brachial plexus injury

[Guest guest]

Hello!

I have been working on this dog since 11/21/07, retriever mix, 5 years

old, 82#. He was let outside and must have gotten his leg stuck in

something and when he went to pull it out he caused the injury, i.e.

there is no way he was HBC. On 11/20/07 a neurologist diagnosed him

with left brachial plexus injury (specifically involving the left C8-T1

nerve roots). I have been using LLLT and e-stim. I was having a lot of

trouble at first getting a contraction with the e-stim so I place them

at the dorsal aspect of the paw and at the mid triceps to get some

contraction/reaction. There has been some improvement, more forward

movement of the limb, it even seems that everything down to the carpus

is normal. He does not tolerate a lot of the exercises so we are trying

UWTM. I have gone to the facility with him twice now amd he just isn't

getting it (turning around, walking backwards, trying to jump out). He

has a DogLeggs wrap to help with contracture of the carpus and the

owner does PROM/stretching. Can soemone offer advice as to other places

I could try to place the e-stim pads, maybe some acupoints I can laser?

Anything else?

Thanks,

Combs RVT, CCRP

[Guest guest]

My Personcal experience:

I am treating a cat with a radial nerve injury. She originally could not bear wt and had no stability to her carpus. We have been working with her on playing with feather toys with her feet with good results. She is now bearing wt fully and can initiate movement with her foot. We also annoy her face so she brings the foot up to push away a cotton ball. I did laser therapy the initial 2 weeks. I have been massaging for the last 2 months- Its 2 months since the injury- she had a broken humerus and I witnessed her flying up in the air at least 8-9 feet before landing at her initial HBC. On VIN , I read a review which I am enclosing- and the bottom line was small pets do better than large. I was shocked at how poor her coordination was originally about her leg- She is a cat after all:) - but most of her improvement came about the first month. She is a young Bengal and needs a home if anyone is interested.

information from VIN:

Radial nerve injury is one of the most common peripheral nerve injuries in the dog and cat. Injury often results in reduced extension of the elbow, carpus, and digits, thus the animal can not extend the limb to bear weight on it. Affected muscles will have little to no tone and will atrophy quickly (usually within 5 days of injury). Triceps and extensor carpi radialis reflexes are depressed or absent and withdrawal reflex may also be depressed. The limb may either be carried off the ground with elbow flexed or supporting weight on the dorsum of the paw. Sensation to the craniolateral surface of the forelimb and the dorsal surface of the paw is depressed to absent. A poor to guarded prognosis for return of nerve function is likely if the patient has no response to deep pain stimuli applied to toes of affected limb.

If the musculocutaneous nerve is not injured, the patient may be able to keep limb flexed at the elbow to decrease abrasions from dragging the paw. If the musculocutaneous nerve is also injured, the patient can not flex the elbow and the limb will be dragged along creating abrasions on the dorsal paw surface. If this happens, then a boot or sock may have to be kept over the paw until it can be determined if the nerve injury was likely permanent or not.

NERVE REGENERATIONAxon regeneration can progress at about one mm/day or one inch/month as long as the nerve sheath is intact. If the axon has to grow more than 8 inches, it is unlikely that the axon will be able to connect to the nerve sheath since the nerve sheath shrinks and disappears over time. Thus if muscle function has not been regained after eight months of recovery, it is unlikely to ever occur.5 Prognosis is thus more guarded for larger breeds of dogs since the nerve has a longer distance to re-grow from point of injury to paw.

Mona L. Gitter DVM If you give 110% you get back 1000%DrFASTTALK.com

I am working with a black lab that ran into a car and suffered a brachial plexus injury. Initially she wouldn't use or move her left front leg. After 1 week, she started toe touching, however, she would only toe touch with the left when she was hopping on the right (both feet would touch at the same time). You could see movement at the shoulder and elbow but she would not extend her carpus or dorsi-flex her foot. There are no contractures in this area due to early ROM and stretching.Rehabilitation was initiated at this time where she was started on a home exercise program (twice a day) and hydrotherapy (UWTM and swimming). We are finding that even though we can place her foot on the ground, she will not bear any weight. Even when doing weight shifting exercises she won't bear any weight. We have made a splint to stop her leg from collapsing but I feel she will not use the muscles for weight bearing. When she's on the UWTM, I will help her do the motions but again no weight bearing.My question is has anyone worked with a simular case and got good results. It has been very discouraging for the owner to see the initial improvement and then nothing for 1 month. I have talked to them about a carpal dorsi-flexion boot to help keep the carpus and foot in the correct position for stepping but I worry that she will just hop around with it on and still not bear weight. When walking her extremely slow, she will try to step independantly but can not hold her self up so she quickly shift back on to the right foot. Thank you for your time Hatton CCRANorth Macomb Canine Rehabilitation and ConditioningWashington, MI

[Guest guest]

What’s her neuro exam reveal?

