Ch. 49-50: Shoulder & Scapula

Question 1

Jones VCOT 2019 PQ?

Measurement of shoulder abduction angles in dogs: an Ex Vivo study of accuracy and repeatability

• inter-obs repeatability?
• intra?
• what two factors increased abduction angle? what were the angles?

Answer 1

Inter-observer repeatability was poor, with all 3 observers having different abduction measurements

Intra-observer repeatability indicated no differences on repeated measurements

Placing the shoulder at a neutral standing angle, and transection of support structures caused an average increase in abduction by 8.2 degrees and 4.4 degrees respectively

Question 2

Livet VCOT 2019 PQ?

Stress radiography for the diagnosis of medial glenohumeral ligament rupture in canine shoulders

• difference b/w abduction in affected vs. normal shoulders?
• angle difference?
• intra/inter observer agreement?

Answer 2

Abduction angles were significantly larger in the AS (affected shoulder) group as measured by goniometer, image analysis, and radiographic stress view than the NS group

The abduction angle difference varied from 12-29.3° (median difference 19.4) between NS and AS groups

There were good intra-observer and very good inter-observer agreements

Question 3

Gemignani VRU 2023

Pilot study of the ultrasonographic examination of the intact and transected medial glenohumeral ligament in dogs

• % ligaments ID’d on US?
• could US dx transected ligaments?
• difference in thickness of transected vs. not?
• articular space transected vs. not?
• space wider than ___mm suggested of medial instability?

Answer 3

67% of medial glenohumeral ligaments were correctly identified during the preliminary study.

Ultrasonographic examination failed to diagnose the transection of all six medial glenohumeral ligaments in the second part of the study.

No difference was observed in the ligament thickness between the dogs with and without a transected medial glenohumeral ligament.

Dogs with a transected medial glenohumeral ligament had a wider articular space compared to dogs without a transected ligament, and an articular space wider than 8.2 mm was discriminatory of a transected medial glenohumeral ligament in all the shoulders

Question 4

Powder VCOT 2023

Age and Sex Comparison of the Canine Supraspinatus Tendon Using Quantitative Magnetic Resonance Imaging T2 Mapping

Answer 4

For every increased year of age, a reduction of -1.56 + 0.47 milliseconds was identified w/ qMRI

There was no significant differences of curve patterns b/w sexes

Reduction in T2 w/ age suggests a senescent change is anticipated w/ canine supraspinatus tendons

Question 5

Carwardine JSAP 2019

Feline shoulder luxation: a cadaveric study of injury and repair using ligament prostheses

• methods of injury?
• difference in ROM?
• % medial fix deemed stable?
• % lat stable?
• % bilateral?

Answer 5

3 methods of injury: medial, lateral, bilateral

No difference in joint ROM between intact and repaired joints

4/6 (66%) medially injured joints were deemed clinically stable and 5/6 (83%) laterally injured joints deemed clinically stable

All bilaterally injured joints were deemed unstable

Question 6

Abbey JSAP 2021

Prevalence of mineralization of the tendon of the supraspinatus muscle in non-lame dogs

• % mineralization?
• size dogs? uni vs bilateral?

Answer 6

Mineralization detected in 4%

Medium to large breeds were affected, left forelimb (unilateral) in all cases

Question 7

Hammer JSAP 2021

Inverted V-shaped extracapsular stabilization technique and arthroscopic findings in 6 dogs with medial shoulder instability

• which 2 structures most commonly affected?
• cartilage damage?
• Implant complications?
• Functional outcome?
• look at scope pics Poss PQ *

Answer 7

The subscapularis tendon & medial glenohumeral ligament were the structures most commonly affected.

All dogs had pathologic cartilage fibrillations

Implants successfully placed in all dogs. Implant loosening occurred in 2/6 dogs (33%) but no revision sx required & both had successful mid-term outcomes.

Function at the time of last follow-up (median, 28 mo) was full in 4/6 & acceptable in 2/6 dogs.

Question 8

Llido VCOT 2023

Treatment of Medial Shoulder Joint Instability (MSI) by Stabilization with an Arthroscopically Guided Prosthetic Ligament: A Cadaveric Feasibility Study in Dogs

• procedure?
• successful repair?
• abduction angles pre vs post op?

Answer 8

Ligamentoplasty was performed arthroscopically using threaded sutures and a bone anchor on the medial aspect of the glenoid cavity, passed through a humeral bone tunnel and then tensioned w/a suture button on the lateral aspect of the humerus

Surgical repair was confirmed in 10/12 shoulders (2 anchors tore off at postop rads)

Abduction angles were not significantly different postop (20 + 3.7 deg) from preop (22.8 + 2.9 deg)

Question 9

Vezzoni VCOT 2021

A modification of the Cheli Craniolateral Approach for minimally invasive treatment of osteochondritis dissecans of the shoulder in dogs: description of the technique and outcome in 164 cases

• technique?
• % seroma formation?
• conclusion?

Answer 9

dog in lateral recumb w/ shoulder hyperflexed & elbow hyperextended → 1-1.5cm skin incision along craniolateral aspect of shoulder- midway btwn cranial edge of acromion & proximal greater tubercule (red line) → blunt separation of intermuscular septum b/w caudal edge of supraspinatus and acromial head of deltoid → Gelpi for visualization → JC incised in proximal to distal plane → reposition Gelpi in joint (careful of lateral collateral)

• 1.2% seroma *
• Conclusion: Reliable approach & can be considered for surgical tx of shoulder OCD as alternative to other approaches or arthroscopy.*

Question 10

Phipps VSURG 2023

Functional outcomes of dogs undergoing shoulder arthrodesis with 2 Locking Compression Plates

• lameness scores?
• functional recovery?
• % complications?

Answer 10

12 dogs, undergoing shoulder arthrodesis using 2 LCPs as principal method of fixation.

Lameness scores decreased post-op from 2.9 to 0.8

11/12 (92%) dogs making a full functional recovery

16% minor complications, no major

Question 11

PQ Paper on difference in the abduction angle under sedation in the normal compared to the affected joint

Answer 11

Livet VCOT 2019?
The abduction angle difference varied from 12-29.3° (median difference 19.4) between NS and AS groups

Question 12

Franklin VSURG 2013 PQ

Outcomes Associated With Treatments for Medial, Lateral, and Multidirectional Shoulder Instability in Dogs

Tx and prognosis? PQ

Answer 12

MSI most common

• Tx cohorts were defined as nonsurgical management, radiofrequency-induced thermal capsulorrhaphy (RITC), or shoulder reconstruction.
• Dogs with MSI treated by reconstruction were more likely than dogs treated without surgery to have a successful outcome (OR 3).
• Similarly, treatment of MDI with reconstruction was more likely to be associated with a successful outcome than nonsurgical management (OR 5).

Success with surgical and nonsurgical management was equivocal between LSI treatment cohorts, but the number of dogs with LSI was small.

Complication rates for all treatment cohorts were <10%.

Question 13

Kulendra VCOT 2019 PQ

Outcome of supraglenoid tubercle fractures in 12 dogs

• methods of stabilization?
• overall success? PQ
• % success comminuted?
• % success simple?
• % major complications?

Answer 13

Methods of stabilization included pin and tension band wire (5) lag screw (2), plate fixation (2), fragment removal (2) and conservative management (1)

• Overall success rate 9/12 (75%) *

4/6 (66%) with comminuted successful, 5/6 (83%) with simple were successful

Major complication rate 2/12 (16%) both were comminuted