Re: Gastrocnemius Injury and Rehab

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With an active dog it is scary to let them play as they risk reinjury. B.R. (Before rehab) times you could cast the limb to make sure to limit that motion to ensure the gastroc would be healed before allowing them to play unprotected. Now we can use a brace that limits the range of motion during play time and can be easily removed for the controlled environment of therapy. Therapy and bracing work in tandem for a quicker return to "normal". Therapy makes sure the range of motion and muscle strength are maintained and bracing makes sure the dog can still play.

I can only speak about the bracing side. I attached a picture of a brace design that works well for limiting flexion of the hock. I suggest a brace like this since flexion is the motion that would most likely to stress the gastroc. This design is different from other hock braces because the plastic wraps cranially. This plastic placement provides a good buttress to stop the flexion. Also if the straps come loose (something that would never happen to a game dog ), you do not lose your buttress and risk injury.

Hope this helps

Ben

Ben Blecha, CPOwww.skyprosthetics.com

-- Those who can laugh without cause have either found the true meaning of happiness or have gone stark raving mad.~Norm Papernick

To: VetRehab Sent: Tuesday, December 2, 2008 7:59:24 PMSubject: Gastrocnemius Injury and Rehab

My question relates to an injury sustained by one of my own dogs. Three weeks ago I was running my seven-year-old setter for a quick fifteen minute run out in a field. She was out of sight for no more than 30 seconds. Back at the vehicle she appeared fine and I gave her a quick once over. When we arrived home, about 45 minutes after the run, she was non-weight bearing on her right rear leg. On exam she had the leg drawn up tight against her body and there was a firm swelling in her gastroc and she was painful upon palpation of the swelling. The achilles felt intact and there were no palpable changes to the stifle. As it was getting late in the evening I didn't take her back to the clinic and thought I'd see how things went over night. I awoke the next morning to most of the rear leg being about three times normal size with edema distal to the gastroc and extending beyond the hock and her thigh being painful, bruised and swollen. There was also a

tremendous amount of bruising to the limb (to see pictures from the second day: http://www.gundogdoc.com/images/blogpix/maggieleg/thurs_leg.jpg and http://www.gundogdoc.com/images/blogpix/maggieleg/closeup_thurs.jpg).

Maggie had a Grade 3 Mast Cell removed 2.5 years ago and I had a Labrador present last fall with a swollen leg that I diagnosed as secondary to Mast cell disruption so I was overly concerned and when rads were normal I headed to Iowa State so we could do some advanced imaging if needed. On ultrasound of the limb there was a 3-cm heterogenous, avascular mass at the proximal left gastrocnemius, on aspiration there was a large number of spindle cells. The worry shifted from a MCT to a sarcoma and of course muscle injury was still on the table. The leg was so swollen and full of hemorrhage that none of the surgeons wanted a go at her and so we elected supportive care over the weekend and a recheck u/s the following Monday. The u/s showed a 3x4 cm hypoechoic mass with the muscle still and the area appeared more organized and had a multilobulated internal appearance.

At surgery the mass was opened and a large consolidated blood clot was removed, during the process of accessing the area and cleaning out the muscle the peroneal nerve was partially torn and sutured. Biopsies confirmed the spindle cells were of muscle origin. In hindsight had this been a client dog I may not have been so worried about neoplasia; however, with this dog's history and the fact there was no evidence (vocal or lameness) at the time of when the trauma would have occurred I probably jumped the gun just a little in the diagnostic process.

So, after that lengthy history, I'd be very open to suggestions for rehabbing this dog from this gastroc injury. She is a hard-charging field dog and I'd like to handle this return to function as best as I can. I've had her on strict rest and within a couple of days of surgery the leg had returned to normal physical appearance. Neurologically she appears normal and will only occasionally non-weight bear on the leg.

Any help or suggestions of a protocol would be greatly appreciated.

Thanks,

Joe

Joe Spoo DVM

www.gundogdoc.com