Written by Patrice Mich, DVM, MS, DACVBP, DACVAA, DACVSMR, CCRT
I first met Mick Jagger at Mile High Stadium in 20…. wait that’s a different story. Mick Jagger, the border collie, was adopted at 8 weeks of age with a markedly deformed left thoracic limb (LTL). He had managed to compensate quite well for 5 years leading a very active life with his family hiking the Colorado Rockies. During one of these hikes, he injured the LTL and presented for assessment. For a month he had been steadily losing stamina on his hikes, coming home with a LTL lameness that lasted for a couple of days and was responsive to NSAIDs. This last hike the concern lasted a week despite the use of NSAIDs..
Jagger’s conformation included an angular limb deformity of the LTL including 2 of 3 planes, external rotation of the manus with pronation (transverse plane) and carpal valgus (frontal plane). His gait was marked by a 3/5 LTL lameness with dynamic pronation and rotation of the the LTL manus in terminal stance meaning the conformation noted in stance was dynamically worse at the walk.
A thorough evaluation revealed discomfort on manipulation of the second digit (esp the MC-P joint) as well the caudomedial carpus. The valgus and rotation were not reducible. There was considerable secondary (compensatory) myofascial soreness of the cervical and thoracic musculature as well as the left pectoral, subscapularis, and digital flexor muscles. The RTL antigravity musculature (i.e. pectoralis, biceps brachii, supraspinatus, triceps, and digital flexors) were reactive as well. The remainder of the exam was unremarkable including neurologic, orthopedic, and general health assessment.
Included radiographs of the carpus and manus and revealed distal antebrachial procurvatum and valgus; degenerative joint disease of the carpus (especially the antebrachiocarpal joint) and MC-P 2; and soft tissue swelling associated with the caudomedial carpus. An enthesiophyte was noted at the origin of the medial collateral ligament.
1. Moderate carpal collateral ligament and palmar fibrocartilage sprain secondary to chronic carpal valgus. Degenerative joint disease of the carpus and MC-P 2 joint (mild). A physical injury or distal R/U fracture as a pup was suspected.
2. Myofascial pain due to compensation for a limb length discrepancy (LTL short).
Included: 1) medical management with NSAIDs and permanent alteration of activities; 2) arthrodesis, but there was a concern for increased risk for complications due to reduction of the valgus and procurvatum; 3) orthosis (brace). The decision was made to proceed with an orthosis first as the least invasive solution prior to pursuing surgery. Option 1 was the least desirable due to Jagger’s active lifestyle.
I prescribed an orthosis with the following features. Double hinged carpus and paw orthosis with a medial outrigger to align his total body force vector. The latter would compensate for the non-reducible carpal valgus and procurvatum.
After 1 month of reduced activity, manual therapy, and gait re-education in the orthosis Jagger returned to touring with the band…… hiking with his family. His family decided against surgery due to his positive response to the orthosis. Jagger has rechecks once to twice per year to assess the fit and function of the device and the condition of his limb. He had his 3-year check this past month. He is now 9 years old and continues to hike the Rockies. For most dogs, such a device is likely to last for the entirety of life with periodic maintenance of the soft goods (straps, pads, tread) depending on activity level.