Carpal hyperextension

RE: Carpal hyperextension

Rob Davis — Sat, 09 Sep 2017 11:55:03 GMT

[quote user="Malcolm Ness"]I have never seen a good, long-term outcome with even the better custom-made splints/orthoses although the technology continues to improve. They have a place for the sub-group of relatively sedentary dogs in which surgery is not indicated[/quote]

The only case I have used these on was an elderly, fat GSD with immune-mediated polyarthropathy and a chronic implant-associated infection following PCA, so not a great candidate for PCA on the other side! It helped enormously in this case, but he was more Johnny Vegas than Usain Bolt....

RE: Carpal hyperextension

Malcolm Ness — Sat, 09 Sep 2017 10:24:12 GMT

As others have intimated, Pancarpal arthrodesis (PCA) is an excellent surgical solution for carpal hyper-extension. Although it is a major surgical undertaking, the results, in terms of returning dogs to previous levels of athletic function are impressive. In my practice, we saw a great many working dogs with traumatic carpal hyper-extension injuries and we would expect to return these dogs to work following PCA.

I have never seen a good, long-term outcome with even the better custom-made splints/orthoses although the technology continues to improve. They have a place for the sub-group of relatively sedentary dogs in which surgery is not indicated and just might be worth a try here but great care will be needed, especially if the clinician has no experience of applying casts and other mechanically functional dressings to thin-skinned gaze hounds.

Some significant caveats about PCA surgery - it is big surgery and technically demanding with a significant complication rate, even in the hands of the experienced, expert surgeon. While outcomes are generally very good in traumatic cases, they are sometimes very disappointing in cases where the aetiology might be "degenerative" The case in this thread has some worrying features - first, it is bilateral and progressive with no obvious history of trauma. Second, the paws are ugly and splayed with the dog failing to support its metacarpo-phalangeal joints. These are signs of pathology progressing and already involving more than just the carpus.

While bilateral PCA is probably still the 'least bad' option for this dog, I would not be terribly surprised if the post-surgical outcome fell well short of expectation due to failures of other joints.

RE: Carpal hyperextension

Dinu Catilina — Fri, 08 Sep 2017 22:09:54 GMT

I used them in the past, very good service. Family business that works very fast and they build sturdy things including 24 hours orthotics (extra padding) which are probably best types for greyhounds.

http://scandiorthopedic.se/en/778-2/carpal-orthosis/

I also think that these dogs do struggle and are better with some form of stabilisation.

RE: Carpal hyperextension

James Dunne — Fri, 08 Sep 2017 15:55:50 GMT

Carpal panarthrodesis gives very good functional results. In some of these slowly degenerating cases the dogs may not 'seem' too painful, but it is amazing what stabilising these joints can do for their quality of life. I recently had a dog whose owner couldn't afford surgery use Therapaws supports for his dog's slowly collapsing carpi and the extra support seemed to give the dog a lot of relief. Very anecdotal, but it may be a way to help - contact Veterinary Instrumentation as they supply that range and while they are not as rigid as an orthotic, they do seem to help. if they cause sores or otherwise irritate the dog, obviously you're back to square one.

RE: Carpal hyperextension

Rob Davis — Thu, 07 Sep 2017 18:28:30 GMT

Have used these on one occasion successfully. They are expensive as they are custom made in the USA from fibreglass casts taken of the patent, but they worked really well in my case. I suspect arthrodesis or conservative management would be the only other options.

RE: Carpal hyperextension

cathal rafferty — Thu, 07 Sep 2017 17:38:32 GMT

It is much more common in big dogs, collies and sighthounds particulrly it seems. The last one I had was small though, both carpi ended up like bags of marbles with crepitus++ but she lasted maybe 18 mths with just analgesia. Maybe her size saved her. They don't seem to get much ulceration as you'd expect they would, they won't do much exercise I suppose

RE: Carpal hyperextension

Neil Wheadon — Wed, 06 Sep 2017 15:43:25 GMT

How painful is this condition or is it merely unsightly?

You see this quite commonly in larger dogs though not as extreme as this.

I only ask as the thought of arthrodesis, the pain, money and trauma involved would make me think twice.

Definitely agree that splinting is a complete waste of time.

Neil

RE: Carpal hyperextension

Niall Taylor — Wed, 06 Sep 2017 15:36:02 GMT

[quote user="Kara Gibson"]Is carpal arthrodesis the onyl way forward for this dog?[/quote]

I'd have said it's either that or conservative management, really. It's tempting to splint these hoping to get some strength back but the ones I've seen approached like that haven't done well, the feeling is it might even make things worse.

Some of them though do very well with exercise modification, weight management and appropriate analgesia. The result looks a bit bizarre but doesn't seem to be any more painful than arthritis would be. Properly performed arthrodesis would probably be 'gold-standard', they can take a bit of managing, particularly if a plate is used. External fixators can also do the trick.

Niall

RE: Carpal hyperextension

cathal rafferty — Wed, 06 Sep 2017 15:35:59 GMT

Yes it is degeneration of the palmar fascia. I've never used an orthotic but it might help, though good ones are nearly as expensive as surgery. Pan carpal arthrodesis would likely give pain free function albeit with an altered gait. Don't be tempted to splint/cast. It'll do nothing to help