Surgery STAT: Rehabilitation therapy of the elbow in dogs - DVM
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Surgery STAT: Rehabilitation therapy of the elbow in dogs
A variety of treatments can get patients back comfortably on all fours.


Manual treatments

• Passive range of motion (PROM) — Perform this slow, controlled movement with slight overpressure at the end range on each joint of the forelimb two to three times daily.

• Joint mobilization — Perform these slow manipulations to improve joint play on the carpus, elbow and shoulder to increase circulation, proprioception and healing while decreasing inflammation.

• Massage and stretching — Soft tissue massage or mobilization and stretching of the surgical forelimb, nonsurgical forelimb, cervical spine and hindlimbs minimize the effects of compensations that occur prior to or secondary to surgery.

Therapeutic exercises

Leash walking may be initiated after surgery. Start with five to 10 minutes three times daily, increasing the duration to 20 minutes as tolerated by the end of the acute phase. Weight-bearing exercises are then gradually introduced and performed on a daily basis:

Photo 4: The three-leg standing technique.
• Three-leg standing — Lift the nonsurgical forelimb, and shift the weight onto surgical limb (Photo 4).

• Down to stand — Ask patient to lie down and then stand.

Rocking on all fours — While the dog stands on all four limbs, gently rock the dog from side to side and diagonally with 3-cm perturbations in each direction, promoting weight bearing and proprioception to the affected limb.

• Ladder — Using Cavaletti rails or an extension ladder on a level floor, walk the dog slowly through the ladder rungs or rails to ensure individual weight bearing on all limbs.

• Wheelbarrow exercises — Hold both rear legs and have the dog walk on its forelimbs only. Begin with a short distance, and increase it as tolerated.

Photo 5: A dog undergoing hydrotherapy with an underwater treadmill.
• Hydrotherapy — Have the dog swim or walk on an underwater treadmill (Photo 5). Before initiating hydrotherapy, full range of motion of the elbow should be present, and there should be no palpable tenderness or inflammation of the elbow or shoulder. Perform the hydrotherapy sessions two to three times a week, and start slowly at five minutes, increasing one to two minutes per session, as tolerated.

Photo 6: A dog balancing on a wobble board.
• Wobble board, BOSU or therapeutic ball — Implement these exercises to improve coordination, balance and strength (Photo 6).

This series on elbow disease in dogs will conclude with Part 3 next month and discuss medical management.

Dr. Canapp is an ACVS board-certified surgeon who practices orthopedic surgery and sports medicine at the Veterinary Orthopedic & Sports Medicine Group in Annapolis Junction, Md.

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Source: DVM360 MAGAZINE,
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