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Case Study: Schatze – A Non-Surgical Patient with an Achilles Tendon Rupture

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Schatze, a 50-pound, 12-year-old Catahoula with a mid-body Achilles Tendon rupture.

Case of Interest: Schatze was a non-surgical candidate in need of support for her left hock due to an Achilles Tendon rupture.  She was initially seen at our clinic in December of 2017 and returns for regular check-ups almost two years later.  Most of our in-house patients visit our clinic three or four times over the course of a year.  In Schatze’s case, we’ve been able to watch her mature over seven appointments and look forward to providing her with care for years to come.

Diagnostic History: Schatze ruptured her left Achilles tendon while jumping into a car on December 5, 2017. She was seen shortly afterwards by an orthopedic veterinarian and was diagnosed with a mid-body calcaneal tendon rupture. She was not a surgical candidate due to being on prednisone for a low platelet abnormality. A wait-and-see approach was followed but she showed no signs of improvement even after stopping the medication. 

It was determined that she would benefit from a custom-made hock brace. The goal of the brace was to reduce any further damage to the calcaneal tendon or the digital flexor tendon, as well as to protect the skin from excessive pressure while walking in a plantigrade stance.

Schatze presented to our clinic on December 29, 2017, limping on her left hind leg. She was collapsing in her hock and in a plantigrade stance. She was contracting her digits on her left hind leg, indicating the superficial digital flexor tendon was still intact.

A cast was made of Schatze’s hind left leg from the distal ends of the nails up to the stifle.  From the cast, a jointed hock brace providing zero degrees of flexion at the joint was fabricated.  The degree of flexion was controlled by range of motion straps affixed to the back outer shell of the brace.  As healing occurred and strength returned, the range of motion straps could be lengthened to allow for greater flexion at the joint.

Less than a week after her casting, she returned for her delivery appointment. At this appointment, the fit of the brace was assessed and appropriate adjustments were performed. Once the brace was donned, Schatze walked with an exaggerated step and consistently put her foot down with more force than necessary.  Her walk normalized as she became accustomed to the brace.

Schatze’s owner was instructed on the proper care of the brace and that Schatze was to wear the brace during her waking hours, but not at night. No exercise restrictions were given, but it was recommended that she begin with 2-3 walks a day for around 10-15 minutes each to allow her to become familiar with the brace as well as to build up the muscle that atrophied during the months she favored the leg.

Follow- Ups: Schatze returned for follow-up appointments approximately 3 weeks, 3 months, 6 months, 1 year and 1.5 years from delivery. At each appointment the condition of Schatze’s skin and the overall leg were assessed. Appropriate adjustments and general maintenance were made to the brace such as replacing the sole of the brace.

Her walk continued to improve at each appointment as she became comfortable and confident in the brace. She was able to run and play in the brace. Schatze received a favorable report from her orthopedic vet when she followed up with them after receipt of the brace. Schatze continues to use the brace for her daily activities and is a happy and active girl.

Case Study: Kirahime – a Doberman with a CCL Tear in her Left Hind Leg

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Kirahime, a 90-pound, 6-year-old Doberman with a CCL tear in her left hind leg.

Case of Interest: Our stifle braces aid in the healing of Cranial Cruciate Ligament (CCL) tears by stabilizing the stifle and controlling the forward thrust of the tibia. This healing process occurs within 9 months with the application of a custom stifle brace. After this time period, the dog may continue to wear the brace for extra support during more strenuous activities or inclement weather.  Kirahime is a strong energetic dog who returned to full activity with the help of her stifle brace.  Over two years after her initial injury and brace fitting, Kirahime occasionally uses the brace during highly active times.

Diagnostic History: In 2016, Kirahime jumped up several stairs and started favoring her left hind leg. She rested for 7 months and returned to normal weight-bearing.  She reinjured her left hind leg in December of 2016 running after a squirrel. She was seen by a veterinarian in March 2017 and was diagnosed with a partial tear of her left CCL and mild Degenerative Joint Disease (DJD). The owner determined that they were not interested in surgery for a variety of reasons and thus decided to pursue conservative management of a custom stifle brace.

Kirahime presented to our clinic for a left stifle brace to assist in the healing of a partial CCL rupture. An evaluation of Kirahime’s body condition and lifestyle was performed and it was determined that she would benefit from a left stifle brace. An accurate cast was taken of her leg from hip to hock using fiberglass casting tape. A brace was constructed using the cast that was taken. This process involves filling the cast with plaster, modification of the mold, vacuum-forming of the co-polymer plastic onto the mold, machining the brace to the correct shape and the addition of buckles, straps and veterinary urethane and nylon stifle joints.  A week after the evaluation, Kirahime was fitted with her brace and the brace was adjusted for a proper and comfortable fit.

