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Dell'Apa D, Auletta L, Okonji S, Cauduro A, Dondi M, Opreni M, Gandini G, Bianchi E. Traumatic and iatrogenic sciatic nerve injury in 38 dogs and 10 cats: Clinical and electrodiagnostic findings. J Vet Intern Med 2024; 38:1626-1638. [PMID: 38634245 PMCID: PMC11099794 DOI: 10.1111/jvim.17076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/01/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Reports describing sciatic nerve injuries (SNI) and their outcome are scarce in veterinary medicine. HYPOTHESIS Describe the causes of traumatic and iatrogenic SNI and evaluate which clinical and electrodiagnostic findings predict outcome. ANIMALS Thirty-eight dogs and 10 cats with confirmed SNI referred for neurologic and electrodiagnostic evaluation. METHODS Clinical and electrodiagnostic examination results, including electromyography (EMG), motor nerve conduction studies, muscle-evoked potential (MEP), F-waves, sensory nerve conduction studies, and cord dorsum potential (CDP), were retrospectively evaluated. Quality of life (QoL) was assessed based on owner interviews. RESULTS Surgery (42%) and trauma (33%) were the most common causes of SNI; in dogs, 24% were caused by bites from wild boars. Ability to flex and extend the tarsus was significantly associated with positive outcome in dogs. Mean time from onset of clinical signs until electrodiagnostic evaluation was 67 ± 65 (range, 7-300) days and 65 ± 108 (range, 7-365) days for dogs and cats, respectively. A cut-off amplitude of 1.45 mV for compound motor action potentials (CMAP) was predictive of positive outcome in dogs (P = .01), with sensitivity of 58% and specificity of 100%. CONCLUSIONS AND CLINICAL IMPORTANCE Clinical motor function predicts recovery better than sensory function. Electrodiagnostic findings also may play a role in predicting the outcome of SNI. Application of the proposed CMAP cut-off amplitude may assist clinicians in shortening the time to reassessment or for earlier suggestion of salvage procedures. Owners perceived a good quality of life (QoL), even in cases of hindlimb amputation.
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Affiliation(s)
| | - Luigi Auletta
- Department of Veterinary Medicine and Animal Sciences (DIVAS)University of MilanMilanItaly
| | - Samuel Okonji
- Department of Veterinary Medical ScienceUniversity of BolognaBolognaItaly
| | | | - Maurizio Dondi
- Department of Veterinary ScienceUniversity of ParmaParmaItaly
| | | | - Gualtiero Gandini
- Department of Veterinary Medical ScienceUniversity of BolognaBolognaItaly
| | - Ezio Bianchi
- Department of Veterinary ScienceUniversity of ParmaParmaItaly
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Dycus DL, Levine D, Ratsch BE, Marcellin-Little DJ. Physical Rehabilitation for the Management of Canine Hip Dysplasia. Vet Clin North Am Small Anim Pract 2022; 52:719-747. [DOI: 10.1016/j.cvsm.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Orthosis in the Conservative Treatment of Cranial Cruciate Ligament Rupture in Dogs – Clinical Observations. ACTA VET-BEOGRAD 2022. [DOI: 10.2478/acve-2022-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Orthoses are increasingly frequently applied orthopedic devices in veterinary medicine. Injury to the knee joint with a rupture of the cranial cruciate ligament is one of the main indications for the use of orthoses in dogs. This study aimed to present the results of treatment of 30 dogs with injured cranial cruciate ligaments using a knee orthosis and describe the reasons for the conservative treatment of cranial cruciate ligament deficiency. The study was conducted between 2017 and 2019 and involved 30 dogs of various breeds aged 7 to 15, weighing from 2.5 kg to 45 kg, diagnosed with cranial cruciate ligament rupture. In the study, a stifle knee orthosis by the Polish manufacturer Admirał (Pl) was used in 29 dogs and, in one case, an orthosis by Balto (USA) was applied. In each case, the orthosis was selected individually, based on the measurements taken. In the twelfth week of treatment using orthoses, the owners of 25 dogs were satisfied with the results of conservative treatment with the application of orthoses. The caretakers of four dogs observed difficulties in the form of slight lameness at rest after prolonged exertion on the previous day. Running difficulty was observed in one dog. In the conducted study, the knee orthosis demonstrated good therapeutic effects in dogs up to 25 kg. In the majority of dogs, a slight increase in the flexion angle of the treated knee joints was observed, X-ray examinations did not show the degenerative disease progress during the studied period.