I'm not sure that what you have described is true motor improvement but rather just compensation of walking on three legs...

Robby

J Porter III, VT, LMT, CCRPAnimal Rehabilitation CenterMandeville, LA70448

To: VetRehab Sent: Thu, November 12, 2009 11:08:01 AMSubject: Brachial Plexus Injury

I am working with a black lab that ran into a car and suffered a brachial plexus injury. Initially she wouldn't use or move her left front leg. After 1 week, she started toe touching, however, she would only toe touch with the left when she was hopping on the right (both feet would touch at the same time). You could see movement at the shoulder and elbow but she would not extend her carpus or dorsi-flex her foot. There are no contractures in this area due to early ROM and stretching.Rehabilitation was initiated at this time where she was started on a home exercise program (twice a day) and hydrotherapy (UWTM and swimming). We are finding that even though we can place her foot on the ground, she will not bear any weight. Even when doing weight shifting exercises she won't bear any weight. We have made a splint to stop her leg from collapsing but I feel she will not use the muscles for weight bearing. When she's on the UWTM, I will help her do

the motions but again no weight bearing.My question is has anyone worked with a simular case and got good results. It has been very discouraging for the owner to see the initial improvement and then nothing for 1 month. I have talked to them about a carpal dorsi-flexion boot to help keep the carpus and foot in the correct position for stepping but I worry that she will just hop around with it on and still not bear weight. When walking her extremely slow, she will try to step independantly but can not hold her self up so she quickly shift back on to the right foot. Thank you for your time Hatton CCRANorth Macomb Canine Rehabilitation and ConditioningWashington, MI

[Guest guest]

Thank you for your input. She can withdraw her foot really well unless the stimulus is on the lateral part of her foot and then she doesn't seem to notice. When the dorsal side it pinched, she sometimes does withdraw. She places the foot a little when her leg is in a splint to keep the carpus straight but she doesn't seem to be able extend the elbow in order to bear weight. I know that all of these are typical with radial nerve damage but I'm just hoping that it may repair even though she's a bigger dog.

Thank you

Subject: Re: Brachial Plexus InjuryTo: VetRehab Date: Thursday, November 12, 2009, 2:56 PM

My Personcal experience:

I am treating a cat with a radial nerve injury. She originally could not bear wt and had no stability to her carpus. We have been working with her on playing with feather toys with her feet with good results. She is now bearing wt fully and can initiate movement with her foot. We also annoy her face so she brings the foot up to push away a cotton ball. I did laser therapy the initial 2 weeks. I have been massaging for the last 2 months- Its 2 months since the injury- she had a broken humerus and I witnessed her flying up in the air at least 8-9 feet before landing at her initial HBC. On VIN , I read a review which I am enclosing- and the bottom line was small pets do better than large. I was shocked at how poor her coordination was originally about her leg- She is a cat after all:) - but most of her improvement came about the first month. She

is a young Bengal and needs a home if anyone is interested.

information from VIN:

Radial nerve injury is one of the most common peripheral nerve injuries in the dog and cat. Injury often results in reduced extension of the elbow, carpus, and digits, thus the animal can not extend the limb to bear weight on it. Affected muscles will have little to no tone and will atrophy quickly (usually within 5 days of injury). Triceps and extensor carpi radialis reflexes are depressed or absent and withdrawal reflex may also be depressed. The limb may either be carried off the ground with elbow flexed or supporting weight on the dorsum of the paw. Sensation to the craniolateral surface of the forelimb and the dorsal surface of the paw is depressed to absent. A poor to guarded prognosis for return of nerve function is likely if the patient has no response to deep pain stimuli applied to toes of affected limb.

If the musculocutaneous nerve is not injured, the patient may be able to keep limb flexed at the elbow to decrease abrasions from dragging the paw. If the musculocutaneous nerve is also injured, the patient can not flex the elbow and the limb will be dragged along creating abrasions on the dorsal paw surface. If this happens, then a boot or sock may have to be kept over the paw until it can be determined if the nerve injury was likely permanent or not.

NERVE REGENERATIONAxon regeneration can progress at about one mm/day or one inch/month as long as the nerve sheath is intact. If the axon has to grow more than 8 inches, it is unlikely that the axon will be able to connect to the nerve sheath since the nerve sheath shrinks and disappears over time. Thus if muscle function has not been regained after eight months of recovery, it is unlikely to ever occur.5 Prognosis is thus more guarded for larger breeds of dogs since the nerve has a longer distance to re-grow from point of injury to paw.

