SA MSK Conditions of Scapula, Shoulder, Humerus

Question 1

Fractures of the scapula.

Answer 1

Body/blade/spine:
- Can tx conservatively if minimal displacement, consider repair if widely displaced.
Glenoid:
- Articular fractures so repair is recommended.
Supraglenoid tuberosity:
- Biceps tendon origin so repair as avulsion fracture or remove fragment.

Question 2

Conditions of the shoulder.

Answer 2

Dislocation - congenital / acquired.
Inflammatory - OCD/OA/Sepsis.
Musculotendinous and ligamentous - infraspinatus contracture, bicipital tenosynovitis, medial displacement of the biceps brachii tendon.

Question 3

1. Aetiology of shoulder luxation.
2. Pathogenesis of shoulder luxation.
3. Signalment of shoulder luxation.

Answer 3

1. Congenital.
   Acquired - following trauma – RTA / dog fight etc.
2. Congenital - never articulates so joint does not develop properly.
   Acquired - traumatic – rupture of collateral ligaments etc.
3. Congenital - often small breeds.
   Traumatic - any, whippets predisposed (racing).

Question 4

Clinical signs of shoulder luxation.
Dx of shoulder luxation.

Answer 4

Lame w/ shortened stride.
Congenital - lameness may be mild/missed.
Palpable abnormal anatomy.
Reduced ROM and pain / crepitus around the shoulder.
Dx w/ imaging orthogonal views / CT.

Question 5

Tx options for shoulder luxation.

Answer 5

Congenital:
- none.
- trans-articular pin.
- excision.
- arthodesis.
Acquired:
- Closed reduction.
– Spica splint (lateral luxation).
– Velpeau sling (medial luxation).
- Open reduction and…
– prosthetic sutures.
– tendon transposition.

Question 6

1. Shoulder osteochondrosis aetiology.
2. Shoulder osteochondrosis pathogenesis.
3. Shoulder osteochondrosis signalment.

Answer 6

1. Hereditary/nutritional.
2. Fissuring and detachment of flap of cartilage.
   Caudomedial humeral head.
3. Giant breeds and border collies, 4-8m.

Question 7

Clinical signs of shoulder osteochondrosis.

Answer 7

Gradual onset, chronic lameness.
Shoulder muscle atrophy.
Pain on shoulder extension (flexion).

Question 8

Dx of shoulder osteochondrosis.

Answer 8

Imaging - radiography:
– mediolateral views of both extended shoulders.
– supinated or pronated views if lesion medial or lateral.
– subchondral defect with flattening of the caudal humeral head.
– mineralised cartilage flap or joint mouse.
– DJD.
– arthroscopy may be useful.
– generally bilateral even if not bilaterally lame.
- CT.

Question 9

Shoulder osteochondrosis tx.

Answer 9

Conservative:
- for small (<1cm =) or non clinical lesions.
- rest for 4w and NSAIDs.
Surgical:
- arthroscopy.
- arthrotomy.
- chondrectomy and debridement.
Post op:
- rest and NSAIDs for 4w.

Question 10

Complications and px of shoulder osteochondrosis.

Answer 10

Complications:
- failure to remove whole flap.
- seroma formation (10%).
Px:
- generally excellent in 90% of cases.
- worse for large lesions and chronic problem.