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Lee S, Wendland TM, Rao S, Magee C. Orthotic Device Use in Canine Patients: Owner Perception of Quality of Life for Owners and Patients. Front Vet Sci 2021; 8:709364. [PMID: 34805329 PMCID: PMC8600258 DOI: 10.3389/fvets.2021.709364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
Orthotic devices are an established treatment for neuromusculoskeletal disease in the human population. Orthoses are an emerging veterinary therapy due to limited practitioner experience, availability of devices, and published data from veterinary patient outcomes. Expanding client education and veterinary expertise in the application of orthoses may allow greater access and successful utilization of these devices to treat appendicular disease. While orthoses have the potential to improve quality of life for veterinary patients, consideration needs to be made for owner related factors with device use. Owner satisfaction and experience may greatly impact compliance with treatment recommendations; therefore, it is crucial that owner expectations are met. The purpose of the present study was to evaluate owner-reported outcomes of orthosis for canine patients and their owner's subjective responses about the shared pet/owner experience utilizing a promoter score. It was hypothesized that owner's impressions of their pet's experience with the orthotic device would influence owner perceptions of quality of life for both the owner and the pet, and these factors would impact the likelihood of the owner to recommend a veterinary orthosis to a friend. An anonymous online survey was sent to 136 clients of a single veterinary orthoses manufacturer. Fifty-six surveys were completed and included for analysis. The owner's reported quality of life was in agreement (P = 0.02) with reported pet quality of life. There was also a higher likelihood (P = 0.02) for the owner to recommend a veterinary orthotic device to a friend when owner perceptions of pet quality of life were positive as compared to negative or neutral. Willingness to recommend an experience to a friend is a reflection of satisfaction with the experience. The dependence of owner and pet quality of life should therefore guide therapeutic decisions for patient management and client communication to ensure that the orthosis experience is positive for both patient and owner.
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Affiliation(s)
- Sera Lee
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Theresa M Wendland
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Sangeeta Rao
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
| | - Christianne Magee
- Department of Biomedical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, United States
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Bertocci GE, Brown NP, Mich PM. Why Owners Choose an Orthosis Over Stifle Surgery for Canine Cranial Cruciate Ligament Deficiency. Top Companion Anim Med 2018. [PMID: 29525232 DOI: 10.1053/j.tcam.2017.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study was to describe the patient population of dogs with cranial cruciate ligament (CrCL) deficiency that were prescribed a stifle orthosis. A total of 215 client-owned dogs with previously diagnosed CrCL deficiency were prescribed a stifle orthosis at a veterinary pain management and mobility clinic. Patient intake data collected included dog signalment, chief medical complaint, home environment and activity description, medical and surgical history, and diagnosing veterinarian. An orthopedic examination was conducted to assess pelvic limb function and determine pelvic limb morphologic measures. Spayed females (57.2%) were most common in our sample. Median age, body weight, and body condition score were 9.00 ± 3.23 years, 32.98 ± 13.37kg, and 6.00 ± 1.04, respectively. Most common breeds prescribed stifle orthoses included Labrador Retriever, Golden Retriever, and German Shepherd. Right and left limbs were equally affected, and 19.5% of dogs previously had stifle stabilization surgery. Primary reasons for seeking a stifle orthosis consultation were surgical concerns, advanced age, and surgery cost. Most common chief complaints included altered gait, decreased weight bearing, and pain following activity. Reduced stifle extension, increased cranial drawer score, and decreased 3-leg stance time characterized the CrCL-deficient stifle. Stifle orthosis represents an alternative approach to surgical stabilization and management of CrCL deficiency. CrCL-deficient dogs prescribed stifle orthoses were generally large breeds of advanced age with above ideal body condition score. Owners commonly sought a stifle orthosis for CrCL deficiency due to reservations regarding surgical management.
