Re: forelimb flexor tendon repair rehab - questions [1 Attachment]

[Guest guest]

Hi Pam,So, while I don't like the look of the picture you sent, the video is a bit more promising that improvements could be made.If not doing so already, I would do some weight shifting onto that leg timing it with e-stim muscle contractions on the flexors.I'd also do mobs on the digits (general medial-lateral & dorsal-ventral) and carpus (into flexion actually).Time will only tell if the tendons will be strong enough to do agility. That'll require a lot of finger-crossing and maybe some horseshoes.As for your surgeon's comments... I'm not a surgeon, but 'no, that would not be my typical advisement.' Not in humans and not in dogs. That being said, unless there is major damage, not many owners go back to the surgeon after they have been discharged and given the go-ahead to run free. So perhaps he doesn't see the longevity of his repairs and what the animal can functionally do and/or how much better his repairs/patients could do with proper, guided, staged rehab post-operatively! :)One more idea, eventually, I'd want this dog digging. And of course, you'll need to address the postural compensations at some point as well.All the best Pam!Laurie

Thanks Laurie for all the info. We have ordered the carpal flex splint kit from Therapaw and will fit it tommorrow. They said you like to get a custom splint made -- but they couldn't do that until next week so we went with the kit. Until the splint is on we are restricting activity severely. I read the owner the riot act several times re letting the dog run free and I think she has come around.

I tried as you suggested to test the SDF and DDF. When testing an individual toe on the right (injured leg) and comparing it to the left I didn't feel like I had a big difference in pain or extensibility. She is painful on extension of digit V but there is a lot of scar tissue there on the lateral edge presumably from the very bad infection she had post op. However, when I try to extend the whole foot as one there is clearly much greater extension on the right vs the left. I have attached a picture here to try and show that. I am pressing up on both feet they are both extended as far as they will go you can see the difference. Do you think this means the tendon repair is shot or just that the collagen is soft at this point and it can improve?

I have also put up a video at :http://youtu.be/VIlVabJyWak -- is this the right way to do it??? Anyone who wishes to view the video and comment with suggestions they would be appreciated.

She reduced carpal and digit flexion of course -- but no ROM was done over 12 wks of coaptation so that is not surprising and I am hoping that we can get that back without too much trouble. But will her tendons (ever) be strong enough to support her in the activities of agility?

I talked to the surgeon, who told me that in normal cases of tendon repair (without the complications this dog had) he coapts for 12 weeks then they are "good to go" back to whatever they want. Huh? That doesn't sound right to me. From a splint/bandage to running and jumping with nothing in between? Surgeons out there, would this be your normal plan?

Pamela Mueller PhD DVM

Laurie Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRTCo-Owner,The Canine Fitness Centre Ltd.Calgary, AB, Canadawww.caninefitness.comCEO,Four Leg Rehab Inc.Canine Rehab Educational Resourceswww.fourleg.comPast-Chair,The Animal Rehab DivisionThe Canadian Physiotherapy Associationwww.animalptcanada.comInstructor,The Canine Rehab Institutewww.caninerehabinstitute.comGuest Lecturer,Faculty of Veterinary MedicineThe University of Calgarywww.vet.ucalgary.caVice-President,International Association of Physical Therapists in Animal PracticeWorld Confederation for Physical Therapywww.wcpt.org