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Thursday, July 23, 2009

A Kitty's Mysterious Wrists

Here's one of the most interesting cases I've seen, sent in by Denise. This is the set-up and history.

My daughter's kitten, Skeeter who wax 6 pounds the other day at the vet, is 10 mos old, female, not spayed yet. She is from a litter of 8, she was #7. Her and her itsy bitsy sister #8 [both were super tiny] survived with our help and have done very well, very healthy, gorgeous fur, happy and very playful. No problems at all - till now. As for nutrition, free food with Diamond Natural's Kitten food till about two months ago when I switched them to Purina One. About a week-1/2 ago Skeeter started walking with a slight gimp on the front, very slightly but I noticed it and kept an eye on her. Then I noticed that she was starting to walk leaning to her wrists, sloping if that makes sense. Both her front legs look very much looks like a dog with carpal hyperextension. We took her to the vet today, they took xrays, and were not sure what to tell us. They told us: Possibly genetic, possibly due to her being so tiny at birth, possibly an injury to both front wrists from jumping off the counter like felines tend to do. They mentioned they could have been broken, I just don't see that and would not know when that could have happened. Our cats are like our kids and loved, and spoiled rotten. No answers from the vet though, they seemed a bit perplexed and that is not comforting because we do not know what route to take now. We are getting a little desperate, because she is pretty uncomfortable and the way it showed up. So fast. She favors the left more and being just 10 mos old that is so sad. We do not want her to suffer. The slope seems to gradually increase, even in just a week. She is not as active now, sleeps more and I can only think it's due to the uncomfortable-ness(?) of the wrist joints.
If it's surgery to fuse a bone to both wrists, to correct this like in hyperextension, is this normally successful for a long happy life, in cats? I read it is for dogs, but can't find anything about cats. And - by the xrays, if you see the problem, how long do you think we have, to raise the money for surgery, before she suffers immensely from this.

Denise, congratulations. You have now stumped four vets, one of them a board-certified internal medicine specialist. This was an odd case, so I ran it by a few other vets I know to make sure we were covering the right bases. The general consensus is that this is an extremely odd case, one that everyone is having a hard time figuring out.

First, I don't see evidence of a fracture in any of the x-rays (to the other readers, she provided several). The case also looks like carpal hyperextension (like you mentioned), which doesn't have to be related to a fracture. This doesn't rule out trauma, just not likely a fracture. Many of the other possibilities are very unlikely due to Skeeter's age and other health status. For example, diabetes can lead to neurological problems that can cause a similar stance in the hind legs. However, it really doesn't normally affect the front limbs, and a kitten her age simply shouldn't have diabetes. I was able to come up with several possibilities.

1. As your vet mentioned, jumping from a high location could cause trauma. This can affect the tendons and ligaments, not just the bones. A situation like this can get progressively worse as more and more damage is done every time she walks. Even though it is not in the bone, a situation like this may require surgery, including fusion of the wrists. A young cat can learn to walk well with fused wrists and can indeed live a long, normal life. It's a bit tougher for a cat since they're normally so flexible, but the can adjust.

2. Nutritional or metabolic diseases can lead to deficiencies in certain minerals or electrolytes that can lead to damage like this. It would be a very rare occurence, but this is already a strange case. I would recommend having your vet run a full blood panel including electrolytes to see if there are any noticable abnormalities.

3. Neurological disorders can manifest like this, but it would be very strange to affect such a specific location and evenly in both limbs. The internal medicine specialist asked several questions about this, including whether or not she was tested for feline leukemia, as it can lead to neurological issues. If your vet hasn't done this recently, have it done or repeated. Even if the test was previously run and was negative, run it again. Sometimes this virus can take some time to develop to the point of being detected. This is a small possibility, but one that can be tested for in your vet's office in a matter of a few minutes.

4. A developmental abnormality is definitely a possibility. However, by 10 months old most of the bone and soft tissue growth is completed. If this was a genetic disorder leading to improper growth, we would expect to see it sooner. However, since this is an usual case, there are instance where the soft tissues will grow at a different rate than the bones, potentially leading to situations like Skeeter. If this is the case, she should grow out of this within the next month or two.

In the end, this is a very tough and unusual case. If this was seen in my office, I would recommend having a consultation at a specialty referral practice or veterinary school that has several specialists. That way you can have both an internal medicine specialist and an orthopedic specialist evaluate the case. But prior to that have your vet run the blood tests. This doesn't appear to be serious or life-threatening, but I would pursue this as quickly as possible because of her discomfort.

