What is Carpal Hyperextension?
For many owners, the first symptom noticed is an unusual gait or refusal to weight bear on a forelimb. As further trauma can cause complications it is vital you contact your veterinarian if you suspect your pet may be suffering from this condition. The prognosis without treatment is poor, however for pets who receive surgery there is a good chance of full limb function recovery.
Carpal hyperextension is caused by excessive force on the carpus, leading to the tearing of the ligaments and fibrocartilage and collapse of the carpal joint. This can be caused by sudden trauma such as falls or injury during exercise or chronic conditions such as abnormal posture while weight-bearing.
Symptoms of Carpal Hyperextension in Dogs
The symptoms will vary but may include:
- Pain and swelling on the forelimb
- Abnormal, hyperextending stance and gait
- Crying or pain vocalisation
- Increased distal limb extension
- Joint instability
Causes of Carpal Hyperextension in Dogs
- Acute traumatic - Caused by excessive force on the carpus, leading to the tearing of the ligaments and fibrocartilage and collapse of the carpal joint; this is common following a fall and injuries while working or exercising
- Inflammatory polyarthropathy - Arthritis that causes the immune system to activate an inflammatory response in the joints causing swelling, pain and joint laxity
- Degenerative - This form is common in some Collie breeds and often causes spontaneous, bilateral carpal joint hyperextension
Diagnosis of Carpal Hyperextension in Dogs
Your veterinarian will perform a full clinical examination on your pet and watch your pet’s gait to assess weight bearing and source of pain. It is likely that your veterinarian will perform radiographs on your pet under sedation. In order to visualise the carpus and assess it for hyperextension a series of radiographs will be performed to demonstrate weight bearing positions. This will allow visualisation of the ligaments and damage.
Treatment of Carpal Hyperextension in Dogs
The best treatment for your pet will depend on the underlying cause of the carpal hyperextension.
Conservative Care
If your pet is suffering from developmental hyperextension or a low-grade sprain he may be able to utilise rest and exercise restriction. Your veterinarian will provide a supportive splint for your pet and may recommend physiotherapy and hydrotherapy.
Surgery
If your pet is suffering from a fracture he will require orthopedic surgery in order to stabilise the fracture. In some cases, a partial carpus fusion is required, where the middle and carpometacarpal joints are fused together to reduce movement without the antebrachial joint. In cases of severe injuries and degenerative hyperextension a procedure called pan-carpal arthrodesis may be required. This immobilizes the carpal joint by fusing all three of these joints together using internal fixation. Your veterinarian will be able to discuss this procedure with you when viewing your pet’s radiographs.
A general anesthetic will be required for this procedure, although there are risks involved with anesthesia a qualified veterinary nurse will carefully monitor your pet’s vital signs throughout the surgery. In order to reduce the anesthesia agent needed, and therefore reduce the risk of respiratory and cardiac depression, a brachial plexus nerve block may be given to your pet prior to the surgery.
Post-operative recovery
To provide pain relief following the surgery a non steroidal anti-inflammatory will be given to your pet. Your pet will be placed in a warm, dark area to recover from the surgery and offered food once he is alert. To support the limb, a Robert Jones dressing will be applied until the swelling reduces.
Recovery of Carpal Hyperextension in Dogs
Provide your pet with a warm, enclosed area to recover in. Although your companion may have a reduced appetite, ensure food is offered. It is important during this healing period that your pet is given excellent nutrition; high fat foods such as anchovies provide palatability while protein, which has a restorative effect on damaged muscle and connective tissue, promotes healing.
The prognosis following surgery is good with 74% of patients regaining full limb function within 4 months. Your pet will be discharged with a coaptation cast that will be required for 6-8 weeks, it is important that this is kept clean and dry, as infection is one of the known complications of this procedure.
One of the main causes of surgery failure is unprotected weight bearing. With this in mind, you may need to restrict your pet’s activity during this time; ensure movement restrictions are discussed with your veterinarian and a clear plan is in place.
Following the surgery, radiographs will be taken at 6 - 8 weeks to assess the the procedure and visualise the fusion of the joint. If the surgery was successful implant removal at 12 -16 weeks may be recommended.