Kirahime was given a restricted exercise program, which included 2 or 3 leashed walks a day at around 10 to 15 minutes each.  No running, dog or ball playing.  Stairs were limited to 1 to 4 steps and if more than 4 were required then some help in the form of a sling under the hips or blocking off the area was suggested.  This limited exercise regimen was only required for the initial 3 to 4 months to allow for the formation of scar tissue. After that time, she was gradually allowed to do more strenuous activities such as stairs and running.

Follow-Ups: Kirahime was seen approximately 1 month, 3 months, 5 months, 8 months, 1 year, and a year and a half post-delivery. At each check-up appointment her walking was assessed and it was noted that she was doing well.  Her weight-bearing and muscle mass on her inured left leg increased to normal. Kirahime’s owner said, “Kirahime and I cannot thank you all enough for giving me back my insane girl! No limping or “toe touching” at all and we’re 5 mile off-lead hiking every day again! Not bad for a 7 year Doberman who had a partial tear.”

Case Study: Hector – A Rescue Dog From Kuwait With Nerve Damage And An Ulcer On His Elbow

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Hector, a 2-year-old desert dog mix with severe carpal hyperextension and an ulcer on his olecranon (elbow).

Case of Interest: A local rescue organization with international ties learned of and adopted Hector from Kuwait.  Hector was severely collapsed on both of his front legs and walked on his elbows.  In Kuwait, he underwent surgery to repair a fractured radius and ulna in his right front leg.  He also sustained nerve damage in his left front leg and had an open ulcer on his olecranon.  When he was brought to the States, his left front leg was in a cast for several months to support the carpus and reduce the pressure on the ulcer on his elbow.  For a long-term solution, My Pet’s Brace recommended a brace to bring Hector into a more functional standing and walking position as well as to protect his olecranon and allow the open ulcer to heal.

Diagnostic History: Hector was seen at the My Pet’s Brace facility for the casting of his leg in March 2019 for a carpal brace.  The brace would replace the splint he was in for many months, stabilize his hyperextension and aid in the healing of the ulcer on his elbow. The brace was fitted to Hector and adjustments were made to ensure a proper and comfortable fit.

The carpal brace for Hector was made with an additional foam wedge affixed to the top outside of the brace.  The brace supports Hector’s leg in a more functional position and the added wedge lifts his leg off the ground when he lays down which allows air circulation and furthered the healing for the ulcer.

Hector was informed to begin wearing the brace for two hours the first day and increase an hour each day until he wore it during his active waking hours.  Hector’s activity and exercise were limited in the beginning of the break-in period until he became comfortable and the ulcer on his elbow healed.

Follow-Ups: Hector was seen two weeks, one and half months, and four and a half months post-delivery. During each of these appointments Hector’s skin was assessed and his overall comfort with the brace was examined. Adjustments and general upkeep were made accordingly.  As of his last appointment in August 2019, the ulcer on Hector’s elbow is fully healed and he is getting stronger every day.  Hector was also adopted by his forever family and is happily living life in his new home.

Case Study: Rockne – a Golden Retriever with a CCL Tear in her Left Hind Leg

By: Katie Mirobelli, My Pet’s Brace Practitioner from Pittsburgh location

The Patient: Rockne, a 67 pound 11.5-year-old Golden Retriever with a CCL tear in her left hind leg

Case of Interest: Rockne was the inaugural patient for the My Pet’s Brace – Pittsburgh location. Rockne is an 11.5-year-old Golden Retriever who presented with a full tear of her left CCL.

Diagnostic History: Rockne presented to her veterinarian in October of 2018 for lameness on her left hind leg after chasing a squirrel in her backyard. The veterinarian diagnosed Rockne with a cruciate ligament tear. Surgery was discussed, but due to her age and concerns about anesthetic risk, Rockne’s owners opted to look into conservative treatment options for Rockne’s injury and made an appointment at My Pet’s Brace Pittsburgh.

Upon evaluation for a brace, Rockne was bright and responsive, with a pronounced limp of the left hind leg. An evaluation of Rockne’s physical condition and lifestyle was performed, and it was decided that she would benefit from a stifle brace. An accurate cast was taken of her leg from hip to hock. A brace was constructed using this cast. The brace was made with medical-grade plastic and veterinary urethane knee joints. Two weeks after the evaluation, Rockne was fitted with his brace and adjustments were made as needed.

Rockne was placed on a restricted exercise regimen, which included no running, dog or ball playing. Stairs were limited to 1 to 4 and if more than 4 were required than some help in the form of a sling under the hips was suggested. Leashed walks or walks in a restricted area were encouraged but limited to 2 or 3 walks a day at around 10 to 20 minutes each walk. These walks could be increased as her healing progressed. This limited exercise regimen was only required for the initial 3 to 4 months to allow time for healing. Afterwards she was gradually allowed to do more strenuous activities such as stairs and running.

