Brachial Plexus canine case study - Linhay

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Brachial Plexus canine case study - Harvey is a 7 year old male black Labrador                                                                             Linhay
                                                                                                                                                           veterinary rehabilitation

Reason for referral:                                Physiotherapy Treatment:                            Treatment:
Road traffic accident (RTA) 19/12/06. Paralysis      Began muscle stimulation of triceps and biceps      Acupuncture of cervical points: BL11, CV14,
of right fore limb and cervical pain. Provisional   + dynamic forelimb stretches on physio ball         and various trigger points neck and shoulder
diagnosis - brachial plexus injury                  with assistance. Advised owner re corrective        area. LI15, TH14, SI9, LI11, TH5, BL60.
                                                    limb placement/weight bearing position.             Needling of deep cervical and subscapular
Medical history:                                    Follow up: To continue with home exercise           acupuncture points initially painful, but Harvey
19/12/06 Seen by own vets and hospitalised          programme and refer for veterinary                  soon relaxed and analgesic effect obviously
post RTA. Given intravenous fluids, pain relief      rehabilitation programme and acupuncture.           demonstrated after approximately 5 minutes.
and treatment for shock. Cranial nerve function                                                         Electroacupuncture for 5 minutes from BL11
ok. Painful right shoulder, elbows and dorsal       Veterinary examination:                             TH14/LI15.
rib area. No obvious signs of internal injury       3/1/07 - Cervical pain C7-T1 and reluctance
detected.                                           to move head and neck laterally, especially to      Physiotherapist demonstrated muscle stimulator
                                                    right. Associated cervical paraspinal muscle        and physio ball exercises again and owners to
20/12/06 Non weight bearing 24 hours post           spasm and pain referral pattern right shoulder      continue at home to slow muscle atrophy.
incident.Radiographs performed and nothing          and neck. Taut muscle band under cranial
abnormal detected Diagnosis: probable muscle        scapula. NWB right fore and pain especially         4/1/07 Owners phoned to say dog much
damage and soft tissue injury.                      right shoulder. Has deep pain and very weak         more comfortable after treatment and definite
                                                    withdrawal reflex and superficial pain response.      movement of shoulder after acupuncture
21/12/06 Neurological exam: Right fore (RF)         Proprioception negative. Muscle atrophy             treatment. Dog seemed to be dragging the
paralysis and negative sensory and motor            infraspinatus, supraspinatus, biceps and triceps.   limb less.
function at all levels. No deep or superficial
pain RF. Suspect brachial plexus avulsion. Sent                                                         9/1/07 Much improved limb placement.
home and for re-evaluation in 2 weeks.                                                                  Harvey able to hold his limb straight when
                                                                                                        sitting. Good superficial and deep pain
2/1/07 Referral for physiotherapy assessment.                                                           response, and limb withdrawal stronger.
RF ongoing paralysis and yelped when moving                                                             Definite proximal limb response but distally        Jubilee Barn
at times.                                                                                               still a poor response. Poor proprioception RF      Ashcombe Road
                                                                                                        limb. Still NWB but holding limb higher when       Dawlish Water
Physiotherapy Examination:                                                                              walking. Neck pain resolved, and he was much       Dawlish
Non weight bearing (NWB) right fore limb                                                                more comfortable with lateral movement of          Devon EX7 0QW
Loss of full carpal extension. Muscle atrophy RF                                                        head and neck. Repeated electro-acupuncture.
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scapular and shoulder area. Loss of deep pain
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and withdrawal reflex. Slight muscle twitch of                                                                                                              m. 07921 068088
biceps and triceps, so possible proximal nerve                                                                                                             e.
recovery. No distal nerve recovery at present.                                                                          continued on next page             w.
                                                                                                                                                    veterinary rehabilitation

Began hydrotherapy treadmill exercise but due      support-dog, enjoyed this although tired           Although we hope Harvey will regain use
to C7-T1 focus of pain, care re overextension      quickly. Arranged to book free swimming            of his right fore, a full recovery of total
of RF shoulder and dorsiflexion of head/            session weekly along with weekly treadmill         limb function may not be possible in this
neck (free swimming not appropriate at this        and acupuncture sessions.                          case. It is important that the owners are
stage.) Did 3x2 minute sessions initially with                                                        informed of this and have a realistic view
support, to encourage proprioception. Harvey       25/01/07 Good proximal forelimb                    of the likely outcome.
attempted to compensate with other 3 legs          activity when free swimming and assisted
and tired easily.                                  proprioceptive and limb weight bearing
                                                   / placement on treadmill. Tried floats to
16/1/07 Repeated treadmill session of              encourage weight bearing on RF limb, as
proprioceptive work with assistance 3 x            Harvey had developed a compensatory gait
2 minutes. Concern regarding the muscle            pattern. Continued work on a peanut ball
atrophy and owners having trouble with             to improve distal limb function and muscle
exercises. Given large peanut ball as dog is       strength.
reluctant to use physio ball.
Harvey developed lick granuloma on the             Harvey is to continue an intensive 6-8 week
dorsum of his right fore paw, so applied a light   rehabilitation programme with swimming,
dressing and prescribed antibiotics.               aquatic treadmill and regular acupuncture
                                                   sessions. We aim to see an improvement in
18/1/07 Improved generally although still          limb proprioception over the next 2-3 weeks
muscle atrophy++ Slow 2 minute warm up             and to maintain or improve muscle strength
on treadmill, then proprioceptive work with        and bulk during this time. We may splint the
assistance 2 x 3 minutes. Tried swimming in        limb using an Ortho-vet splint once the lick
treadmill, however he showed some ability          granuloma on Harvey’s paw has resolved.
to advance the RF limb he tired easily after 2     The owners are to carry on with progressive                                                      Jubilee Barn
minutes. Discussed splinting, although difficult    exercise programme at home using peanut                                                          Ashcombe Road
at present, as inability to advance the limb,      ball and muscle stimulator initially. Owner                                                      Dawlish Water
due to muscle weakness.                            compliance is essential in these cases and                                                       Dawlish
                                                   we do find they really need our advice and                                                        Devon EX7 0QW
23/1/07 Aquatic treadmill and assisted             guidance with these long term rehabilitation
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proprioceptive work 3x3 mins after warm            cases, especially when there is a plateau in the
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up. 3 minute free swimming with life jacket        animal’s progression.                                                                            m. 07921 068088