Brachial Plexus canine case study - Harvey is a 7 year old male black Labrador Linhay
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.
t. 01626 867614
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. email@example.com
recovery. No distal nerve recovery at present. continued on next page w. www.linhayvet.co.uk
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
t. 01626 867614
proprioceptive work 3x3 mins after warm cases, especially when there is a plateau in the
f. 01626 889911
up. 3 minute free swimming with life jacket animal’s progression. m. 07921 068088