Accessory Carpal Ligament Damage
Jun 18, 2011 10:16:54 GMT 10
Post by Tom Meulman on Jun 18, 2011 10:16:54 GMT 10
Accessory Carpal Ligament Damage
In my experience one of the most common injuries of the wrist is also the one where the early symptoms seem to be missed the most by both Vets and MM alike, and that is: a severely strained Acc. Carpal ligaments and concurrent damage to the Flexors of the wrist (both the Flex. Carpi Ulnaris and the Perforatus).
The most common site is the left wrist, but if the bullring has been used extensively the right wrist can also sustain the same damage.
This injury can to some extent be compared to a sprung toe joint as it is the joint capsule of the wrist that is damaged and weakened.
Symptoms:
These may vary considerably depending upon the extent of the damage, and can range from slowing down slightly on the turns and/or very slight lameness immediately after the run, to running wide on both turns through to severe swelling of the wrist joint after a run.
This injury, because it allows the wrist to flex further forward than normal, often results in bone damage to the Scapho-Lunar bone just below the front of the Radius and/or the Unciform bone just above the fourth and fifth Metacarpal bones.
It is unfortunate that many greyhounds that suffer the early symptoms of this injury are often believed to be non chasers, due to the fact that far too many of those whose job it is to check greyhounds for injuries fail to diagnose it correctly.
The most common period of time when this injury is first caused, is during the education or breaking-in period, with pulling up on the arm, and/or chasing the lure in a tight bullring doing the most amount of damage.
When this injury is sustained during the breaking-in period and the pup is then spelled allowing the damage to heal, it is often left with a weakness in one or both wrist due to the overstretching of the ligaments. Then when the angle of both of the wrists to the forearm is carefully compared with the pup standing squarely on both front feet, you can often see that one wrist actually flexes further down than the other wrist depending on which wrist is damaged.
Any greyhound showing this symptom is guaranteed to suffer further wrist damage during its racing career unless the weakness is rectified at that time.
Detecting Accessory Carpal Ligament Damage
An extremely simply procedure for detecting both past and recent damage to the stabilising tissue of the Accessory Carpal Bone is as follows.
Elevate the front limb just off the ground; bend the wrist to 90 degrees in regard to the forearm, place your thumb in the hollow behind the wrist, and exert pressure to the stopperbone by attempting to push it towards the toes.
You should not be able to move the base of the bone at all, nor should you be able to move the top of the stopperbone more than 1 or 2mm, and anything in excess of that indicates damage to the ligaments.
In a situation where there is old damage that has healed, but has left the ligaments in a stretched condition, it is sometimes possible to just about fold the stopperbone downwards 5mm without causing any discomfort to the dog.
When however a more recent injury exists, any moderate pressure on the stopperbone will result in a considerable pain reaction from the dog.
In every instance it is always worth comparing the degree of movement in the stopperbone in both wrists.
If the movement in the stopperbones of both wrists is identical, but appears excessive taking the above guide into consideration, and providing the greyhound is performing within expectations, it is best not to attempt any treatment to tighten the ligaments because why mess with something if it is not worrying the dog.
Treatment
It is essential that if there is any swelling at all in or around the wrist joint, particularly if this swelling is around the stopper bone or at the front of the wrist joint, that suitable X-Rays are done to rule out bone fractures or bone chips.
That any swelling is treated with ice water or cold packs over a period of some days, and is completely gone before further treatment is undertaken.
Strengthening of the ligaments is then undertaken by flooding the ligaments of the joint with a low level sclerosing agent. My mixture of choice is one percent of Ethanolamine Oleate per ML or if available a substance called Promote may be used.
Use two 1ML syringes with a 29 gauge needle. Care must be taken not to blunt these very fine needles by pushing them through the rubber top of a multidose vial, and subsequently hurting the dog by using a blunt needle.
Syringes with such very fine needles are best filled by first extracting the injection with another syringe with a heavy gauge needle, and then loading the 1 ML needles from the back after first removing the plunger. Care again must be taken when replacing the plunger by just sitting it in place and then allowing any air to travel to the top before pressing the plunger to the 1 ML mark.
Two ML in total of this is injected in the following manner:
The first 1ml syringe is mainly used to the outer side of the wrist joint.
Inject 1/4 ML into the tissue surrounding the Flexor Carpi Ulnaris accessible via the hollow at the back of the wrist, with the injection starting about 15mm above the stopperbone injecting down towards the stopperbone.
