Laurie's Blogs.

Good Afternoon Laurie

Thank you in advance for any advice you can give.

My patient is a 10 month old FS Labrador mix that jumped from a moving vehicle resulting in a brachial plexus partial or complete avulsion on the left side.  Originally she had no motor, but seemed to have some sensation there (difficult to tell b/c she is still very much a puppy).  Owners have been doing ROM and PNF exercise 4-6 times daily 25 reps per time and 2 weeks ago we got a slight twitch in her carpal flexors.  Owners unfortunately went on vacation and did not communicate with me for 2 weeks despite my best efforts so when I went back this week on Monday she has significant atrophy of all of her forelimb muscles on the left and contracture starting at the carpal flexors and brachialis muscles.

This week there was no reaction to e stim on any of the muscles and she has started to licking / chew a little on the limb.

Just trying to decide when to recommend amputation.

L.

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Hi L.,

You don't tell me the time frame... how long ago was the original injury?

Nerves grow at a rate of 1mm / day or 1 inch a month.

I often think of licking and chewing as a sign of sensation.

Be sure to try the e-stim with the spots well 'gooped' under each electrode, high pulse width (i.e. 300usec) and a frequency down at 5pps.

Carpal flexors are ulnar & median nerve, extensors are radial nerve (which is most often the affected one).  If all are affected... could be nerve root avulsion(s)... 

I tend to give them up to 2 months to show me 'something' of life in the leg (not that it will be 100% at that point... just something)

As well, if the dog is licking and chewing now.  She has to go in a cone for her own protection... should you see signs of 'life' in the leg!

If no signs of life in the leg by 2 months (or even 6 weeks) I would then recommend amputation.

Cheers!

Laurie

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Sorry - we are 5 weeks out this week.

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Okay then...

So I'd tell them to give it 3 more weeks.  You are right in the ballpark for 'late return' or rather return / regeneration of an axonotmesis lesion (sheath intact, nerve damaged inside).

Test the muscles with the parameters described.

I have tested using NMES clipped to acupuncture needles... if you have anyone in your clinic doing acup... you just  insert two needles into the same muscle, connect the electrode clips and turn the machine on slowly.  Sometimes if there is just a flicker of nerve conduction, you can get a contraction this way.

Keep her in a cone for sure... and cross your fingers!

Good luck!

Laurie