Follow Up: Rockne was seen 3 weeks and again at 5 months after receiving her brace. Rockne adjusted quickly to using the brace, and she and her owners were happy to have her mobile again. Rockne’s primary form of exercise were calm walks around her neighborhood. When walks weren’t an option due to weather or schedule, Rockne’s owners would play a calm game of “fetch” by rolling a frisbee slowly across the room for Rockne to walk after and retrieve. At her 5 month appointment, Rockne’s gait was markedly improved and she was able to be more active and to begin to use stairs if desired (squirrel chasing was still discouraged however). As of July 2019, Rockne is 12.5 years old and walking well. Though she is starting to slow down a bit with age, she still enjoys the occasional game of fetch, her walks and saying hello to her many friends. She is able to start weaning off the brace, though she generally still wears it for most of the day.

Case Study: Purdy – a Golden Retriever with Bilateral Rear Prostheses

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Purdy, a 45-pound Golden Retriever with missing rear paws.

Case of Interest:  Purdy suffered from frostbite on both of her rear paws when she was around 1 week old and both of her paws were amputated.  At 8 weeks old, she was rescued and her new family provided her with all the love and medical care she needed.  Besides the missing rear paws, she was a happy healthy puppy.

As she grew, she put almost all of her weight on her front legs to walk which caused severe kyphosis.  The distal ends of her limbs had abrasions and callousing of the skin due to her walking on them without any protection.  She put some weight on her right rear leg, but her left appeared to cause her more pain, possibly from scar tissue adhered to the bone.

Purdy visited My Pet’s Brace for two protheses to protect her rear residual limbs and to provide her with greater mobility.  She was evaluated at our facility when she was 5 ½ months old and two prosthetic devices were fabricated.  A new design of prostheses were made when she was around two years of age.  She also attended physical therapy sessions to help desensitize the ends of her stumps and to walk with proper alignment.

Diagnostic History:  Purdy visited our facility to be evaluated for prosthetic devices.  Two prostheses were created and fitted in August of 2016, when Purdy was approximately 6 months old.  Adjustments were made to the prostheses to relieve any excess pressure and reduce the chance for rubbing and sores. Purdy’s owners were instructed to allow her to wear the devices for 30 minutes the first day and increase by 30 minutes each day, for a total of 6 – 8 hours per day. She was given no restrictions with regards to play and exercise but was encouraged to go out for short walks a few times a day.  With time, she learned to bear more weight on her rear legs, which reduced the stress on her front limbs and allowed her to flatten out her spine.

In February of 2017, when Purdy was approximately 2 years old, a second set of prostheses were fitted.  The new design was non-jointed at the hock, wrapped farther up the stumps of her legs and fabricated with a more flexible plastic for the outer shell.  Purdy never took to the new prostheses even though no pressure points or fit issues were detected.  She continues to wear her original devices to this day.

Follow-Ups:  Purdy returns every six months to My Pet’s Brace for follow-up appointments. At each of these appointments the condition of her skin and her activity level are assessed and the prostheses are adjusted accordingly. An adjustment that has been made several times was the replacement of the soles as they wear down due to her activity level.

Purdy is a very happy active dog and her prostheses enable her to use all four of her legs to walk, run and play with her human and doggie family.  She enjoys lots of love and going to the beach with her siblings, but she prefers to stay on the sand and out of the water.

Case Study: Bentley – a Doberman with a CCL Tear

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Bentley, an 86-pound 7-year-old Doberman with a CCL tear in his right hind leg

Case of Interest: Bentley is an example of a typical patient that would be seen at our clinic. Bentley is an 86-pound 7-year-old Doberman. Bentley presented with a partial tear of his right CCL. Surgery was performed on Bentley’s left CCL three years earlier.

Diagnostic History: In 2015, Bentley injured his left CCL and underwent TTA surgery to repair the ligament. When Bentley injured his right CCL three years later, his owner decided to go the conservative management route of a brace versus surgery due to heart issues that had developed after the original surgery.

Bentley presented to our clinic in July of 2018 for a stifle brace for his right hind leg to aid in the healing of the rupture of his CCL. An evaluation of Bentley’s body condition and lifestyle was performed, and it was determined that he would benefit from a right rear stifle brace. An accurate cast was taken of his leg from hip to hock. A brace was constructed using the cast. The brace was made with medical-grade plastic and veterinary urethane knee joints. A week after the evaluation Bentley was fitted with his brace and adjustments were made as needed.

