5 mos GSD with carpal hyperextension

[Guest guest]

I'm a relatively new CCRT, and I have just gotten involved with a case that I would like opinions on. This is a 5 month-old German Shepherd that has carpal hyperextension and flattening of the foot and hyperextension of 3rd and 4th digits. This has happened due to application of splints. The origional splint had been applied to help stabilize a P1 fracture of the 3rd digit that happened when the pup was 8-10 weeks old. That led to initial deformity of the carpus and non-union of the toe fracture.

The pup most recently has had application of a rigid splint over the past month, with the surgeon wisely getting the pup in 2x/wk for removal of the splint for ROM of carpus before re-application of the splint.

The surgeon now wants the splint left off in order to correct the carpal hyperextension, and the toe may have surgery once the dog is skeletally mature. He wants no support at all of this carpus, stating that any continued support will exacerbate the carpal laxity. He says that the pup needs lots of rehab exercise, and this should then straighten up his carpus. I have read that many pups with even severe carpal laxity will straighten like this, but I'm not sure about this case. Additionally, unfortunately the owner purchased this pup with the intention to show the dog in conformation classes. I really don't think that this will be possible now even if all goes well. For sure her goal is not only to have a sound dog, but also she wants him to be cosmetically perfect.

The opposite carpus has minor hyperextension and the rest of the pup seems to be normal. He appears to be a very normal and very active puppy. There is no restriction of carpal flexion.

What can be done in rehab for this pup? Are there exercises that I can prescribe that will help with flexor tendons and muscles of flexion that will lead to less carpal hyperextension and lessen the flattening of the foot? Does he need some carpal support, such as a supportive wrap? Or is no support at all recommended hoping he'll straighten up as he grows? Would support, even partial support, impede correction of the carpal hyperextension?

Is a supplement like Ligaplex useful for a case like this? Are all similar supplements safe to use in skeletally immature dogs without causing detrimental changes to his adult skeleton?

Thanks for your help,

Stoots, DVM, CCRT

(I have pictures to post, but can't seem to figure out how to do this. Can you tell me how?)