Denise, I really wish you the best with this, and wish I could give you a more definitive answer. Please let me know how Skeeter turns out, as I'm very curious. And since I have readers who are vets, I would be appreciative if any of you could add any differing viewpoints or opinions.

19 comments:

  1. Dr. Bern, thank you so much for the time you [and the other doctors] have spent on Skeeter's case. I deeply appreciate it, and want you to know this is the most in-depth information we have received. She is definitely unique, in many ways. I will keep you posted on what happens! Thank you so much again! Denise

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  2. Glad to help, Denise! I feel sorry for Skeeter, but it's a very interesting case and was educational to me as I researched it.

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  3. Hi Dr. Chris, I just emailed you new photos to update you. Skeeter is a medical mystery. Maybe you or an associate of yours will have an answer? Thanks again! Denise

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  4. I have a male cat that is 8 months old. We noticed that his paws were doing the same as described in the above blog post. We took him in to the vet and all three vets at the practice said that they had never seen this before. They recommended seeing an orthopedic specialist to see if they could figure anything out. After reading your response, I am hoping it is just a genetic abnormality that he will grow out of, but he looks so sad hobbling around the house.

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  5. Hi Rem,

    When Skeeter was prevented from jumping off counters and any higher places her tendons tightened back up, amazingly. I think Dr. Chris will agree it is like hypo extended.

    I believe surgery would only make matters worse for them, causing other problems and think the key is to keep them from jumping from higher places so the joints can tighten, if they will and not be continually stressed from the impacts of the landing. Skeeter's mother did the same thing a few months back and we discovered she was jumping down from the top shelf in a closet. She is slowly tightening back up since it's now known she does this and we have stopped her from doing it.

    I wonder too if it is not a genetic weakness of sorts. Our other cats jump and have never had joint problems.

    Hopefully all the info will help you someway and that your cat gets better. It does look painful for them.

    Denise

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  6. I am not sure if anyone checks this anymore but I am desperate as well! My 6 month old male kitten Achilles has this exact same issue I have taken him to multiple vets and no one is sure what is wrong with him. I now have him in splints in hopes that his tendons/ligaments will tighten up. Did you ever find out what was wrong? Did Skeeter recover from this? If you read this please let me know! Any information is appreciated.

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  7. Hi! I have the exact same problem with my kitten. He's nearly a year old now, and this hyperextension of his front paws has occurred, resolved itself and is now back again! Bizzare. He doesn't seem to be in any discomfort, and behaves like a normal healthy kitten. He's an indoor cat that doesn't really over exhert himself enough for it to be injury related. His paws also shake when he's relaxed or asleep. The vets have no idea what to tell us at all! I'd also really appreciate an update/advise.

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  8. Hello, my Marten also has this problem and it first happened at ~10-12 months, just in one side, which resolved from cortisone and amoxil, and now he is about 8 months older and it's happened again in both sides this time. He runs around like nothing's wrong, but he's been flicking his tail in this agitated kind of way and behaving as though he's irritated in general, but doesn't seem to be in any real pain with his joints. I personally suspect some sort of bacterial infection, because he did have gut problems when he was younger (persistent soft stools passing several times a day) and used to live at a shelter before we took him in at 8 months old. Nothing helped his gut until I ran a course of broad spectrum antibiotics through him, then his poo problem calmed down. Everybody knows gut and immune are linked - this inflammatory process could just be expressing in a very weird and specific way - god knows why.

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  9. Well that was an infuriating process. I just typed out my whole reply and the thing redirected me to create a "limited blogger profile" (no WAY I'm making a Google + profile) and then when I did this it redirected me back here and my comment is gone. WARNING TO OTHERS: copy paste your comment before pressing the "Publish" button >:(

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    1. Sorry it was frustrating for you. I deliberately do not allow most anonymous comments due to problems with spammers and rather inappropriate posts in the past. Moderating the comments and making sure people are "real" are some steps I take to make sure the comments stay appropriate to the topic.