Bentley was given a restricted exercise regiment, which included no running, dog or ball playing. Stairs were limited to 1 to 4 and if more than 4 were required than some help in the form of a sling under the hips was suggested. Leashed walks or walks in a restricted area were encouraged but limited to 2 or 3 walks a day at around 10 to 15 minutes each walk. These walks could be increased as his healing progressed. This limited exercise regimen was only required for the initial 3 to 4 months to allow time for healing. Afterwards he was gradually allowed to do more strenuous activities such as stairs and running.

Follow-Ups: Bentley was seen at approximately three weeks, three months and four month post-delivery. At each check-up appointment his weight-bearing and walking were assessed and it was noted that he was doing well. Adjustments and maintenance were performed at each appointment. Bentley’s owners discontinued use of the brace after nine months. Bentley’s weight bearing increased and muscle mass returned to normal. Bentley’s owners were also instructed to continue to use the brace if the dog will undergo unusual strenuous activity or will experience unstable footing such as during winter snow/ice or on sand.  Now he enjoys playtime with his doggie sibling brace free.

Case Study: Nya – a Shepherd mix with a Carpal Brace Post Fixator Surgery

By: Clayton Blunk, My Pet’s Brace Practitioner

The Patient: Nya, a five-year-old, 50-pound, Shepherd mix that was hit by a car.

Case of Interest: Over 80% of our business is providing stifle braces for Cranial Cruciate Ligament injuries. However, we also fabricate carpal, hock and elbow braces for multiple etiologies. In special cases, we are brought onto a case in collaboration with orthopedic specialists for a non-standard brace.

Nya was hit by a car in mid-2018. After being stabilized by an emergency department in Maryland, the initial prognosis was that Nya would not be able to save both of her forelimbs. She was transferred to the University of Pennsylvania to attempt to save her legs. My Pet’s Brace become involved in the case at the end of December 2018 to make a special carpal support brace.

Diagnostic History: In mid 2018, Nya was hit by a car. Eventually, after multiple procedures, her right forelimb needed to be placed in an external fixator. In December, the fixator was removed. Diagnostic imaging after the fixator was removed showed promising stability, but there were still considerable open wounds that needed managing and protecting. While Nya was still sedated, her condition was evaluated and her medical team at University of Pennsylvania determined that she would benefit from a carpal brace.

Nya presented to My Pet’s Brace limping and in a splint.  We made a cast of Nya’s forelimb from the paw to just distal to the olecranon. This cast was then used to create a custom-made, non-jointed carpal brace. This brace was made with a closed-cell foam interior and a hard-medical grade plastic exterior. Special consideration was given to the bony areas where the pins from the fixator were located. It was important to unload those areas to allow them to heal. Additionally, Nya did not have a normal weight-bearing surface because of the position her limb was fixed. Nya’s brace was designed to have extra padding to prevent excessive pressure on her toes as well as widen the base of support for her paw.

Follow-Ups: Nya was seen approximately 1 month and 3 ½ months post-delivery. At each of the follow-up appointments her condition was evaluated and straps were replaced as necessary. At Nya’s first recheck, her swelling had reduced significantly so padding was added to the inside of the device to tighten the fit of the brace. The owners reported that she was able to ambulate well and the brace was helping effectively manage her wounds because of the ease of removing the brace and cleaning the limb. By early April 2019, her wounds had entirely healed and her team at UPenn cleared her for a return to normal activity with the brace.  Her owners report she is able to keep up with their new puppy. We will continue to follow up with Nya’s progress as she continues to recover from such a traumatic event. She is a happy dog who will be able to enjoy life as a normal dog for years to come.

Case Study: Grady – a Labrador Retriever with an Elbow Brace for Arthritis

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Grady, an 11 year-old, 74-pound, Labrador Retriever with severe arthritis of the right elbow.

Case of Interest: Over 80% of our business is providing stifle braces for Cranial Cruciate Ligament injuries. However, we also fabricate carpal, hock and elbow braces for multiple etiologies.

Grady was diagnosed with severe arthritis in his right elbow. His owners were medically managing his condition for approximately 5 years when they decided to pursue an elbow brace for additional stabilization.

Diagnostic History: In October 2017 Grady presented to our clinic for a brace for his right elbow for severe arthritis. The brace aids in protecting the joint as well as giving the elbow stability and support. An evaluation of his condition and lifestyle were evaluated and it was determined that he would benefit from an elbow brace.

A cast was made of Grady’s elbow from the styloids of the radius and ulna to as high into the axilla as possible. This cast was then used to create a custom-made brace for Grady. This brace was made with a closed-cell foam interior, a hard-medical grade plastic exterior and specialized veterinary urethane joints at the elbow.  Range of motion straps allowed 10-15° of motion at the joint. The brace was fit and adjustments were made as necessary.

