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Carpal and Digit Injuries Injuries to the carpal joint and digits are common, but sometimes overlooked due to the focus on the elbow and shoulder. The digits, nails, and pads should be inspected first when looking for a cause of forelimb lameness. Small injuries to the digits or bouts of Sesamoiditis are common, especially in the athletic dog. Carpal injuries may be acute or the result of chronic stresses. Some carpal injuries result in carpal arthrodesis and are a popular rehabilitation patient. The inflammation and pain need to be addressed initially with the carpal joint and digits. Again, a multimodal approach should be adhered to – with a combination of a pharmaceutical intervention and modalities. Laser therapy works very well on the small joints of the wrist and toes. Ice massage is a wonderful pain reliever and antiinflammatory for the area. Moist heat is also appropriate in more chronic cases, but may be difficult to apply to the nature of the area. The restoration of function and movement will need to be addressed both passively and actively. The entire forelimb complex should be attended to since compensations commonly occur throughout the complex. For example, it is very important to stretch the shoulder in to extension in dogs that have undergone arthrodesis to the carpal joint secondary to the compensations. Strengthening activities include balance activities, walking on uneven surfaces, core strengthening, balance and proprioceptive work and functional restoration. Carpal supports are available in varying supports. Introduction - Hindlimb injuries and problems are very common in the rehabilitation clinic and will consist of both chronic and acute problems. The cranial cruciate caseload will undoubtedly be a popular patient, as will dogs with canine hip dysplasia. But other diagnoses will also be present. The hindlimb is responsible for generating power and movement of the dog, and this will be an important fact to consider in the rehabilitation of the dog with a hindlimb injury. Cranial Cruciate Injuries Injuries to the cranial cruciate ligament are a fact of life in the dog. There are many different surgical approaches to the repair of the cranial cruciate ligament, and approaches to non-surgical treatments as well. It is important to understand the type of repair performed in consideration of the rehabilitation program and any other problems possibly present with the dog, such as canine hip dysplasia or other orthopedic problems. Different surgeons have different approaches to the same technique and this also must be considered in the rehabilitation process. Immediately postoperative care includes cyrotherapy, laser therapy, range of motion exercises, controlled weight bearing and balance exercises, controlled leash walking, and possibly electrical stimulation for both pain control and neuromuscular education with the hamstring and quadriceps complex. Adequate pain control is another key component. Objective data, such as range of motion, girth measurements, and force plate analysis is performed for a baseline and then monitored throughout the treatment.
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