Page 301 - Cote clinical veterinary advisor dogs and cats 4th

Brachial Plexus Injury 128.e3

• Limb amputation may be indicated in cases • Brachial plexus neuritis carries a guarded but the client should be warned that a limb
prognosis, but recovery has been reported.
with • Overall prognosis is poor for malignant amputation may be necessary if self-muti-
VetBooks.ir ○ Documented or highly suspect malignant nerve sheath tumors that are not surgically • If limb amputation is deemed necessary, the Diseases and Disorders
lation persists.
○ Permanent unilateral brachial plexus
avulsion (no improvement after 6 weeks)
benefits of amputation and the ease with
resectable.
nerve sheath neoplasia
• Radiation therapy can be considered for cases PEARLS & CONSIDERATIONS which most pets adapt should be discussed.
of brachial plexus tumors SUGGESTED READING
• Limb-sparing treatments (e.g., nerve root Comments Dewey CW, et al: Disorders of the peripheral nervous
transplantation, transposition, neurotization, • Physical rehabilitation is imperative; therapy system: mononeuropathies and polyneuropathies.
muscle transposition) for brachial plexus should be initiated soon after the injury. In Dewey CW, et al, editors: A practical guide to
avulsions are often unrewarding with limited ○ Splints/bandages should be avoided if canine and feline neurology, ed 3, Ames, IA, 2015,
reports of recovery of neurologic function possible because they can impede joint Wiley-Blackwell, pp 445-480.
in the affected limb. and muscle mobility.
• Perform a thorough neurologic examination ADDITIONAL SUGGESTED
Nutrition/Diet in all cases. Some peripheral nerve injuries READINGS
Avoid diets containing horse meat (for brachial can be so specific as to affect only one Bailey CS, et al: Spinal nerve root origins of the
plexus neuritis). cutaneous zone or digit. cutaneous nerves arising from the canine brachial
• Neoplasia can present with an acute onset plexus. Am J Vet Res 43:820-825, 1982.
Behavior/Exercise of clinical signs. Bailey CS: Patterns of cutaneous anesthesia associated
Physical rehabilitation (see chronic treatment) with brachial plexus avulsions in the dog. J Am
Prevention Vet Med Assoc 185:889-899, 1984.
Possible Complications Minimize the risk of high impact or motor Cummings JF, et al: Canine brachial plexus neuritis:
• Continued trauma to the dorsum of the paw vehicle trauma. a syndrome resembling serum neuritis in man.
Cornell Vet 63:589-617, 1973.
of the affected limbs can occur due to scuff- Kraft S, et al: Magnetic resonance imaging charac-
ing/dragging during ambulation. Care should Technician Tips teristics of peripheral nerve sheath tumors of the
be taken to prevent this trauma and possible • Patients with a history of traumatic injury canine brachial plexus in 18 dogs. Vet Radiol
infection. should be assessed for comorbidities. In the Ultrasound 48:1-7, 2007.
• Paresthesia due to sensory nerve injury can immediate phase, the patient should be Rose S, et al: Ultrasonographic evaluation of brachial
predispose to self-mutilation. monitored continuously for systemic dys- plexus tumors in five dogs. Vet Radiol Ultrasound
46:514-517, 2005.
• Malignant nerve sheath neoplasms, if not function and pain/hyperesthesia. Rudich SR, et al: Computed tomography of masses
surgically managed, continue to grow, • Physical rehabilitation can sustain joint and of the brachial plexus and contributing nerve roots
causing further paresthesia and continued muscle mobility and avoid decubital ulcers. in dogs. Vet Radiol Ultrasound 45:46-50, 2004.
neurologic dysfunction due to invasion of A thorough explanation of rehabilitation Steinberg HS: The use of electrodiagnostic techniques
the vertebral canal. techniques, possible complications (i.e., in evaluating traumatic brachial plexus root injuries.
hyperesthesia, limb dragging/scuffing, and J Am Anim Hosp Assoc 15:621-626, 1979.
Recommended Monitoring self-mutilation), and future neurologic Steinberg HS: Brachial plexus injuries and dysfunc-
Serial neurologic assessments should be per- re-evaluations should be discussed with the tions. Vet Clin North Am Small Anim Pract
formed every 2-4 weeks as a means to monitor client. Limb amputation may be necessary 18:565-580, 1988.
sensory and motor function. in cases with a complete avulsion or if self- AUTHOR: Joshua Gehrke, DVM, DACVIM
mutilation occurs. EDITOR: Karen R. Muñana, DVM, MS, DACVIM
PROGNOSIS & OUTCOME • The attending veterinarian should be notified
immediately about any changes in the
• Brachial plexus injury patient’s neurologic status.
○ Preservation of deep pain sensation war-
rants a fair to good prognosis for return Client Education
to function over weeks to months. • Clients should be taught effective physical
○ Loss of deep pain sensation suggests an rehabilitation techniques and encouraged to
avulsion and warrants a grave prognosis seek a rehabilitation specialist for further
for return to function. treatment, care, and education.
○ Lack of any neurologic improvement over • The client should monitor the pet for signs
a 4-6 week period suggests permanent of self-mutilation (licking and/or chewing
injury. of the limb or paw). An e-collar can be used,

www.ExpertConsult.com