Grady was given a restricted exercise regiment, which included eliminating running and ball/dog playing.  Stairs were limited to 1 to 4 steps and if more than 4 steps were required, then some help would be needed. Leashed walks were encouraged, starting with 3 times a day for around 5 to 10 minutes each.  As he became accustomed to the brace, his walks increased and he was given more freedom.

Follow-Ups: Grady was seen approximately 1 month, 3 ½ months, and 6 ½ months after delivery. At each of the follow-up appointments his condition was evaluated and straps were replaced as necessary. He was able to go out for walks and was off most of his pain meds. Unfortunately, he had a recurrence of soft tissue sarcoma in his good elbow in August 2018 which is being managed.  With the help of the brace, Grady is getting along well and he enjoyed playing in the snow this winter.

Case Study: Lucy – a Cocker Spaniel with a Stifle Brace for a Postsurgical CCL Repair

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Lucy a 7-year-old, 17-pound, mini Cocker Spaniel with bilateral stifle braces for postsurgical CCL repair and protection.

Case of Interest:  We have been asked if stifle braces can be used post-surgically and the answer is yes. Braces can be applied after sutures have been removed.  Lucy was one such case.  On July 5, 2017 Lucy jumped off the porch and began limping on her right hind leg. She had previously been diagnosed with bilateral luxating patellas and was scheduled for surgery for bilateral patella stabilization. During the patella surgery it was determined that the right CCL was ruptured and an extracapsular stabilization was performed. Lucy recovered from the surgery with minimal side effects. However, during recovery Lucy jumped from her owner’s arms as she was being carried down from bed and Lucy started limping again. The veterinarian examined Lucy during her two-week post-surgical follow-up and determined that drawer motion was present but was significantly less than the movement felt prior to the surgery. The veterinarian suggested Lucy be fit with a right stifle brace for post-surgical support and a left stifle brace for additional protection.

Lucy with My Pet's Stifle Brace

Diagnostic History: In September 2017 Lucy presented to our clinic for bilateral braces for post-surgical support of the right hind leg following a CCL stabilization surgery and for support of the left hind leg to reduce the chance of injury due to compensation.  We evaluated Lucy’s weight-bearing during walking and standing, contractures, range of motion, muscle atrophy, inside and outside activity levels, owner participation and home environment.  It was determined that Lucy would benefit from bilateral stifle braces to resist tibial thrust during activity.  Casts were made of both legs and the braces were fabricated using medical-grade plastic and closed-cell foam. The braces were fit a week after the casts were taken and adjustments were made as necessary.

Lucy with My Pet's Stifle Brace

Lucy was given a restricted exercise regimen which included no running or dog and ball playing. Stairs were limited to 1 to 4 and if more than 4 were required it was suggested she be carried. Leashed walks were encouraged but limited to 2 or 3 walks a day at around 10 to 15 minutes each walk. This limited exercise regimen was only required for the initial 3 to 4 months to allow time for scar tissue to form. Afterwards she was gradually allowed to do more strenuous activities such as stairs and running.

Follow-Ups: Lucy was seen 3 weeks and 3 months after delivery. Lucy adjusted quickly to the braces and both Lucy and her owner were happy. During the follow-up appointments straps on the brace were replaced as necessary. Lucy’s limp disappeared and she was able to return to her normal activity level. Lucy wore the braces for nine months.  Currently, she only wears them for extra support during walks.

Lucy with My Pet's Stifle Brace

Case Study: Philomena – a Pug with a Brachial Plexus Injury

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Philomena, a 15 pound 1-year-old Pug with a spinal injury and a brachial plexus nerve injury resulting in a paw contracture and partial paralysis of her front left leg.

Case of Interest: The most successful clinical outcome for a pet with a custom brace is the result of a team effort between the pet family, veterinarian, rehab specialist and the My Pet’s Brace practitioners.  With everyone working together, Philomena’s condition continues to improve to this day.  Philomena originally visited our Morgantown, PA facility for a carpal brace at the referral of her physical therapist.  As her range of motion improved, a second carpal brace was fabricated.  Philomena was in need of a third brace, but had moved away from our main facility.  Luckily, she was within driving distance of our new patient care clinic in Knoxville, Tennessee where she was cast and fit with her third carpal brace.

Diagnostic History: In February of 2017, Philomena jumped from a couch and landed heavily on the floor. The impact resulted in a brachial plexus nerve injury which caused partial paralysis of her left side and contracture of the left front paw. The contracture of the paw caused her to drag her leg and walk on the top of her paw, resulting in abrasions. She attended hydro and physical therapy sessions and was regaining function in her left side. Her physical therapist referred Philomena to My Pet’s Brace for a brace to protect the left paw and carpal joint.