Mona L. Gitter DVM If you give 110% you get back 1000%DrFASTTALK.com

In a message dated 11/12/2009 12:11:52 P.M. Eastern Standard Time, kellou16yahoo (DOT) com writes:

I am working with a black lab that ran into a car and suffered a brachial plexus injury. Initially she wouldn't use or move her left front leg. After 1 week, she started toe touching, however, she would only toe touch with the left when she was hopping on the right (both feet would touch at the same time). You could see movement at the shoulder and elbow but she would not extend her carpus or dorsi-flex her foot. There are no contractures in this area due to early ROM and stretching.Rehabilitation was initiated at this time where she was started on a home exercise program (twice a day) and hydrotherapy (UWTM and swimming). We are finding that even though we can place her foot on the ground, she will not bear any weight. Even when doing weight shifting exercises she won't bear any weight. We have made a splint to stop her leg from collapsing but I feel she will not use the muscles for weight bearing. When she's on the UWTM, I

will help her do the motions but again no weight bearing.My question is has anyone worked with a simular case and got good results. It has been very discouraging for the owner to see the initial improvement and then nothing for 1 month. I have talked to them about a carpal dorsi-flexion boot to help keep the carpus and foot in the correct position for stepping but I worry that she will just hop around with it on and still not bear weight. When walking her extremely slow, she will try to step independantly but can not hold her self up so she quickly shift back on to the right foot. Thank you for your time Hatton CCRANorth Macomb Canine Rehabilitation and ConditioningWashington, MI

[Guest guest]

I have had success with electroacupuncture treatment and modified postural triggers such as putting different inappropriate stimuli under the weight beraing foot as the function in the affected leg starts to improve. One dog (large) returned to function after years of disuse.

Judith M. Shoemaker, DVMAlways Helpful Veterinary Services305 Nottingham RoadNottingham, PA 19362ph fax info@... www.judithshoemaker.com

To: VetRehab From: kellou16@...Date: Thu, 12 Nov 2009 16:39:47 -0800Subject: Re: Brachial Plexus Injury

Thank you for your input. She can withdraw her foot really well unless the stimulus is on the lateral part of her foot and then she doesn't seem to notice. When the dorsal side it pinched, she sometimes does withdraw. She places the foot a little when her leg is in a splint to keep the carpus straight but she doesn't seem to be able extend the elbow in order to bear weight. I know that all of these are typical with radial nerve damage but I'm just hoping that it may repair even though she's a bigger dog.

Thank you

From: DrFastTalkaol <DrFastTalkaol>Subject: Re: Brachial Plexus InjuryTo: VetRehab Date: Thursday, November 12, 2009, 2:56 PM

My Personcal experience:

I am treating a cat with a radial nerve injury. She originally could not bear wt and had no stability to her carpus. We have been working with her on playing with feather toys with her feet with good results. She is now bearing wt fully and can initiate movement with her foot. We also annoy her face so she brings the foot up to push away a cotton ball. I did laser therapy the initial 2 weeks. I have been massaging for the last 2 months- Its 2 months since the injury- she had a broken humerus and I witnessed her flying up in the air at least 8-9 feet before landing at her initial HBC. On VIN , I read a review which I am enclosing- and the bottom line was small pets do better than large. I was shocked at how poor her coordination was originally about her leg- She is a cat after all:) - but most of her improvement came about the first month. She is a young Bengal and needs a home if anyone is interested.

information from VIN:

Radial nerve injury is one of the most common peripheral nerve injuries in the dog and cat. Injury often results in reduced extension of the elbow, carpus, and digits, thus the animal can not extend the limb to bear weight on it. Affected muscles will have little to no tone and will atrophy quickly (usually within 5 days of injury). Triceps and extensor carpi radialis reflexes are depressed or absent and withdrawal reflex may also be depressed. The limb may either be carried off the ground with elbow flexed or supporting weight on the dorsum of the paw. Sensation to the craniolateral surface of the forelimb and the dorsal surface of the paw is depressed to absent. A poor to guarded prognosis for return of nerve function is likely if the patient has no response to deep pain stimuli applied to toes of affected limb.

If the musculocutaneous nerve is not injured, the patient may be able to keep limb flexed at the elbow to decrease abrasions from dragging the paw. If the musculocutaneous nerve is also injured, the patient can not flex the elbow and the limb will be dragged along creating abrasions on the dorsal paw surface. If this happens, then a boot or sock may have to be kept over the paw until it can be determined if the nerve injury was likely permanent or not.

