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Canine Carpal Laxity Syndrome

Canine Carpal Laxity Syndrome. Trisha J Oura March 26, 2012. “Carpal Laxity Syndrome”. Encompasses hyperextension and hyperflexion of the carpus AKA: Carpal Hyperextension, Carpal Hyperflexion , Carpal Flexural Deformity, Carpal Instability, Carpal Flexion Syndrome. Inspired by:.

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Canine Carpal Laxity Syndrome

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  1. Canine Carpal Laxity Syndrome Trisha J Oura March 26, 2012

  2. “Carpal Laxity Syndrome” • Encompasses hyperextension and hyperflexion of the carpus • AKA: Carpal Hyperextension, Carpal Hyperflexion, Carpal Flexural Deformity, Carpal Instability, Carpal Flexion Syndrome

  3. Inspired by: • Accession: 131102 • Patient ID: 154665 • 4 mo Weimeraner • Acute onset carpal flexure w/o pain on palpation RIGHT LEFT

  4. Etiology • Large animal cases well documented • Congenital (in utero positioning, genetic, etc) • Acquired (diet, exercise) • Few case series in the literature for small animals • Cause unknown: • Rapid growth = excessive wt gain before adequate bone development • Asynchronous development between skeletons and muscuolotendinous apparatus • Faster bone growth = relative musculotendinous shortening • Diet? 1 case series w/ over-supplemented or imbalanced diet, others with no dietary abnormalities

  5. Signalment • Young (6-12 wk old) • Large breeds: GSD, Doberman*, SharPei*, Great Dane, etc • Male > Female? • Unilateral, bilateral, flexion, extension, flexion & extension • Clinical signs: • Acute onset limb deformity without pain, swelling, CP deficits, etc • Pain on manipulation—should think of other concurrent disease (e.g. HOD)

  6. Presentation

  7. Anatomy • Ginglymus joint (hinge w/ movement in 1 plane) • Majority of motion antebrachiocarpal joint (70%) • Least at carpometacarpal joint (~5%) • Predominant disruptive force = hyperextension • Prevented by plamarradiocarpal & ulnocarpal ligaments, flexor retinaculum, palmar carpal fibrocartilage

  8. * *

  9. Therapy • Controversial • Exercise…. • Or not…. • Splint • Or not…. • Good prognosis: self-limiting, almost all resolve within 4 weeks, most within first 2 weeks • Those that don’t improve may require splints, rarely require surgical resection of contracted tendons or arthrodesis

  10. DDX • Traumatic hyperextension • Jump/fall with acute disruption of palmar support • Often w/ associated injuries (e.g. proximal MC fractures) • Degenerative carpal hyperextension • Middle-aged, older Collie-type breeds w/o hx of trauma • Usually non-painful but may have periarticular soft tissue thickening and reduced range of motion

  11. DDX • Flexor carpiulnaris injury • Documented in racing Greyhounds, Weimeraners • Grading of accessory carpal bone fractures (type I-V) • May present with carpal flexion • Radiographic abnormalities** Soft tissue swelling +/- carpal bone avulsion fragments

  12. FYI: • Caudal distal luxation of radial carpal bone • Rare! Reported in dog and cat • Occurs with hyperextension, pronation, THEN suppination • Rupture of short radial collateral, dorsal radiocarpal, and intercarpal ligaments

  13. References • Altunatmaz K, S Ozsoy. Carpal flexural deformity in puppies. VeterinariaMedicina 2006:2:71-74. • Cetinkaya, MA, et al. Carpal laxity syndrome in 43 puppies. Vet Comp OrthopTraumatol 2007;20:126-130. • Harasen, G. Canine carpal conundrums. Can Vet J 2010;51:909-10. • Vaughan LC. Flexural deformity of the carpus in puppies. J Small AnimPract 1992;33:381-384. • Whitelock R. Conditions of the carpus in the dog. In Practice 2001:2-13.

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