I do, however, believe strongly in informed consent. That is giving pet owners the information they need to make an informed decision on treatment. Pet owners need to know the documented results that are available for the treatment that they are being offered and being charged for. If there is no documented benefit then owners need to know that the treatment is experimental and that there is no data to support it.

I often offer "experimental" treatments for pets with cancer because in some cases, nothing conventional is effective. These include new radiation therapy protocols, chemotherapy protocols, etc. I am always VERY clear with clients that we have NO DATA to support what we are offering, and I also offer all alternatives that are available.

I just think pet owners need to know what they are paying for, and if what they are paying for has been shown to work.

Charles

[dressagegirl]

Hi Charles

I understand where you are coming from but I think sometimes Dr's and Vets are a little closed to alternative therapies.

For instance - about 8 years ago I got really sick - temps over 41 degress for three weeks - hair falling out - kept complaining of kindney pain.... Dr's had no clue and didn't know what to do to treat it. They tried all different kinds of drugs and nothing worked.... was at the point where we couldn't get my temp below 40 and I couldn't walk unassisted anywhere and Dr's still insisted that there was nothing physically wrong with me or my kidneys.

Rung a well respected accupuncturist and even before we got to tell him the part about my kidneys killing me he diagnosed kidney issues.

Treated me intensively for two weeks and even after the first treatment I felt better.....

Acupuncture has been around for a very long time and I belive that there is a lot that we don't know about it - I don't think it needs to be scientifically proven to mean it works.

I will keep you all posted as to my dogs progress. He has had good results in the past so I am hopping that they will be reflected in my dog as well.

Regards

Emma

[rickw0708]

Hi Emma

Hope things go well for you and your dog - I may need your accupuncturist if all goes well !!

I have a 15 month old Border Terrier (Lexie). About 2 and a half weeks ago she was struck by a car. Fortunately the car was not travelling fast and her immediate injuries were not visually too severe. She spent a night in the hospital to keep an eye on her shock and to watch for any internal injuries.

She returned home and has returned to normal apart from an inability to stand on her front left leg. The vet had mentioned it may be a brachial plexus avulsion(?) (which in its worst case would require amputation) but that as Lexie was able to hold her leg up rather than it typically dragging on the ground was a good sign.

After 2 weeks now she still doesn't bear weight on this leg but she does use it to paw at things, rub her nose, etc but just can't seem to actually stand on it. She was taking tablets for potential swelling on the brain which have now finished so the vet has put her on anti-inflammatories to hopefully help with the leg.

At her last vet visit the vet thoroughly checked her leg and said that she was somewhat perplexed as structurally the leg was fine (Xrays on the night of the accident) and that nuerologically(?) the leg seemed fine and she appears to be in no pain. Her pupils have returned to normal as after the accident there was some concern about one of them. She said she was not too sure why she wasn't able to bear weight on the leg.

I now have an appointment next week with the vets senior colleague for a more intensive evaluation - she did mention tendon/ligament damage.

As I said, Lexie behaviourly is pretty well back to normal - its just the leg. Last night, she got quite excited at the prospect of the dog next door being out and she ran back and forth along the fence and she used all 4 legs as if nothing was wrong - but as she had to slow down to turn around she would go back to hopping before taking off again on all fours and once back inside went back to hopping. I have also watched her furiously dig at the lawn/dirt with both front legs although I am not too sure how much force is being produced by the bad leg.

I am a bit confused/perplexed as to what the problem could be and was hoping someone could shed some light on this for me.

Regards

Rick

[Charles Kuntz]

Hi, Charles Kuntz here. I have read your description and I have to say that I would be a bit perplexed as well. If x-rays are truly normal then the injury would probably be soft tissue in origin. Brachial plexus avulsion involves a tearing of the nerve fibres as they exit the spinal canal. They can be partial or complete. Generally they don't result in a leg-carrying lameness. Just a flaccid paralysis. Your vet has ruled that out because of the normal sensation.

Other soft tissue injuries could be a torn ligament or tendon- obviously difficult for me to determine without an examination. If your dog were in my clinic, I would start with a complete palpation of the integrity of the ligaments, looking for laxity and pain. I would also closely check the toes, both radiographically and by palpation to make sure there is no fracture of a small bone, missed previously. Please let me know if I can be of more assistance.

Charles

[rickw0708]

Hi Charles

Thanks for your advice.

As the accident happened at night I had to take Lexie to an emergency hospital - closest being the one in Plenty Rd Bundoora. I have taken her back there for her followups as they (I think) know best her history re this accident - although, she has seen 4 different vets on her 4 visits. That said, they have been kind and to me, as a layman, thorough.

On her last visit, the vet did spend quite a while feeling all along her leg from shoulder to foot. She did say to me that as the Xrays showed no breaks and nuerologically she seemed very good, she had expected to find some excessive movement in the joints to indicate problems with the tendons/ligaments but had found nothing obvious and no obvious signs of pain. [Forgive me, these are my words not the vets exact words:) ]

This is why she felt it would be best for me to bring Lexie back next week for a more detailed appraisal by one of her more senior(?) colleagues - perhaps even to leave her there for the day. She gave her anti-inflammatries but I am sure she did say she didn't think they were going to be the cure-all.

I have spent many hours now pouring over the internet looking for information - not sure its such a good thing to do, but...

I have seen many articles talking about how long these nerve type issues can take to resolve so I am hopeful.

Thanks again

Rick