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Post by Wrist Issue on Sept 22, 2017 6:12:28 GMT 10
Hi, I'm a canine physio who is treating a greyhound who keeps going lame on the front right wrist. She's been seen by two vets, the go to local greyhound man (unqualified but experienced fixer), an osteopath and nobody has diagnosed any main issue as she's sound very quickly after going lame. She was rested (bar walks) for almost a year and had a gently easing back into straight sprints etc with some setbacks on the wrist. She always seems good to go again but after a second or third run goes lame on the front right again with a yelp of pain if the wrist is palpated or mobilised straight after but often is fine again the next day. I am stumped as she always seems in good shape after recovery and it's devastating to hear she's breaking down again. Several times I've visited her the day after injury and she's fine again or else has a painful response from the wrist. I've noted poor neck movement and a tight right shoulder so have been working on those areas as well as the wrist and also the back and the only thing I can think of is that it's a nerve issue which is why I sent the owner to another vet and then an osteopath but nobody has diagnosed the condition. I am not supposed to make a diagnosis but trained to treat after diagnosis from the vet but the vet hasn't diagnosed the condition properly in my opinion (but has signed the referral form to allow me treat with physio). I really thought I'd made progress by freeing up the shoulders more and getting movement into the neck but these set backs are terrible. I feel like I'm just repeatedly treating symptoms whilst the main cause is undiagnosed. Where do I go from here? - except back to school  By the way I'm only newly qualified so have no real experience with greyhounds so hoping there is some experienced based advice here! thanks for reading! |
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Post by Tom Meulman on Sept 22, 2017 20:49:18 GMT 10
I understand where you are coming from, and it's an extremely frustrating situation to be in. For a starter pain upon firmly bending the wrist as well as pain upon palpitation can be, and often is, caused by a severe muscle spasm across the junction of the cervical and thoracic spine. However, while that condition causes the dog to yelp when the wrist is flexed and palpitated, it generally does not result in any lameness, and in fact having a greyhound running behind the lure with an undiagnosed wrist or front limb injury, particularly if it involves a bone or ligament damage, will isooner or later result in a painful muscle spasms not only across the cervical and thoracic spine junction but also in the top three thoracic spinal segments. Therefore it's my belief that the tightness you are finding in the base of the neck, the pain upon wrist flexion, and if you placed rubbing pressure on the path of the radial nerve across the shoulder and front limb, you would most likely also find discomfort if not pain along that pathway, are all the result of an injury that does not allow the dog to place full pressure on its right front limb while negotiating a bend in the track. Further information hereHowever all of that still means that there is an injury somewhere in the right front limb which so far has not been found. An injury which, while most likely, may not necessarily be in the actual wrist and could also involve damage to the origin of the radialis at the elbow joint, toe sesamoids, or even damage to the spine of the scapula. Because it's been an ongoing issue for such a long time my guess would be that the initial injury was damage to the accessory carpal ligaments which allowed the wrist to flex too far forward under pressure. Further information hereThe only thing you can do is relieve any pressure that may be on the root of the radial nerve by freeing the appropriate section of the spine so that the pain in the wrist caused by flexion is gone, and then very carefully examining the stability of the wrist, as well as carefully examining the bone structure of the wrist starting at the lower end of the radius. Cheers, Tom |
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Post by Wrist Issue on Sept 24, 2017 1:56:28 GMT 10
Thanks so much for the detailed response! Lots of helpful info there.
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Post by Wrist Issue on Oct 2, 2017 1:17:58 GMT 10
Hi,
I got the owner to go back to the vet again and this time diagnosis came in. There is tendon under the stopper bone that is sometimes but not always touch a nerve which explains the erratic lameness and head scratching!
Operation can be done to "move it". I wasn't speaking to the vet so just hearing this back from the owner. Owner not keen to get op done and is talking about "blistering" it.
I've heard of this before but understand it's a dated technique of intentionally adding scar tissue which somehow kills the nerve endings and works to stop the pain but does not fix the actual problem?
Even if this works for purpose, there will still be compensatory problems?
