Cowboy is a 1.5-year-old mixed breed who is a patient through our OrthoPets Michigan Partner Clinic, Pawsitive Steps Rehab and Therapy for Pets. He originally presented in July 2017 as a puppy for a number of issues, but the most severe was his congenital ectrodactyly of both forelimbs. Additionally, he presents with bilateral severe shoulder joint OCD. Cowboy originally saw a number of different specialists around the Midwest who were unable to agree on a suitable surgical intervention or long-term care plan. Chief among these challenges are his age, predicted growth, and numerous deformities and orthopedic issues. Dr. Tari Kern and her staff met him and determined he could benefit from mechanical support to his forelimbs enabling Dr. Kern to focus on his other orthopedic issues.
During his physical examination, his left forelimb demonstrated increased pain and discomfort. Once he was closer to skeletal maturity, he would be casted for a custom left carpal orthosis. His radiographs and his exam are quite interesting. Just distal to the carpus on the left thoracic limb, the paw is separated into 2 sections featuring the metacarpals separated from each other rather than united as a single structure. The paw is also separated into the 2nd digit and its phalanges and a grouped structure that includes 3rd/4th/5th digits. Cowboy started a rehabilitation program with Dr. Kern in the meantime and was scheduled for arthroscopy of both shoulders to make him as comfortable as possible.
When Cowboy was 1, he returned to Dr. Kern for his V-OP evaluation and fiberglass impression of his left forelimb for his custom orthosis/prosthesis. One of the most important things to discuss with your clients when determining if an orthosis is the right thing for their pet is to review the “goals” for the use of the orthosis. It is very important to inform OrthoPets of the stated therapeutic goals that have been communicated to the client. In some cases, the client goal for the use of the device may not be something that is possible based on the diagnosis and history. In Cowboy’s case the clients and vet had 3 simple goals:
- Provide support for L FL paw / carpus
- Reduce discomfort
- Improve quality of life
Once the goals have been listed and the fiberglass impression and measurements have been received at OrthoPets, Martin Kaufmann (OrthoPets owner/founder) and the OrthoPets case manager are able to take all of those things into consideration and determine the best V-OP plan for the device to meet those goals. OrthoPets utilizes the requested information and data for each patient to perform a comprehensive case review to develop a V-OP fabrication plan that is the most beneficial and useful device for that patient. You can take a look at this process in the video below.
The device that was the best option for Cowboy was one that allowed us to corral the limb into one solid section via the use of a fully removable foam liner. This is one of our hybrid-style devices that is built similar to a prosthesis but has a paw segment and outer shell similar to an orthosis. Due to the severe deformity of the limb and an abnormal carpal joint along with the MCPJs, we were not able to articulate either the paw segment or the carpus segment. The shell of the device was a caudal style non-hinged device. Cowboy was fitted with his device recently and was quite comfortable even at the first fitting, and by the second follow-up visit, he was moving well and really learning to trust his device!
Great job to Cowboy’s rehab team and his dedicated family for working so hard to keep him happy and healthy from the start!