NERVE REGENERATIONAxon regeneration can progress at about one mm/day or one inch/month as long as the nerve sheath is intact. If the axon has to grow more than 8 inches, it is unlikely that the axon will be able to connect to the nerve sheath since the nerve sheath shrinks and disappears over time. Thus if muscle function has not been regained after eight months of recovery, it is unlikely to ever occur.5 Prognosis is thus more guarded for larger breeds of dogs since the nerve has a longer distance to re-grow from point of injury to paw.

Mona L. Gitter DVM If you give 110% you get back 1000%DrFASTTALK.com

In a message dated 11/12/2009 12:11:52 P.M. Eastern Standard Time, kellou16yahoo (DOT) com writes:

I am working with a black lab that ran into a car and suffered a brachial plexus injury. Initially she wouldn't use or move her left front leg. After 1 week, she started toe touching, however, she would only toe touch with the left when she was hopping on the right (both feet would touch at the same time). You could see movement at the shoulder and elbow but she would not extend her carpus or dorsi-flex her foot. There are no contractures in this area due to early ROM and stretching.Rehabilitation was initiated at this time where she was started on a home exercise program (twice a day) and hydrotherapy (UWTM and swimming). We are finding that even though we can place her foot on the ground, she will not bear any weight. Even when doing weight shifting exercises she won't bear any weight. We have made a splint to stop her leg from collapsing but I feel she will not use the muscles for weight bearing. When she's on the UWTM, I will help her do the motions but again no weight bearing.My question is has anyone worked with a simular case and got good results. It has been very discouraging for the owner to see the initial improvement and then nothing for 1 month. I have talked to them about a carpal dorsi-flexion boot to help keep the carpus and foot in the correct position for stepping but I worry that she will just hop around with it on and still not bear weight. When walking her extremely slow, she will try to step independantly but can not hold her self up so she quickly shift back on to the right foot. Thank you for your time Hatton CCRANorth Macomb Canine Rehabilitation and ConditioningWashington, MI

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[Guest guest]

I've had two dogs (lab and a golden) with similar injuries and the weight

bearing was slow to come for both of them. I found with one dog that she would

weight bear best in the UWTM when her head was down and she was almost

crouching. We offered treats low to the belt and water level was mid-forelimb.

Her owner began tracking with her then, and the pulling in the harness with her

nose to the ground drastically improved her function and weight bearing. The

other dog we focused on the same thing (though she did not begin tracking) but

we encouraged pulling from a harness with a weight behind her on walks. Again,

the weight bearing was slow to come back fully and even 9-10 months after injury

I could still see some weight shifting in both of their gaits. However, they

were both functioning quite well and 2 years later I can't tell a gait deviation

in the golden (whom belongs to a friend).

Side note, I also tried a carpal brace to try and keep the carpal joint from

collapsing however, I found that one, it would never stay in place (it was a

rigid splint) and two, the dog just carried the leg even more. So, I just

stressed to the owner that she needed to focus on static stretches of the carpus

both with and without weight bearing.

Good luck! These injuries can be quite hard to see but they can be the most

rewarding I've found in the rehab world.

-Holly Grant, RVT, CCRP

>

> I am working with a black lab that ran into a car and suffered a brachial

plexus injury. Initially she wouldn't use or move her left front leg. After 1

week, she started toe touching, however, she would only toe touch with the left

when she was hopping on the right (both feet would touch at the same time). You

could see movement at the shoulder and elbow but she would not extend her carpus

or dorsi-flex her foot. There are no contractures in this area due to early ROM

and stretching.

>

> Rehabilitation was initiated at this time where she was started on a home

exercise program (twice a day) and hydrotherapy (UWTM and swimming). We are

finding that even though we can place her foot on the ground, she will not bear

any weight. Even when doing weight shifting exercises she won't bear any

weight. We have made a splint to stop her leg from collapsing but I feel she

will not use the muscles for weight bearing. When she's on the UWTM, I will

help her do the motions but again no weight bearing.

>

> My question is has anyone worked with a simular case and got good results. It

has been very discouraging for the owner to see the initial improvement and then

nothing for 1 month. I have talked to them about a carpal dorsi-flexion boot to

help keep the carpus and foot in the correct position for stepping but I worry

that she will just hop around with it on and still not bear weight. When walking

her extremely slow, she will try to step independantly but can not hold her self

up so she quickly shift back on to the right foot.

>

> Thank you for your time

> Hatton CCRA

> North Macomb Canine Rehabilitation and Conditioning

> Washington, MI

>