Philomena presented to our facility in July of 2017 with a contracted left paw. She had good mobility in the remaining limbs and was alert and eager to move. It was determined that a non-jointed carpal brace would be beneficial for Philomena. The brace would protect the top of the paw from abrasions and would halt any further collapse of the carpal joint. A cast was taken of her front left leg from the elbow down at an angle that was comfortable for Philomena. A custom brace was then created using the cast. The brace was made using medical grade plastic and straps with pads to hold the brace securely on her leg. The brace was also equipped with a rubberized sole to aid in walking and movement. Philomena returned a week later to be fit with the brace. Appropriate adjustments were made to ensure an accurate and comfortable fit.

Follow-Ups: Philomena returned in November of 2017 to be re-cast for a second brace.  Through therapy she was achieving greater flexibility in her paw and she needed a new brace with a more accurate angle. She returned a week later to be fit with her new brace.

Due to her progress with physical therapy, in June of 2018 it was determined that a third brace would be best for her continued improvement. Philomena and her family had relocated to Georgia during this time.  Happily, our Knoxville, Tennessee location was convenient for them to visit for appointments.  The practitioners at our Morgantown and Knoxville facilities discussed Philomena’s case and shared notes prior to the casting and fabrication of her third brace.

Philomena continues to go to physical therapy, hydrotherapy, and acupuncture.  We look forward to seeing her progress as her condition continues to improve with the help of her brace and her entire team.

Follow Philomena on Instagram, Facebook and YouTube @PhilomenathePug!
Video courtesy of Philomena’s humans.

Case Study: Tonka – a Saint Bernard with a CCL Tear

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Tonka, a 137-pound 7-year-old Saint Bernard with a Cranial Cruciate Ligament (CCL) tear in his right rear leg.

Case of Interest: We have fabricated braces for over 180 breeds of dogs, from Pitbulls and Retrievers to Afghans and Greyhounds. Tonka is definitely a dog that we do not see everyday. Tonka is a Saint Bernard and is one of the larger dogs that has walked through our doors. Tonka presented with a CCL tear of his right hind leg. A drug-resistant bacterial infection was present in his leg prior to the tear so Tonka was not a candidate for surgery. A stifle brace was fabricated with special heavy-duty aluminum joints to handle the increased stress of a larger dog while preventing the tibial thrust that is associated with a CCL injury.

Diagnostic History: In August of 2017, Tonka slipped on the stairs and proceeded to limp on his left rear leg. He was seen by a veterinarian and was diagnosed with a tear of his right CCL.

Tonka presented to our clinic for a stifle brace for his right rear leg for support and to aid in the healing of the rupture. The brace resists the anterior drawer motion associated with a CCL injury. Excessive drawer motion puts stress on the newly growing scar tissue. An evaluation of Tonka’s body condition and lifestyle was performed and it was determined that he would benefit from a right rear stifle brace. An accurate cast was taken of the leg from hip to hock. A brace was made using the cast. Due to his height, weight and activity level, the brace was made with heavy-duty aluminum joints. A week after the evaluation, Tonka was fitted with his brace.

Tonka was given a restricted exercise regiment, which included no running or dog and ball playing. Stairs were limited to 1 to 4 and if more than 4 were required than some help in the form of a sling under the hips was suggested. Leashed walks were encouraged but limited to 2 or 3 walks a day at around 10 to 15 minutes each walk. This limited exercise regiment was only required for the initial 3 to 4 months to allow time for healing. Afterwards he could be gradually allowed to do more strenuous activities such as stairs and running.

Follow-Ups: Tonka was seen at 1 month, 2 months, and 4 months post-delivery. Tonka had taken well to the brace and was happy and moving better.  The limp disappeared and the atrophied muscle mass was regained. Adjustments were made to the brace and straps replaced as needed. Tonka has since been weaned off the brace but does continue to wear it only during hikes or longer walks.

     

Case Study: Teddy Bear – a Samoyed with a Rear Prosthesis

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Teddy Bear, a 45-pound Samoyed with a missing left rear paw

Case of Interest: When a portion of a limb is missing, the dog compensates in one of two ways, either they put their weight down using the stump as a weight-bearing surface or they hold the limb up and off-load their weight onto the other three legs. Both responses put abnormal stresses and strains on the remaining limbs which could cause joint, ligament, tendon, or spinal issues. Putting weight down on the end of the remaining limb can cause sores, cuts, and scraps which have the potential for infection and pain to the dog.

A prosthetic device takes the place of the missing portion of the limb, allowing the body to be held in a more natural position. There are different levels of prosthetics available depending on how much residual limb is remaining. For our design, a minimum of 1.5-2 inches of residual limb is needed below the carpus and hock. This is needed to allow for enough suspension of the device and because dogs cannot manipulate a jointed prosthetic device.

