Traumatic Carpal Hyperextension in Dogs: Surgical vs. Conservative Management

Ah Young Kim
Oct 3
2 min read

Why This Injury Is Challenging

Traumatic carpal hyperextension is one of the difficult injuries to manage in canine sports medicine and orthopedics. The challenge lies in the carpus’ inherently poor soft tissue healing capacity and the need to tailor treatment to multiple factors:

Location of instability: antebrachiocarpal, intercarpal, carpometacarpal, or extra-articular (e.g., FCU avulsion)
Severity of instability
Chronicity (acute vs. chronic presentation)
Patient temperament and lifestyle
Owner’s ability to manage long-term care

Traditional Management: Arthrodesis

Historically, the gold standard has been arthrodesis, either:

Pancarpal arthrodesis (PCA) – the most common, but removes all active range of motion (aROM). Even in successful cases, secondary consequences are common (digit deformity, altered shoulder mechanics, compensatory gait patterns).
Partial carpal arthrodesis (PCAr) – preserves some carpal range of motion if instability is isolated to mid-carpal or carpometacarpal joints, but technically demanding.

Bottom line: Arthrodesis is a salvage procedure. When it fails, outcomes are poor.

Conservative Management: Orthosis and Biologics

With the growth of sports medicine, custom orthoses are increasingly considered.

In my personal experience (10–15 cases), 2 dogs achieved full recovery of normal carpal angle and function after 9–10 months of strict orthosis use (24 hours/7 days wear) combined with regenerative therapies such as PRP and shockwave. And these dogs are no longer using the braces currently.
The majority used orthoses palliatively (for comfort during walks, activity support).

Key insight:

Acute cases with good healing potential but no mechanical support → fail.
Chronic cases with mechanical support but poor healing potential → fail.
Right timing + mechanical stability + biological stimulation + owner/dog compliance → success.

Counseling Owners

For every acute hyperextension case, I spend at least an hour counseling owners:

What orthosis management really involves (24/7 wear, skin checks, maintenance).
The uncertainty and long timeline (≥9 months).
The fact that failure → arthrodesis remains an option.
Owner dedication and patient temperament are as important as the device itself.

Where Do We Stand?

We don’t yet know the “best” treatment.
Arthrodesis remains the most predictable and commonly performed.
Orthosis-based management is not a quick fix—but for the right dog, with the right owner, it may restore near-normal function.
Veterinary medicine is evolving, and so is our understanding of conservative management for this injury.

Remaining Question?

Carpal hyperextension injury is induced by mechanical injury to the soft tissues around the carpus, but it can also occur when there is reduced activation of the carpal and digital flexor muscles (e.g., after immobilization of the carpus in young dogs).
During conservative management, it can be difficult to differentiate whether persistent hyperextension is due to the original injury or to weakness of the carpal/digital flexors and extensors. Normal carpal stability requires co-contraction of flexors and extensors to maintain the functional carpal angle.
Even in normal dogs, physiologic carpal hyperextension is observed when they jump down or when running. So, what do we really know about this injury—and how the body works?