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  10. Hi Chris, sorry that was not intended as a personal criticism, I totally understand the reasons WHY the system needed to be implemented. I was highlighting the limitations of the system itself and publishing a work-around for others who might encounter the same error. Not personal at all and I'm very grateful for your site. The person who programmed the code however… unless that was you and you are a vet AND a computer programmer, LOL, well then I take my hat off to you ;-)

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  11. As far as Marten goes (yes he's a marten, not a cat LOL, no just kidding he's a cat that looks like a marten), all the researching into carpal hyperextension does not add up. I've palpated him and carefully observed his responses as I lower him to the ground and he is flinching when his toes come into contact with the surface. He's then reflexively relaxing his carpal joints to protect his phalangeal/metacarpal area. I think he's got something going on with the tendons or ligaments in that area and the apparent collapse of the carpus is an adaptive behaviour to prevent further stress on those areas while they heal. I just can't understand what is causing the problem in the first place, since it is now recurring bilaterally, rather than unilaterally as it showed up the first time. If it is indeed autoimmune then inflammation would be the driving etiological factor right? So I've started him on a small dose of ocortisone to see how this plays out. If it's bacterial in origin he may not respond to the steroids alone and could even get worse (I'm not setting the dose too high - I don't want to suppress the immune system too much, just enough to bring down the swelling). Then I will need to give him antibiotics. But if it's something else… gosh I really hate trial and error. I will update on this however (unlike the OP) because I see the value in this type of site only really helps anybody if we get to resolution, and I'd like to contribute to that.

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  12. Brief update: he's been on cortisone for a few days and no improvement.

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  13. My kitten has this problem. He was born feral to a litter of 7. He's the smallest and his mother was a small cat. She always brought us her babies but this time she brought them real early. They were flea infested and we bathed them all. After their eyes changed color my kitten started being real sweet so I started thinking of making him an inside cat. A few weeks later I noticed his front left paw was long. He never seems to be in pain. Of course after that he became an inside cat. He's been to the vet. He said Pedro had a dropped hoof? He only said when he gets older it may stiffen up. He acts like a normal healthy kitten. He shakes when he's relaxed or sleeping as someone else said. Sometimes he holds his foot up. He's only about 6 mos old and it isn't getting better or much worse. I feel so bad when I see him sitting with his bad foot.

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  14. Update on Marten: I tried him on hydrocortisone tablets 4mg twice daily for 2 weeks and no improvement. Going to have to try a different approach.

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  15. Thank you for posting this! I have been looking for answers too for a few months. I have a kitten of 10 months who had the same problem with her left paw. It started when she was 4/5 months old. The vet referred me to an orthopedic specialist, and he made her wear a plaster cast. She managed to keep it on for four weeks (with lots of struggle)... it was perfect after that. Until unfortunately the problem came back one week ago, I think due to excessive jumping since she has been in a different environment with lots of places to jump on/off and other cats to chase. She doesn't show discomfort, but I am also looking for answers and to find out if there is somebody who has experience with advantages/disadvantages of surgery since this seems to be a long-term recurring problem.

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  16. Thanks Aranka for your input. I will discuss plaster cast with my vet. I do not know about the success of surgical options, but it does seem extreme. Update on Marten: We tried him on Meloxicam (a feline anti-inflammatory analgesic) for a couple weeks to no avail. His blood glucose test for diabetes showed up normal. He has now been x-rayed, which showed some small bone spurs starting to grow in his carpal joints, that are not causal, but are a result of the hyperextended ligaments/tendons. My vet is still investigating possible causes, and the next step is to have a series of blood tests done. I'm waiting to claim back on insurance for this latest expense before moving forward. I will report back when I have further information. But for now all I can say is the problem occurred bilaterally when he made the transition from an indoor-only cat to becoming an indoor-outdoor cat. I'm caging him back in now to make sure he can't run around so much.

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  17. I would like to give an update since my cat miraculously cured... all over the course of 3-4 days. I saw a slight improvement in the stance of the wrist on day 1, and within 3-4 days it went from the worst it had been so far, to 95% normal. Then for 2 weeks after she was still lifting her leg when sitting so she might have had a slight discomfort. Since then, all looks 100% perfect. Ever since she developed the problem, we tried limiting her jumping, but since she is still so young she has been quite active (just an indoor cat, not locked up). How this could have happened? No idea. But the way it cured so fast makes me question the fact that her ligaments/tendons were damaged. I still have to tell the vet about her sudden 'cure', maybe he will have an explanation??
    For now i hope the problem will not come back another time.

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  18. Wow , so my dicky kitty 12 years old has a paw issue, that looks like carpal hyperextension, he is gimping around and it breaks my heart. Xrays were done and no abnormalities were spotted. I am assuming if it was a metastes to the digits coming form the lungs the bones on the xrays would have been abnormal?

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