Holding the wrist very slightly flexed to take the pressure of the tissue surround the stopperbone, inject 1/4 ML into the underside of the stopperbone by starting the injection just to the side of the bottom corner of the outer side of the stopperbone, and angling the needle slightly towards the centre of the stopperbone.
Inject 1/2 ML sideways directly under the stopperbone sliding the needle sideways just above the metacarpals and just under the tendons to strengthen the fifth metacarpal ligament.
The second 1ML syringe is mainly used to the inner side of the wrist joint.
Inject 1/4 ML into the tissue surrounding the Perforatus starting about 15mm above the stopperbone and injecting down towards the stopperbone.
Again holding the wrist very slightly flexed to take the pressure of the tissue surround the stopperbone, inject 1/4 ML into the underside of the stopperbone by starting the injection just to the side of the bottom corner of the inner side of the stopperbone, and angling the needle slightly towards the centre of the stopperbone. Taking care to avoid puncturing the vein that is located in this area.
Again inject 1/2 ML sideways directly under the stopperbone sliding the needle sideways just above the metacarpals and just under the tendons.
At no time is any sclerosing agent injected into the wrist joint itself!
All of these injections, if care is taken, and sharp very fine needles (29 Gauge) are used, should cause minimal discomfort to the dog.
Rest the dog for ten days, by kennelling in a race style kennel, and by emptying out on the lead only, with no free running in a yard. During this ten day period massage Iodised Oil (MR Iodine) into the Flexor muscles at the back of the forearm daily, starting about 20 CM above the stopperbone and massaging down to the top of the stopperbone.
At the end of ten days a light poultice is applied overnight for three nights to the wrist joint, this is best done by again using Iodised Oil.
Rub a liberal quantity to the top and both sides of the stopperbone as well as the front of the wrist joint.
Then using a section of cottonwool just wide enough to fit around the wrist joint and long enough to cover the wrist from around 50mm above the stopperbone to just above the foot pad, split it into two thinner sections and liberally apply Iodised oil to one section only.
Wrap this around the wrist joint, taking care to tuck some into the hollow at the back of the wrist, place the second section of cottonwool over the top and lightly wrap with Vet Wrap or similar.
Muzzle the dog overnight to stop it from removing the bandage.
After this treatment is completed the dog is ready for a few handslips up a straight.
It is then best if its first run behind a lure consists of a handslip into the first turn over the shorter distance.
After each of its next three runs behind the lure into a bend, repeat the Iodised Oil poultice for one night only.
Tom
In my experience one of the most common injuries of the wrist is also the one where the early symptoms seem to be missed the most by both Vets and MM alike, and that is: a severely strained Acc. Carpal ligaments and concurrent damage to the Flexors of the wrist (both the Flex. Carpi Ulnaris and the Perforatus).
The most common site is the left wrist, but if the bullring has been used extensively the right wrist can also sustain the same damage.
This injury can to some extent be compared to a sprung toe joint as it is the joint capsule of the wrist that is damaged and weakened.
Symptoms:
These may vary considerably depending upon the extent of the damage, and can range from slowing down slightly on the turns and/or very slight lameness immediately after the run, to running wide on both turns through to severe swelling of the wrist joint after a run.
This injury, because it allows the wrist to flex further forward than normal, often results in bone damage to the Scapho-Lunar bone just below the front of the Radius and/or the Unciform bone just above the fourth and fifth Metacarpal bones.
It is unfortunate that many greyhounds that suffer the early symptoms of this injury are often believed to be non chasers, due to the fact that far too many of those whose job it is to check greyhounds for injuries fail to diagnose it correctly.
The most common period of time when this injury is first caused, is during the education or breaking-in period, with pulling up on the arm, and/or chasing the lure in a tight bullring doing the most amount of damage.
When this injury is sustained during the breaking-in period and the pup is then spelled allowing the damage to heal, it is often left with a weakness in one or both wrist due to the overstretching of the ligaments. Then when the angle of both of the wrists to the forearm is carefully compared with the pup standing squarely on both front feet, you can often see that one wrist actually flexes further down than the other wrist depending on which wrist is damaged.
Any greyhound showing this symptom is guaranteed to suffer further wrist damage during its racing career unless the weakness is rectified at that time.
Detecting Accessory Carpal Ligament Damage
An extremely simply procedure for detecting both past and recent damage to the stabilising tissue of the Accessory Carpal Bone is as follows.
Elevate the front limb just off the ground; bend the wrist to 90 degrees in regard to the forearm, place your thumb in the hollow behind the wrist, and exert pressure to the stopperbone by attempting to push it towards the toes.
