Veterinary Rehabilitation and Hydrotherapy

Ramsay Elders – total elbow replacement (TER)

History

Ramsay, a seven-year old Labrador dog, presented with left forelimb lameness, secondary to arthroscopic surgery on his left elbow several years previously. He was deemed a suitable candidate for total elbow replacement. This was carried out by James Grierson at Anderson Moores, and Ramsay was subsequently referred to Kennel & Paddock.

Assessment

On assessment at Kennel & Paddock, Ramsay had significant swelling of the elbow and was reluctant to weight-bear whilst walking. We taught his owners ice massage of the surgery site, gentle mobilisations of wrist and shoulder joints, and soft-tissue massage to the opposite limbs to relieve muscle soreness.

Treatment

During his four-month treatment period, Ramsay had electrotherapy to various muscle groups and joints for pain relief and tissue healing; effleurage (massage intended to facilitate drainage); and soft-tissue stretches and gentle exercises to encourage weight-bearing and use of the limb. (The functional exercises included sit-to-stand practice/weight-transference exercises.) These gradually increased in frequency and intensity. We then gave him more challenging exercises: stepping over obstacles, walking up and down slopes and walking on unstable surfaces. The aim was to improve his gait by increasing his stride length.

Eight weeks after surgery, Ramsay had a follow-up x-ray at Anderson Moores to confirm the success of the implant. Twelve weeks post-surgery and once he was consistently bearing weight at various speeds of walk, he was ready for hydrotherapy. Although he had always been a very keen swimmer, we had to ensure that his healing had progressed sufficiently before exposing his joint replacement to the relatively uncontrolled environment of swimming.

Outcome

Ramsay became noticeably stronger with normal functional daily activities, and his owners reported increased success with his use of the limb. Consequently his exercise programme was progressed, adding weave exercises with challenging circling. To demonstrate the progress Ramsay had made, we analysed his gait using our Gait4Lite pressure walkway and video analysis – this showed that he was using both forelimbs effectively. At discharge, we advised the owners to continue his swimming outdoors and progressively increase his off-lead exercise.

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