Teddy Bear was rescued from a puppy mill while he was a small puppy. His mother chewed off his left rear paw and the tip of his tail. He healed from this traumatic injury and was taken in by his current owners who are avid hikers with three older Samoyeds. They were referred to My Pet’s Brace by their veterinarian for a prothesis to protect his residual limb and to correct the height difference between the rear legs. He was evaluated at our facility when he was 9 months old, but the casting was postponed three months to ensure he was fully grown and would therefore not out-grow the prosthetic device.

Diagnostic History: He returned in January of 2017 for a casting of the residual limb, which was used to create a positive mold of his stump. A prosthesis was created, the outside is a shell made of hard medical grade plastic and a rubberized sole. The inside is a flexible sleeve which is in direct contact with the remaining limb. The flexible sleeve slides in/out of the outer shell. This allows for the prosthesis to be slipped on and off in case the prosthesis becomes trapped while outside, but allows for ample suspension so it does not come off during play or running.

Teddy Bear returned approximately 2 weeks post-casting for the fitting of the prosthesis and adjustments were made to the inner sleeve and outer shell to relieve any excess pressure and reduce the chance for rubbing and sores. Teddy Bear’s owners were instructed to allow him to wear it for 30 minutes the first day and increase by 30 minutes each day until he wears it for a total of 6 – 8 hours. He was given no restrictions with regards to play and exercise, but was encouraged to go out for walks a few times a day for around 10-15 minutes.

Follow-Ups: Teddy Bear returned several times over the course of the next two years. At each of these appointments the condition of his skin and his activity level were assessed and the prosthesis was adjusted accordingly. An adjustment that was made several times was the replacement of the sole of the prosthesis. This is done for ground-contacting orthotics and prosthetics, as the sole wears out from use it can be easily replaced at our facility to allow for ample traction.

Teddy Bear is an active dog and he wears his prosthesis every day, for most of the day.  It allows him to keep up with his pack on walks and hikes and enables him to lead a happier life.

Case Study: Denali – a Labrador Retriever with a CCL tear in her left hind leg

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Denali, a 90-pound 7-year-old Labrador Retriever with a CCL tear in her left hind leg.

Case of Interest: Denali is an example of a typical patient that would be seen at our clinic. Denali is a 90-pound 7-year-old Labrador Retriever. Denali presented with a partial tear of the CCL of her left hind leg. Surgery was performed on Denali’s right CCL two years earlier. The CCL tear on her left leg was due to falling down the stairs combined with compensation.

Diagnostic History: In 2015, Denali injured her right CCL and underwent surgery for repair. It was also determined that Denali had developed arthritis in both of her stifles during this time. Two years later in early 2017, Denali fell down the stairs and was lame on both hind legs which were noticeably painful on manipulation. Diagnoses of degenerative joint disease (DJD) and CCL ruptures were determined, and options were presented to the owner. The owner chose conservative management with a custom brace versus surgery on the left leg which had not had surgery performed on it.

Denali presented to our clinic for a stifle brace for her left hind leg to aid in the healing of the rupture of her CCL. An evaluation of Denali’s body condition and lifestyle was performed, and it was determined that she would benefit from a left rear stifle brace. An accurate cast was taken of her leg from hip to hock. A brace was constructed using the cast. The brace was made with medical-grade plastic and veterinary urethane joints. A week after the evaluation, Denali returned to My Pet’s Brace for the fitting of her brace.

Denali was given a restricted exercise regimen, which included no running or dog and ball playing. Stairs were to be blocked or limited to 1 to 4 steps.  If more than 4 steps were required than help in the form of a sling under the hips was recommended. Leashed walks were encouraged, but limited to 2 or 3 walks a day at around 10 to 15 minutes each walk. These walks were increased as her healing progressed. This limited exercise schedule was only required for the initial 3 to 4 months to allow time for healing. Afterwards she was allowed to do more strenuous activities such as stairs and running.

Follow-Ups: Denali was seen at 3 weeks and at 4 months post-delivery. At each check-up appointment her weight-bearing and walking were assessed. At each appointment, general maintenance was performed on the brace and it was noted that she was doing well. Her weight bearing and muscle mass had returned to normal.  Denali’s owners discontinued use of the brace following the successful healing process.

Denali was seen again at 1 year 4 months post-delivery to perform routine maintenance on the brace in preparation for the upcoming winter season. It was noted that Denali continued to use the brace only during bad weather and that she had fully regained weight-bearing on her left rear leg and was moving about eagerly and normally.

Denali with Stifle Brace

Case Study: Bella with Nerve Damage and Rotation of the Hock

By: Amy Rosenthal, My Pet’s Brace Practitioner


The Patient:
Bella, a 90-pound 7 year-old Anatolian Shepard/ Afghan mix with nerve damage resulting in internal rotation at the stifle and hock with subluxation at the hock.