You should not be able to move the base of the bone at all, nor should you be able to move the top of the stopperbone more than 1 or 2mm, and anything in excess of that indicates damage to the ligaments.
In a situation where there is old damage that has healed, but has left the ligaments in a stretched condition, it is sometimes possible to just about fold the stopperbone downwards 5mm without causing any discomfort to the dog.
When however a more recent injury exists, any moderate pressure on the stopperbone will result in a considerable pain reaction from the dog.
In every instance it is always worth comparing the degree of movement in the stopperbone in both wrists.
If the movement in the stopperbones of both wrists is identical, but appears excessive taking the above guide into consideration, and providing the greyhound is performing within expectations, it is best not to attempt any treatment to tighten the ligaments because why mess with something if it is not worrying the dog.
Treatment
It is essential that if there is any swelling at all in or around the wrist joint, particularly if this swelling is around the stopper bone or at the front of the wrist joint, that suitable X-Rays are done to rule out bone fractures or bone chips.
That any swelling is treated with ice water or cold packs over a period of some days, and is completely gone before further treatment is undertaken.
Strengthening of the ligaments is then undertaken by flooding the ligaments of the joint with a low level sclerosing agent. My mixture of choice is one percent of Ethanolamine Oleate per ML or if available a substance called Promote may be used.
Use two 1ML syringes with a 29 gauge needle. Care must be taken not to blunt these very fine needles by pushing them through the rubber top of a multidose vial, and subsequently hurting the dog by using a blunt needle.
Syringes with such very fine needles are best filled by first extracting the injection with another syringe with a heavy gauge needle, and then loading the 1 ML needles from the back after first removing the plunger. Care again must be taken when replacing the plunger by just sitting it in place and then allowing any air to travel to the top before pressing the plunger to the 1 ML mark.
Two ML in total of this is injected in the following manner:
The first 1ml syringe is mainly used to the outer side of the wrist joint.
Inject 1/4 ML into the tissue surrounding the Flexor Carpi Ulnaris accessible via the hollow at the back of the wrist, with the injection starting about 15mm above the stopperbone injecting down towards the stopperbone.
Holding the wrist very slightly flexed to take the pressure of the tissue surround the stopperbone, inject 1/4 ML into the underside of the stopperbone by starting the injection just to the side of the bottom corner of the outer side of the stopperbone, and angling the needle slightly towards the centre of the stopperbone.
Inject 1/2 ML sideways directly under the stopperbone sliding the needle sideways just above the metacarpals and just under the tendons to strengthen the fifth metacarpal ligament.
The second 1ML syringe is mainly used to the inner side of the wrist joint.
Inject 1/4 ML into the tissue surrounding the Perforatus starting about 15mm above the stopperbone and injecting down towards the stopperbone.
Again holding the wrist very slightly flexed to take the pressure of the tissue surround the stopperbone, inject 1/4 ML into the underside of the stopperbone by starting the injection just to the side of the bottom corner of the inner side of the stopperbone, and angling the needle slightly towards the centre of the stopperbone. Taking care to avoid puncturing the vein that is located in this area.
Again inject 1/2 ML sideways directly under the stopperbone sliding the needle sideways just above the metacarpals and just under the tendons.
At no time is any sclerosing agent injected into the wrist joint itself!
All of these injections, if care is taken, and sharp very fine needles (29 Gauge) are used, should cause minimal discomfort to the dog.
Rest the dog for ten days, by kennelling in a race style kennel, and by emptying out on the lead only, with no free running in a yard. During this ten day period massage Iodised Oil (MR Iodine) into the Flexor muscles at the back of the forearm daily, starting about 20 CM above the stopperbone and massaging down to the top of the stopperbone.
At the end of ten days a light poultice is applied overnight for three nights to the wrist joint, this is best done by again using Iodised Oil.
Rub a liberal quantity to the top and both sides of the stopperbone as well as the front of the wrist joint.
Then using a section of cottonwool just wide enough to fit around the wrist joint and long enough to cover the wrist from around 50mm above the stopperbone to just above the foot pad, split it into two thinner sections and liberally apply Iodised oil to one section only.
Wrap this around the wrist joint, taking care to tuck some into the hollow at the back of the wrist, place the second section of cottonwool over the top and lightly wrap with Vet Wrap or similar.
Muzzle the dog overnight to stop it from removing the bandage.
After this treatment is completed the dog is ready for a few handslips up a straight.
It is then best if its first run behind a lure consists of a handslip into the first turn over the shorter distance.
After each of its next three runs behind the lure into a bend, repeat the Iodised Oil poultice for one night only.
Tom