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Affiliation(s)
- Gina E Bertocci
- Department of Bioengineering, J.B. Speed School of Engineering, University of Louisville, Louisville, KY.
| | - Nathan P Brown
- Department of Bioengineering, J.B. Speed School of Engineering, University of Louisville, Louisville, KY
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Dycus DL, Levine D, Marcellin-Little DJ. Physical Rehabilitation for the Management of Canine Hip Dysplasia. Vet Clin North Am Small Anim Pract 2017; 47:823-850. [PMID: 28576271 DOI: 10.1016/j.cvsm.2017.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hip dysplasia is among the most common orthopedic conditions affecting dogs. Joint laxity is responsible for abnormal development of the femoral head and acetabulum, leading to excessive wear of the articular cartilage. Wear leads to secondary osteoarthritis. Rehabilitation is either conservative or after surgical management. Conservative rehabilitation therapies are directed at decreasing pain, improving hip range of motion (ROM), and building or maintaining muscle mass. Postoperatively, rehabilitation focuses on decreasing postoperative pain and inflammation, improving comfort and limb use, and protecting the surgical site. Once the patient has healed, rehabilitation is directed at improving ROM and promoting muscle mass.
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Affiliation(s)
- David L Dycus
- Department of Orthopedic Surgery, Veterinary Orthopedic and Sports Medicine Group (VOSM), 10975 Guilford Road, Annapolis Junction, MD 20701, USA.
| | - David Levine
- Department of Physical Therapy, University of Tennessee at Chattanooga, 615 McCallie Avenue, Chattanooga, TN 37403, USA
| | - Denis J Marcellin-Little
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, NCSU CVM VHC #2563, 1052 William Moore Drive, Raleigh, NC 27607, USA
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Torres BT, Fu YC, Sandberg GS, Budsberg SC. Pelvic limb kinematics in the dog with and without a stifle orthosis. Vet Surg 2017; 46:642-652. [PMID: 28198549 DOI: 10.1111/vsu.12634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/30/2016] [Accepted: 11/02/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report a method of evaluating 3-dimensional joint motion in dogs with a stifle orthosis. STUDY DESIGN Experimental. ANIMALS Six healthy dogs. METHODS Three-dimensional pelvic limb joint motion was recorded with and without a stifle orthosis. Kinematic data were collected from dogs at a walk and trot for the hip, stifle, and tarsus prior to, and after application of, a stifle orthosis. Data were also obtained for the orthosis alone. Comparisons were made between the braced and unbraced limb, and between the braced limb and the orthosis alone. Complete waveforms, kinematic, and temporospatial variables were compared. RESULTS Gait waveforms differed between braced and unbraced limbs for all joints and planes of motion (P < .05), as well as between the braced stifles and the orthosis alone at both a walk and trot. However, joint ROM was inconsistently altered. The effect of bracing on stifle ROM was limited to a reduced extension at the end of stance. Adjacent joint ROM was affected by the stifle orthosis. Temporospatial variables were predominantly affected while walking. CONCLUSIONS The restrictive motion of the stifle orthosis is not fully translated to the underlying joint, based on the limited differences between the motion of braced and unbraced stifles. This effect varies with plane of motion and phase of the gait cycle, with most changes in stifle motion being detected during the stance phase. The stifle orthosis had an equal or greater effect on the motion of adjacent joints, especially the tarsus.
