Puck and Radial Nerve Paralysis
Puck was presented to our clinic September 2005. Some kind soul brought him in as a little black fur ball. "He was found by the side of the road". When I examined him there was an obvious neurological problem with the right front leg. The shoulder looked loose, the elbow appeared dropped, and the carpus was adducted. I had just returned from a continuing education seminar focusing on "Neurology". I thought what a coincidence this cat has a problem that was discussed in detail in the seminar. Therapy and bandaging of limbs with peripheral nerve paresis (partial paralysis) sounded too good to be true. My clinical impression was that of radial nerve paralysis. The odds of it returning to full use were low, but what the heck. The time needed for regeneration of peripheral nerve tissue is long, if at all. This would make a good clinical trial with an "n of 1". This would also make a neat university research project trying new methods and gene technology to stimulate functional tissue and synapses.
We did physical stretching and bringing up the flaccid toes. Our staff religiously massaged his forelimb muscles. (They said it was massage, it looked suspiciously like a cover to play with him. But what do I know?) We tested him for feline leukemia and feline (AIDS) immunosuppressive virus, both were negative. To evaluate the limb and joints we used our dental x-ray unit and # 4 intraoral films to radiograph him. The carpus showed exquisite detail of a normal feline carpus (wrist). No bone fractures, joint trauma, arthritis or signs of cancer visible. As you probably know nerves do not show on radiographs. Nerve tissue requires a MRI test. Peripheral nerves would have a huge increase in size to be visible. A fat suppression setting may show some peripheral nerves.
We were diligent about changing bandaging materials. Eventually the soft support from cast padding, Kling, and "ouch coflex" (Vetwrap) was not furnishing enough stabilization. A metal "spoon" (elbow to toe) splint was placed on his right front leg. Shortly after this appliance was added he started "using" his right front leg. It was really motion from above the trauma line on the radial nerve. Although he could not move the distal (far) end he was generating partial control from upper forearm, elbow and shoulder.
You have probably figured out why he is named "Puck". It was after the splint was applied he started using his front leg like a hockey stick. Puck would bat small objects wad of paper, catnip mouse, and small balls around the clinic. He became very adept at mastering his sheathed stick. We changed bandages and splint for almost three months. When it was noticed decubitus ulcers and necrosis of the toes starting we had to go to plan "A". Amputation was done at the elbow ligating blood vessels and resecting upper forelimb muscles and repositioning them up and over the end of the humerus. The nerve sheath was bathed in local blocks prior to separating it. I also placed a "weeping red rubber catheter" in for a postoperative pain local block. This was in addition to very heavy duty injectable pain abatement medication. I also neutered him at the same surgical time. All healing followed an expected time line and was uneventful.
Puck adapted to life after surgery without incidents. His recovery was rapid and he was able to adapt to the three point stance. Soon he was vaulting to counter tops and the half doors in my exam room. We would watch him balance on his hind legs and batting or feather fighting. Soon I noticed he was using the humerus stub at the same time trying to use the right front to secure the catch.
This cat enjoyed the limits of our clinic. Greeting clients and ambushing our older clinic cat Turbo were two of his favorite pastimes. When Puck healed from surgery he also was starting to look for boundaries larger than we were able to provide. After he spent over a year in our clinic he developed a taste for expensive things. His all-time best was biting holes in the tubing on my mobile dental unit. This decreased the air flow by a bunch. I can assure you this was not solved by plastic vinyl glue-it-all or the veterinarian's version of duct tape (adhesive tape) would not staunch the air leakage. The only plus was it did generate a mini-air fan effect when the dental unit operator put the petal to the metal.
After multiple exuberant adolescent destructive attempts I elected to try to rehouse where there was more room to rumble about. We found a client looking for an additional cat. It was a setup just made for Puck. Great client, cat lover already, she loved and understood cats. Everybody was feeling good. Puck had slightly different ideas about this new housing. This client is a nurse on night shift. She needs to sleep during the day. It turns out living in the clinic had turned Puck into a day cat. He slept in a cage at night, due to nocturnal shelf clearing. Puck came back to our clinic.
After Puck's return, I lowered his criteria to a placement in a good Christian home. A month later another client was willing to give Puck a home. We felt it was a good fit. I went over his history, vaccinations, amputation and he was getting a great deal. We placed him in a home with room and people with a desire to live with him.
Twenty five percent of a cat off, it does not get any better.
Puck lived with them for about a year. One day he got outside and was never located.
For more information about a specific case, consult your veterinarian.
Mike Sweet, DVM