Carpal Hyperextension Questions and Advice from Veterinary Professionals
Has Symptoms
Hi, my 8 month old Italian Greyhound puppy Fabi (Fabiana) had an accident when she was only 4.5 months. A pice of wood fell on her and broke her ulna and radius on the left side. It was a clean break. The out a plate and 7 screws. She was in a splint for 4 weeks to heal and 3 weeks after being released she had a small fracture on the same area again by where one of the screws was. After seeing the xrays 4 weeks after that we noticed that the bone was now growing with a medial valgus due to what could be suspected to be damage to growth plate. Because of this at 7.5months old they did surgery again to remove the plate so it wouldn’t go through her skin due to the curve in the bone. After finally healing from all that and being in a splint for 12 weeks in a row (lost all muscle mass and ligaments stretched out) when the splint was taken out we noticed she was hyperextending her carpal joint.
We ordered a brace for support while she regains muscle mass and soft tissue but I am frightened.
On soft ground like grass she can completely hyperextend the leg. When she’s without the brace she will it walk on the grass but on the sidewalk it seems to look better although not perfect but she will walk ‘normal’ without picking it up. With the brace on she will take a few steps on the grass and walk great on the sidewalk. She doesn’t seem to be in pain and let’s me touch it.
Will this be something that with time 4-6 months and physical therapy and dog paddle in the water will recoil and come back in your opinion??? I am frightened for her and she has gone through so much at such an early age I don’t think I can put her through anymore surgeries in that area.
I appreciate any help and advice you can give me. Thank you!
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Our pit bull has had this as a degenerative issue for several years. It has recently escalated to the point where we have been referred to an orthopedic surgeon for a consult. Because she is 8 and has it in both front paws and arthritis as well, I am concerned she will not be a candidate for surgery. Her quality of life is deteriorating and it is heartbreaking to see our sweet girl in so much pain. She’s been on Rimadyl 2x/day for years and is now on Tramadol as well 2-3x/day. Our consult is 4/10.
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My collies condition has recently deteriorated again, he has arthritis and carpal hyper-extension in both front carpal joints, his exercise is managed and on soft ground only alongside using rugs and runners at home and hydrotherapy and massage. His front legs have started to bow so has resulted in paw pad movement. He wears carpal supports to help on his walks but only manages 20 minutes now. The last couple of walks he's stopped in his tracks and plods behind me, after checking his paws I found they were sore and weeping between the two outer pads which must be taking the pressure more now while walking. I've tried a booty and bandaging but it doesn't stay on long, I've kept it clean too but wonder if this will keep reoccurring? I know when he is pain and is being managed suitably but this has really knocked the wind out of his usual happy go lucky joyful walkies. I've had to carry the 23kg soft sod back to the car before now. It's really getting him down and just looking for some ideas to help him walk a short way without the wounds opening or reoccurring. Thank you
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Hi, my dog had surgery on the the 30/08/17 for this problem all they did was cut the ulna bone as it had not grown the same lenght as the radius i collected her after the opp with no dressing at all and have kepted her resting as much as possible the leg now looks worse than before and she cant walk far I have had a secound apion and have been told the bone is still broken and she shouldent have had this done to her she was 14 mounths old time off opperation.
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Hello,i have a doberman pinscher 5 months old.I saw he has a problem when walking lowly he limping but he can Run with no problem.He has a swelling carpal.I don't know is from of sprain or arthrisitis(disease).When i touch the carpal he don't have pain.I think the dog is overweight.He licking the carpal.I hope so you can help me please.
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Hello, my dog seemingly has hock hyperextension. He has it on both legs, however the left one is more severe than the right. He limps, and rarely does not let his left leg touch the ground. Our vet told us to use a special hock bandage that would have fixed the problem, and we also did physiotherapy. However both legs have been getting worse. He still runs and jumps, but not as active as he was before. He bites the hock joint a lot. What do you recommend us to do? thank you.
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I noticed last night that my almost 13 year-old German Shephard/Dalmation mix has a paw that sits almost flat on the ground. About three years ago she slipped on the ice and sprained that joint/area and was treated for about a year off/on by our vet until they said "she will likely favor it the rest of her life". She has not had any problems walking or exhibited any signs of pain. However, it shocked me when I noticed it. I called and explained everything to the vet tech who relayed it to our vet between appointments. When they called back it was basically "given her age she would not be a good candidate for surgery, unless she is having an issue walking I would not advise a car ride" (NOTE: she does not like car rides). Aside from restricting her stair use is there any advise you can give or things I can do?
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