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Affiliation(s)
- Bryan T Torres
- The Department of Veterinary Medicine and Surgery, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Yang-Chieh Fu
- The Department of Health, Exercise Science, and Recreation Management, University of Mississippi, University, Mississippi
| | - Gabriella S Sandberg
- The Department of Small Animal Medicine and Surgery, University of Georgia, College of Veterinary Medicine, Athens, Georgia
| | - Steven C Budsberg
- The Department of Small Animal Medicine and Surgery, University of Georgia, College of Veterinary Medicine, Athens, Georgia
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Bertocci GE, Brown NP, Mich PM. Biomechanics of an orthosis-managed cranial cruciate ligament-deficient canine stifle joint predicted by use of a computer model. Am J Vet Res 2017; 78:27-35. [PMID: 28029280 DOI: 10.2460/ajvr.78.1.27] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate effects of an orthosis on biomechanics of a cranial cruciate ligament (CrCL)-deficient canine stifle joint by use of a 3-D quasistatic rigid-body pelvic limb computer model simulating the stance phase of gait and to investigate influences of orthosis hinge stiffness (durometer). SAMPLE A previously developed computer simulation model for a healthy 33-kg 5-year-old neutered Golden Retriever. PROCEDURES A custom stifle joint orthosis was implemented in the CrCL-deficient pelvic limb computer simulation model. Ligament loads, relative tibial translation, and relative tibial rotation in the orthosis-stabilized stifle joint (baseline scenario; high-durometer hinge]) were determined and compared with values for CrCL-intact and CrCL-deficient stifle joints. Sensitivity analysis was conducted to evaluate the influence of orthosis hinge stiffness on model outcome measures. RESULTS The orthosis decreased loads placed on the caudal cruciate and lateral collateral ligaments and increased load placed on the medial collateral ligament, compared with loads for the CrCL-intact stifle joint. Ligament loads were decreased in the orthosis-managed CrCL-deficient stifle joint, compared with loads for the CrCL-deficient stifle joint. Relative tibial translation and rotation decreased but were not eliminated after orthosis management. Increased orthosis hinge stiffness reduced tibial translation and rotation, whereas decreased hinge stiffness increased internal tibial rotation, compared with values for the baseline scenario. CONCLUSIONS AND CLINICAL RELEVANCE Stifle joint biomechanics were improved following orthosis implementation, compared with biomechanics of the CrCL-deficient stifle joint. Orthosis hinge stiffness influenced stifle joint biomechanics. An orthosis may be a viable option to stabilize a CrCL-deficient canine stifle joint.
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Abstract
Exoprostheses are devices that are secured to incomplete limbs to enable locomotion. By comparison, orthoses are devices externally applied to support or protect an injured body part. Orthoses also can be used to control, guide, protect, limit motion of, or immobilize an extremity, a joint, or a body segment. Exoprostheses and orthoses are a growing aspect of the physical rehabilitation of companion animals. They require precise design and fabrication. Patients and owners must be trained to use the devices. Exoprostheses and orthoses can have a profound beneficial impact on the mobility and the quality of life of companion animals.
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Hardie RJ, Lewallen JT. Use of a custom orthotic boot for management of distal extremity and pad wounds in three dogs. Vet Surg 2013; 42:678-82. [PMID: 23889595 DOI: 10.1111/j.1532-950x.2013.12031.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 04/01/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe use of a custom orthotic boot for management of distal extremity and pad wounds in dogs. STUDY DESIGN Clinical report. ANIMALS Dogs (n = 3). METHODS A custom orthotic boot made of lightweight copolymer plastic was used to immobilize the distal extremity and protect full-thickness wounds involving the medial or lateral aspect of the metatarsus including a portion of the metatarsal pad in 3 dogs. Boots were made in a bivalve design with closed-cell foam padding and adjustable straps that allowed for easy application. They were molded with the tarsocrural joint in slight hyperextension and the metatarsophalangeal joints in a neutral position so that the wounds and metatarsal pads were "off weighted" when the dogs were standing. In addition, a "window" was cut out directly over the wounds to minimize direct contact between the boot and the wound. RESULTS Wounds healed by contraction and epithelialization in 21, 21, and 45 days. The only complication encountered was mild skin irritation at the top of the boot in 2 dogs that was managed with additional closed-cell foam padding. CONCLUSION A custom orthotic boot was effective at immobilizing the distal extremity and reducing contact between the wound and the boot which allowed for complete healing by contraction and epithelialization.
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Affiliation(s)
- Robert J Hardie
- Department of Surgical Sciences, University of Wisconsin, School of Veterinary Medicine, Madison, Wisconsin 53706, USA.
