282 Canine Sports Medicine and Rehabilitation
Case Study 11.2 Subtotal amputation and below carpus prosthesisSignalment: 2‐y.o. MC Yorkshire Terrier.History: Patient suffered a catastrophic injury to right
front foot after being bitten by another dog. Digits 2,
4, and 5 were amputated initially. Remained unwill
ing to use right thoracic limb (RTL); remaining digit
painful on palpation.Home environment: Multiple toy breed dogs in fam
ily, hardwood and carpeted floors, stairs, and out
door yard.Job: Companion dog.Evaluation: General health: WNL for age and breed.
BCS 4.5/9.
Conformation: WNL for breed and age. Weight
shifted to left thoracic limb (LTL) and pelvic limbs. LTL
shifted mediad (adducted) from glenohumeral joint.
Gait: Ambulatory × 3. Grade 5/5 RTL lameness.Clinical evaluation: Orthopedic: Excellent ROM of
remaining joints of RTL; normal ROM of remaining
limbs.
Neurological: Unremarkable.
Myofascial: Muscles of cervical, thoracic, and lum
bar epaxial; left lateral shoulder stabilizers (supraspina
tus, infraspinatus, deltoideus); and pectoral muscles
sensitive to palpation with restriction secondary to
compensatory gait. Iliopsoas flexibility decreased due
to cranial shifting of pelvic limbs.
Biomechanical: ROM of all appendicular joints
WNL.V‐OP goals:(1) Weight bearing on RTL by providing exten
sion to the ground and mechanical foot to
accommodate limb length discrepancy, pro
vide propulsion assist, and align shoulders
in frontal plane.
(2) Allow as much PROM and AROM as possible
for RTL proximal joints.Case management: Subtotal amputation of right
foot performed via carpo‐metacarpal disarticula
tion, preserving accessory carpal bone and pad.
Suture line placed caudally. Perioperative pain
management included regional nerve block (bra
chial plexus), NSAIDs, NMDA receptor antagonist,
and gabapentin. Two weeks postsurgery, a fiber
glass impression of RTL was obtained and prosthe
sis was prescribed.Rx: (1) Below carpus prosthesis (Figure 11.15).
(2) Rehabilitation for gait re‐education; acclimation
to activities of daily living including transitions, bal
ance, and proprioception; recovery from myofascial
sensitivity; and a long‐term tripedal health mainte
nance plan.
Mechanical principle considerations: Device sus
pension; faux foot construction to facilitate braking
and propulsion; and control of transverse plane
motion of the residual limb within the device. No
instabilities to control.
Wearing schedule: Gradual breaking in over 2–4
weeks with goal of day use only with breaks as
needed during the day. Activity tolerated in device
to be determined with tissue acclimation to device.Case follow‐up: Patient returned to full activity.
Ambulatory × 4. Myofascial pain reduced significantly
and managed with home massage therapy and condi
tioning exercises. Conformation improved with pelvic
limbs repositioned beneath pelvis and weight bearing
more evenly dispersed over all four limbs. Twice‐yearly
evaluations and device refurbishment as needed. At 3‐
year recheck patient continues to do well.
Take home point: Small patient size is not a factor
in determining the necessity for a prosthesis or for the
capability to fabricate a prosthesis.Figure 11.15 Thoracic limb below‐carpus prosthesis
with weight shift onto the prosthetic limb during a
rehabilitation session. The inset shows the
postoperative subtotal amputation at the level of the
carpometacarpal joints.