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Post by Tom Meulman on Oct 2, 2017 7:09:14 GMT 10
Hi, I got the owner to go back to the vet again and this time diagnosis came in. There is tendon under the stopper bone that is sometimes but not always touch a nerve which explains the erratic lameness and head scratching! Operation can be done to "move it". I wasn't speaking to the vet so just hearing this back from the owner. Owner not keen to get op done and is talking about "blistering" it. I've heard of this before but understand it's a dated technique of intentionally adding scar tissue which somehow kills the nerve endings and works to stop the pain but does not fix the actual problem? Even if this works for purpose, there will still be compensatory problems? A tendon under the stopper bone that touches a nerve after strenuous exercise is a new one for me as dogs do not suffer tunnel carpal syndrome, and as far as I'm concerned that diagnosis simply confirms my previous belief of damage to the accessory carpal ligaments some time ago and the resulting instability of the wrist causing pain and intermittent limping as well as causing muscle spasm to the upper thoracic spine. It's also highly likely that at this late stage after the initial injury occurred there is some osteoarthritis of the wrist due to its instability, and I certainly agree with the owners assumption that surgery on the wrist is not going to solve the problem. In fact I can only see it making it worse as it will do nothing to repair wrist stability. To that end a careful blistering of the area of the wrist both below and to each side of the stopper bone may just increase ligament strength enough to improve wrist stability and allow running without further pain. A search in the top bar with the words " blister, blistering" on this forum should provide more in formation on this subject as it has been asked about on previous occasions. Cheers, Tom |
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Post by ROB on Oct 26, 2018 18:31:13 GMT 10
hi tom I was hoping you can help me with a wrist injury problem 3months ago I was teasing my dog with a toy tied to a piece of rope and for some reason the dog let out a yelp and lifted its left front foot of the ground and was in a bit of pain so I took the dog home and found the dog lame in the wrist so for the next six weeks I spelled the dog while I was also using laser therapy and bone radial to fix the problem.After six weeks of treatment the dogs wrist seemed fine so I put the dog back in work after 4 trials the dog was lame in the left wrist again and also started to have a track leg so I spelled the dog again this time I used the magnetic field therapy and bone radial while I spelled the dog for another six weeks. I strapped both wrist today and trialled the dog when I got home I lifted the dogs right foot of the ground and ran my finger down the metacarpals of the left foot and found slight lameness when applying pressure on the third metacarpal im puzzled tom can you help me please
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Post by Tom Meulman on Oct 27, 2018 5:41:19 GMT 10
Hi ROB,
From what you have written it seems to me that you have had two different injuries to the wrist. The first one being accesory carpel ligament strain from the dog trying to twist too quickly while playing with the teaser toy.
The second problem occurring after four trial sessions would most likely be due to metacarpal strain, with possibly micro fractures in the bone surface of the railside metacarpal.
While all that would definitely be healed, you need to keep in mind that with the six weeks off the bones of the wrist would have gone back to their resting state, and further remodeling needs to take place before these bones, particularly the metacarpals, can handle the full on strain of the dog driving around a bend without some soreness.
I’m therefore inclined to believe that the discomfort you are finding is due to further remodeling being initiated and obviously needed to strengthen the bones sufficiently to handle further strain.
All you can do at this point in time is to space runs around a turn to once a week, with an additional run up a straight track, a couple of days of bone radial treatment after each run on a bend, and give it another four weeks of this type of exercise to give the bone surfaces a chance to catch up.
The only other thing to make sure of is that there is sufficient calcium in the diet to allow efficient bone remodeling to take place.
Cheers,
Tom
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Post by ROB on Oct 27, 2018 23:46:22 GMT 10
thank you tom do you think I should still use the magnetic field therapy on her wrist
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Post by Tom Meulman on Oct 28, 2018 8:23:52 GMT 10
thank you tom do you think I should still use the magnetic field therapy on her wrist Magnetic field therapy is certainly worthwhile, the only precaution is not to use it immediately after having applied something like Boneradiol as that could blister the skin. Cheers, Tom |
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Post by ROB on Nov 8, 2018 21:24:13 GMT 10
hi tom just got back from the vet after telling him about the wrist injury he checked the dog and told me the extensor muscle on the forearm was the problem he squashed the wrist very hard and the dog was crying do you think the extensor muscle could be the cause for the dog being lame after every trial would it cause pain in the metacarpals he said their was no bone damage and what can I do to fix the problem
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Post by Tom Meulman on Nov 9, 2018 3:59:54 GMT 10
hi tom just got back from the vet after telling him about the wrist injury he checked the dog and told me the extensor muscle on the forearm was the problem he squashed the wrist very hard and the dog was crying do you think the extensor muscle could be the cause for the dog being lame after every trial would it cause pain in the metacarpals he said their was no bone damage and what can I do to fix the problem Hi ROB, Sorry mate but it’s just about impossible for me to be able to provide any advice whether the Vet is correct in his/her diagnosis of the cause of the lameness without being able to thoroughly examine the dog. Your Vet is the person that has examined the greyhound and is therefore in the best position to provide the right advice in how to overcome the injury found. I must admit that I have some concerns because severe pain on firmly flexing the wrist can be caused by a number of injuries and in my experience lameness is seldom caused by a muscle injury unless the muscle has torn or split. If it is caused by extensor muscle damage it would be the very top of the extensor carpi radialis with a split in the inner surface where it joins the bone and that area would then be very sensitive to any pressure or palpitation. As always it’s extremely important to find the exact location of the damage to have best chance of treating an injury quickly and thoroughly, and hopefully your Vet has marked the injury site and has provided approximate treatment advice. Cheers, Tom |
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