Case of Interest: Custom bracing enables us to design and fabricate devices made specifically to meet the needs of each individual pet.  After fitting Bella’s first hock brace, there continued to be significant laxity and internal rotation at the stifle. A second hock brace was created with a special upper cuff around her thigh to prevent the unwanted rotation.

Diagnostic History: In September of 2010, Bella had been hit by a car which caused severe injuries. Bella underwent several surgeries to repair the broken bones, but unfortunately she had also sustained nerve damage. This nerve damage resulted in a subluxation of the right hock and severe knuckling on the right rear leg. After years of knuckling, sores and calluses had developed on the top of her toes as well as an abnormal walking gait and stance.

In September of 2017, she was referred to My Pet’s Brace by her veterinarian for a brace to aid in returning Bella to a more normalized conformation.

Treatment and Plan: Bella presented with severe laxity in the hock and stifle. This caused subluxation of the hock resulting in weight-bearing on the dorsal aspect of Bella’s right rear paw and severe varus at the hock. It was determined that a right rear hock brace would be fabricated to allow for weight bearing to return to the proper surface of the paw. An accurate cast was taken of the leg from the most distal aspect of the paw to the stifle. A week later Bella returned to be fitted with her brace.

Bella was given no restrictions and could continue her daily habits, however, the brace was to be slowly introduced to her by having her wear it one hour the initial day and increasing one hour each day until she had it on from morning until night, only taking it off if she was sleeping or if she was crated or kenneled.

Follow-Ups: Bella was re-evaluated at three weeks. At this three-week check-up it was determined that the brace controlled the subluxation and laxity in the hock, but did not account for internal rotation at the stifle which had become more apparent as the hock’s movement was restricted.

Another cast was taken with more flexion to control the internal rotation. A second brace was created. This brace combined a typical hock brace with an additional cuff around the thigh to control the unwanted rotation. This brace was fit approximately one week later. It was immediately apparent that she was walking with a normalized gate with little to no rotation at the stifle or hock. Bella was seen approximately three weeks and eight month post-delivery. Bella continues to improve, muscle mass has increased and the sores have healed.

Case Study: Nikko with Bilateral CCL Tears

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Nikko, a 92-pound 7-year-old German Shepard / Black Mouth Cur mix with bilateral cranial cruciate ligament (CCL) tears.

Case of Interest: The majority of our canine patients present with only one CCL tear.  Nikko’s veterinarian diagnosed bilateral CCL injuries.  At his initial evaluation/casting appointment at our clinic, he showed significant pain while walking with substantial weight transfer to his front legs and only slight weight bearing on both of his rear legs.

Diagnostic History: Nikko had been limping on and off for about two weeks on his right hind leg. The family then played ball with Nikko and he aggravated the injury causing non-weight bearing on the right hind leg. Shortly afterwards, Nikko started limping on his left hind leg.  Nikko’s veterinarian diagnosed bilateral CCL tears and recommended custom stifle braces for his injuries.  His owners decided to pursue conservative management treatment for his condition and contacted our facility approximately two weeks after injury of his left hind leg.

Treatment and Plan: An evaluation at our clinic confirmed Nikko’s bilateral CCL tears.  He presented with pain due to weight bearing, severe limping, toe-touching on both rear legs and shifting weight to his front legs during static standing. Bilateral CCL stifle braces and a restricted exercise regimen were determined to be the best treatment plan for Nikko. The CCL stifle braces restrict the tibial thrust and limit full extension at the knee.

Accurate casts of Nikko’s rear legs from his hip to his hock were obtained at our clinic.  Nikko returned a week later to be fitted with his bilateral stifle braces. The CCL stifle braces were created with antimicrobial, hypoallergenic, closed cell foam and medical-grade co-polymer plastic in royal blue. Specialized veterinary molded urethane knee joints were utilized to ensure full-range of motion to encourage movement and natural healing.

Nikko was put on a limited exercise plan, including the restriction of stairs, running, and dog or ball playing. Walks were encouraged but limited to 2 to 3 walks a day at 10 to 15 minutes each. These walks were increased as Nikko became accustomed to the braces.

Follow-ups: Nikko was re-evaluated at three weeks and four months post fitting of the braces. At each follow-up appointment visual pain and weight bearing was evaluated. At the four-month check-up, mild irritation was noted and addressed on the caudal region of the Achilles tendon by adding additional padding to the Achilles tendon pad. At the same four-month check-up appointment, the My Pet’s Brace clinician noted increased weight bearing in both rear legs, a normalized stance, increased muscle mass in the rear, decreased muscle mass in the front, an increased willingness to walk, as well as anecdotal evidence presented by the owners. Medial buttressing was present in both stifles indicating scar tissue build-up and stifle stabilization. Nikko’s family was instructed to continue wearing both braces for an additional 5 months.