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Forterre F, Tomek A, Rytz U, Brunnberg L, Jaggy A, Spreng D. Iatrogenic sciatic nerve injury in eighteen dogs and nine cats (1997-2006). Vet Surg 2007; 36:464-71. [PMID: 17614928 DOI: 10.1111/j.1532-950x.2007.00293.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report clinical features associated with iatrogenic peripheral nerve injury in dogs and cats admitted (1997-2006) to a referral teaching hospital. STUDY DESIGN Retrospective study. ANIMALS Dogs (n=18), 9 cats. METHODS Patients had acute signs of monoparesis attributable to sciatic nerve dysfunction that developed after treatment. Neurologic examination and electrodiagnostic testing were performed. Surgical therapy was used for nerve entrapment and delayed reconstructive surgery used in other cases. RESULTS Of 27 nerve injuries, 25 resulted from surgery (18 with treatment of pelvic injuries). Iliosacral luxation repair resulted in tibial (4 cats) and peroneal (3 dogs) nerve dysfunction. Other causes were intramedullary pinning of femoral fractures (3), other orthopedic surgery (cemented hip prosthesis [2] and tibial plateau-leveling osteotomy [1]), and perineal herniorrhaphy [1]. Nerve injury occurred after intramuscular injection (1 cat, 1 dog). Immediate surgical treatment was removal of intramedullary nails, extruded cement, or entrapping suture. Delayed nerve transplantation was performed in 2 dogs. Within 1 year, 13 patients recovered completely, clinical improvement occurred in 7, and there was no improvement in 7. Five of the 7 dogs that did not recover had acetabular or ilium fracture. CONCLUSION Iatrogenic sciatic nerve injury occurred most commonly during treatment of pelvic orthopedic diseases and had a poor prognosis. Clinical variation in sciatic nerve dysfunction in dogs and cats can be explained by species anatomic differences. CLINICAL RELEVANCE Iatrogenic sciatic nerve injury leads to severely debilitating locomotor dysfunction with an uncertain prognosis for full-functional recovery.
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Affiliation(s)
- Franck Forterre
- Small Animal Clinic, Department of Surgery and Neurology, University of Berne, Berne, Switzerland.
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Granger N, Moissonnier P, Fanchon L, Hidalgo A, Gnirs K, Blot S. Cutaneous saphenous nerve graft for the treatment of sciatic neurotmesis in a dog. J Am Vet Med Assoc 2006; 229:82-6. [PMID: 16817718 DOI: 10.2460/javma.229.1.82] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION A 2-year-old Griffon Vendéen was examined because of a 1-month history of right hind limb lameness after a traumatic injury. CLINICAL FINDINGS Neurologic examination revealed monoplegia and anesthesia of the right hind limb distal to the stifle (femorotibial) joint except for the area supplied by the cutaneous saphenous nerve. Results of electromyographic testing were consistent with a severe lesion of the tibial and peroneal nerves at the level of the stifle joint. TREATMENT AND OUTCOME Exploratory surgery revealed an 80-mm-long gap in both the peroneal and tibial branches of the right sciatic nerve. A section of the left cutaneous saphenous nerve was interposed to graft the nerve defects. The dog received joint mechanotherapy and electrophysiologic therapy during the reinnervation process. Ten months after surgery, the dog had recovered almost completely. Neurologic examination revealed diminished flexion of the tarsal and digital joints. Repeat electromyographic testing revealed no abnormal spontaneous electrical activity in the right hind limb musculature, and small compound muscle action potentials were recorded in the right interosseous and cranial tibial muscles. CLINICAL RELEVANCE Without surgical treatment, neurotmesis injury results in poor recovery of motor and sensory functions and may result in amputation. If a nerve defect exists, nerve grafting should be considered, even if the procedure is delayed until well after the injury. The sensory portion of the cutaneous saphenous nerve is a potential source of peripheral nerve for grafting in dogs. Reinnervation is a long-term process and physiologic support and owner involvement are necessary, but nearly complete functional recovery is possible.
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Affiliation(s)
- Nicolas Granger
- Unité de Neurologie, Ecole Nationale Vétérinaire d'Alfort, 7 avenue de General de Gaulle, 94704 Maison-Alfort Cedex, France
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Adamson C, Kaufmann M, Levine D, Millis DL, Marcellin-Little DJ. Assistive Devices, Orthotics, and Prosthetics. Vet Clin North Am Small Anim Pract 2005; 35:1441-51, ix. [PMID: 16260321 DOI: 10.1016/j.cvsm.2005.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Deciding on which supportive device, orthotic, or prosthetic is best suited for a given patient is a complex process involving many different factors. The ability to manage biomechanical abnormalities successfully may be enhanced by an understanding of the properties of the various materials that comprise these devices, their effect on functional performance, and other associated patient factors. Veterinary health care providers are faced with the challenge of effectively addressing the physiologic and fiscal needs of the patient in a rapidly changing patient care environment.
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Affiliation(s)
- Caroline Adamson
- Alameda East Veterinary Hospital, 9770 East Alameda Avenue, Denver, CO 80247, USA.
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