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  • Writer's pictureSacha Packer

Carpal Laxity Syndrome aka Knuckling Over in Puppies

Carpal Laxity Syndrome is a more general term, used for both hyperextension and hyperflexion deformity. The cause is not known but may be related to unbalanced growth, poor muscle tone, or weakness between the flexor and extensor muscle groups. Improper exercise, poor footing (eg, slippery surfaces), inappropriate nutrition, and genetics have also been implicated. Exercise and commercially available balanced diets without any other treatment is usually enough to achieve physical and functional recovery.

Some breeds such as Shar Peis and Dobermann’s appear to be predisposed to the condition. Male puppies seem to more affected due to their more rapid growth.

Age of presentation is usually 6 to 16 weeks; dogs may be unilaterally or bilaterally affected. While all breeds can be affected, large breeds tend to be affected more often than small breeds

In rescue puppies, this condition can typically be seen where a puppy has come into care suffering from malnutrition.

When malnourished puppies suddenly start getting quality nutrition, this can lead to rapid growth which can trigger the condition, it is therefore recommended that such puppies are not over-fed to put on weight. Sometimes this condition is simply unavoidable in malnourished puppies as the processes have already begun when they come into care.

The first red flag is often the twisting of toes, this is the ligament laxity beginning and whilst some puppies will not advance past this stage, this is your red flag that something isn't right and that you need to have a look at diet and environment if the puppy hasn't been malnourished. Chubby aka overweight puppies are at higher risk of developing this condition, it is very important to grow puppies lean especially large-giant breed puppies.

Balanced diets are very important for these puppies, whether that be a puppy kibble or a balanced commercially available raw diet suitable for puppies.

It is important you see your Vet so your Vet can monitor your puppy, it is unlikely your Vet will recommend anything too different to what we are but your Vet is an important partner in your dogs recovery.

Whilst the condition is generally self-limiting, affected puppies should only ever be on surfaces they can grip, this means they should not be slippery surfaces such as floorboards etc. Taking an affected puppy on a walk is not appropriate nor is physical play. Puppies should be kept on surfaces such as carpet, rubber mats & grass. Whilst penning/crating a puppy may seem appropriate when the puppy struggles to walk, it is generally recommended that the puppy still moves about on these appropriate surfaces – caretakers should take a common sense approach and follow the advice of their Vet.

Puppies who are knuckling over should be kept in warm environments as cold weather can worsen the condition.

Should splints be used in more severe cases? There is no right, or wrong answer here - there are 2 studies looking at both options and both options were successful. Many Vets will ask for the dogs to be left without splints but restricted to a safe area (not a crate or pen) with appropriate flooring with the hope that within 2-4 weeks the condition will rectify.

Whereas other Vets, will want to splint for anywhere between 7-10 days to get on top of the condition quickly. Long term use of splints is not appropriate unless absolutely necessary as it will lead to muscle atrophy. Splints can sometimes be tricky to keep on and some dogs may object and bite at the bandages keeping the splints in place. The puppy may also start to knuckle again after the splints come off.

Dogs with secondary carpal contractures (the inability to extend the carpal {wrist} joint) that are not wearing splints require stretching sessions two to three times daily. The families Vet can show them how to do this or a referral to an Animal Physiotherapist can be given.

In this photo, stretching exercises are being performed on the left carpus by supporting the forearm with one hand and extending the carpus with the other. Carpal extension is maintained for 10 seconds and this is repeated 10 times in each physiotherapy session.

Adopting puppies with the condition Ideally puppies should stay with their carers until fully recovered however. it would be deemed appropriate for puppies to start their journey’s with their new families if the knuckling over is minor and the family understand what to look for and how to manage the puppy. The great news is that most puppies make full recovery especially when the family are following the guidelines mentioned in this info sheet. In an exceedingly small amount of serious cases, the dog may need minor surgery to correct the contractures.

New families should ensure they are not over feeding their puppy, growing their puppy in a lean state is the goal. Choosing a high-quality diet is imperative, avoiding low quality supermarket dry & tinned foods is recommended. For families wanting to stay with a dry food diet, I would recommend an Australian brand called Stay Loyal and select their Large Breed puppy formula even if the dog is small as it has appropriate protein fat, calc & phos amounts to encourage slow growth. We recommend you try and keep to below 26% protein. For families who want to feed a fresh food diet, I recommend Prime100 Lamb or Chicken raw Patties OR Vets All Natural Complete Mix Puppy that you add fresh meat too and offer raw meaty bones around 4 times per week such as chicken necks, chicken frames, chicken wings etc. – whatever is an appropriate size and style for your dog. Supervise your dog when they are eating bones. Learn more about bones here.

Supplements We recommend the following supplements for these puppies, starting off with the most important so if you can only do one, start there.

1. MSM Powder Supports connective tissues such as collagen, ligaments and tendons. We make My Doggie Support which is the highest quality MSM available paired with vitamin C for further bioavailability. If you are not in Australia, below is the dosage for MSM, try and find OptiMSM being the most pure version. 1-10 kilos of body weight: 1/4 teaspoon 10 - 20 kilos of body weight: 1/2 teaspoon 20 – 40 kilos of body weight: 3/4 teaspoon over 40 kilos: 1 teaspoon and then 1/4 teaspoon for every 10 kilos over that These doses can be doubled when there are joint disease/challenges. When not giving My Doggie Support, add Vitamin C to increase absorption of MSM. Use a ratio of 4 parts MSM to 1-part Vitamin C. Ester C is much gentler on the tummy that standard Vitamin C and comes in a powder.

2. Vitamin C - look for Ester C as it's more gentle on the tummy. Your Vet will be able to confirm the dosage, generally 250mg for a large breed puppy is enough, you can read more about vitamin C and dosage here.

3. Zinc Blackmores Bio Zinc used to be our go-to. Recently we've had more success with Blackmores Nails, Hair & Skin which is a bit higher in Zinc. Start with a lower dose and see if that does the trick, you can increase where needed, you'll speak to your Vet about how much to give.

4. Anitone A liquid, organic, nutritional supplement providing over 60 minerals and trace elements in a highly bioavailable, chelated form. Google for best price. Dosage as per packaging. Google for best price. Link to product here.

5. Antinol Rapid An incredible powerful full spectrum omega-3 supplement that not only is used in dogs with active joint disease but also used to support the growth of puppies and acts as a preventative of joint disease. Some nice side effects include improving trainability in puppies but also improves coat and skin. If your Vet doesn’t stock this supplement and you would like an online supplier with free shipping, please feel free to touch base: or

6. Do not give calcium or vitamin D supplements unless okay-ed by your Vet. Tinned sardines in the DIY raw diet is generally enough natural vitamin D for most puppies.

7. Wellbeing for dogs (Wellbeing Essentials) This is a nice supplement that compliments DIY (not commercial prepackaged) raw diets and can cover off a range of nutrients to ensure puppy is getting enough of everything. --- References:

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