Guest guest Posted June 22, 2012 Report Share Posted June 22, 2012 ,I would really promote that the owners again consult with (a) or (the) surgeon concerning surgical repair of the CCL. With the degree of lameness you are describing I am also concerned about the meniscal injury. Following surgery prolonged rehabilitation will be required due to the length of time your patient has been non-weight bearing. Rick Wall, DVMThe Woodlands, TX Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2012 Report Share Posted June 22, 2012 It may be worth considering a Dynasplint for this dog. It is a low-load, long-duration stretch type of splint (has a dynamic spring tension in it)- the size of the dog may be a problem. I have used it for two cases; a lab mix with a stifle flexion contracture from an extracapsular repair gone bad and in a GSD with brachial plexus injury that developed an elbow flexion contracture. We were able to gain about 30 deg. of motion in both cases, but if the joint is actually "fixed" in a caudal drawer position, don't know if it would be successful. Just a thought... Bedenbaugh, PT, CCRP IG "frozen knee" I've been working with a 5yr old F IG that was dx'd with R CCLX last year, the owner elected non-surgical treatment, had taken the pet for some laser treatments, etc, was able to get the dog to the point of consistent TTWB (as described by owner), then owner was out of country in December and since then the dog is NWB. We started treating this patient in March, the dog has full flexion of the stifle, but very limited extension, measured at 110° today while under general anesthesia; 3 months ago measured the pt at 124° while awake. The patient is completely NWB, will only engage the RHL if the limb is in a crouched position or when swimming. Surgeon reports: On radiographs the left stifle had DJD and seems fixed in a caudal drawer placement. There is limited stifle extension either due to no quads and/or previously untreated stifle disease. The owner does not want to amputate the limb, I feel that rehab has not done a lot for this dog. I talked with the owner about just continuing with swimming sessions (vs full sessions of UWTM, manual, ther ex, U/S, etc) and put the money she saves into something else, ie accupuncture, Adequan, etc but I'm not sure either of those would even help! Just trying to get some other ideas of what this owner can do for her very nervous pup! Thank you, Shinas, LVT, CCRP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2012 Report Share Posted June 23, 2012 When did the surgeon see this dog? I'm concerned that this dog has been continuing rehab for nearly 4 months and is still NWB. I am very aggressive in my goals for NWB dogs. If I can't get them progressing in 2 weeks, maybe 3, then it is likely something that will require a more invasive intervention. Marti Drum DVM, PhD, CCRP, CERP Diplomate American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR) Clinical Assistant Professor Small Animal Physical Rehabilitation University of Tennessee C247 Veterinary Teaching Hospital Knoxville, TN 37996 (o) (f) mdrum@... " The most exciting phrase to hear in science, the one that heralds the most discoveries, is not 'Eureka!' (I found it!), but 'That's funny...' " -Isaac Asimov > > I've been working with a 5yr old F IG that was dx'd with R CCLX last year, the owner elected non-surgical treatment, had taken the pet for some laser treatments, etc, was able to get the dog to the point of consistent TTWB (as described by owner), then owner was out of country in December and since then the dog is NWB. We started treating this patient in March, the dog has full flexion of the stifle, but very limited extension, measured at 110° today while under general anesthesia; 3 months ago measured the pt at 124° while awake. The patient is completely NWB, will only engage the RHL if the limb is in a crouched position or when swimming. > Surgeon reports: On radiographs the left stifle had DJD and seems fixed in a caudal drawer placement. There is limited stifle extension either due to no quads and/or previously untreated stifle disease. > > The owner does not want to amputate the limb, I feel that rehab has not done a lot for this dog. I talked with the owner about just continuing with swimming sessions (vs full sessions of UWTM, manual, ther ex, U/S, etc) and put the money she saves into something else, ie accupuncture, Adequan, etc but I'm not sure either of those would even help! > Just trying to get some other ideas of what this owner can do for her very nervous pup! > > Thank you, > Shinas, LVT, CCRP > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2012 Report Share Posted June 23, 2012 Marti, Very well said! I also see a new accomplishment under your name, congratulations on your new Diplomate status! , Maybe I am not understanding your thoughts properly but why would you want to use a device to attempt to improve stifle range of motion. The muscle contracture resulting from sustained nociceptive withdrawal reflex will probably not effectively be corrected until stifle joint dysfunction is better addressed. The over 6 months of continuous non-weight bearing lameness should followed by several months of conservative therapy does not offer much hope that surgery can be avoided, in my opinion. I remain somewhat confused about the term " caudal drawer position " , does this refer to an abnormal caudal displacement of the tibia in its relationship to the femur suggesting injury to caudal cruciate ligament or the normal caudal displacement of the lateral femoral condyle to the tibia when the stifle is in flexion and the lateral collateral ligament becomes lax. The later movement could become more prominent in a cranial cruciate ligament deficient stifle. Rick Wall, DVM The Woodlands, TX Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.