Shoulder Flashcards
What is the typical signalment of shoulder OCD?
- biphasic age distribution: young (cartilage injury), mature (DJD)
- male
- large to giant breeds
Describe the physical exam findings of a dog with shoulder OCD
- forelimb lameness (head bob, muscle atrophy)
- pain on hyperextension and flexion of shoulder joint
What are the indications for conservative management of should OCD?
- small defect
- minimal to no lameness
- young dogs
How can shoulder OCD be managed conservatively?
- rest
- diet: control energy, vitamin D, and Ca intake
- NSAIDs
Describe the typical surgical procedure done for shoulder OCD
- flap removal and lavage
- debridement of bone
- defect heals with fibrocartilage
What is the prognosis for a dog with shoulder OCD?
- good to excellent with surgery (fair to good for working dogs)
- DJD expected (mild with surgery)
Describe the pathogenesis of biceps brachii tendinopathy
- repetitive strain microtrauma
- tendon fiber disruption
- acute to chronic inflammation of tendon and associated synovial tissue
Describe the anatomy of the biceps brachii tendon
- origin: supraglenoid tubercle
- travels through intertubercular groove
- contained by transverse retinaculum
- insertion: proximal-medial radius
What is the typical signalment/presentation for biceps brachii tendinopathy?
- adult, median to large breeds
- weight bearing lameness
- chronic, intermittent
Describe how you would assess pain in a patient with biceps brachii tendinopathy
maximally flex shoulder and extend elbow - deep palpation over intertubercular groove - apply tension to biceps insertion standing exam - palpate insertion of tendon - pressure applies tension to biceps
How is acute biceps brachii tendinopathy treated?
- confinement
- NSAIDs
- physical therapy
How is recurrent/persistent biceps brachii tendinopathy treated?
- intra-articular corticosteroid injections
- strict confinement
- physical therapy
What are the indications to surgically treat biceps brachii tendinopathy?
- refractory to medical treatment
- radiographic changes
- mechanical deficits
- moderate to severe lameness
What surgical procedures are used to treat biceps brachii tendinopathy?
- tenotomy of biceps tendon
- tenodesis of bicipital tendon
Describe the pathophysiology of shoulder intability
- abnormally increased range of motion
- laxity in support structures of the shoulder
- repetitive microtrauma
What are the physical exam findings of a dog with shoulder instability?
- muscle atrophy
- pain on joint manipulation
- medial: increased abduction angle (50 degrees)
What is the treatment for moderate shoulder instability?
- arthroscopic thermal capsulorrhaphy
- rest, PT, hobbles
What is the treatment for severe shoulder instability?
- medial glenohumeral ligament reconstruction
- velpeau sling
Define contracture
muscle shortening not caused by active contraction
Describe the pathogenesis of infraspinatus contracture
- acute, traumatic disruption of muscle fibers
- fibrosis and contracture secondary to necrosis
- non-painful, non-weight bearing lameness
- acute lameness subsides, then chronic lameness appears
What is found on physical exam of a dog with infraspinatus contracture?
- elbow adducted, antebrachium abducted
- scapula elevates when shoulder is rotated
- limited range of motion
- usually no pain on manipulation
How is infraspinatus contracture treated?
- tenectomy of infraspinatus tendon
- release of other capsular adhesions
- physical therapy
What is found on physical exam of a dog with traumatic shoulder luxation?
- non-weight bearing lameness
- pain on shoulder palpation
- malpositioning of greater tubercle
- M luxation: limb abducted
- L luxation: limb adducted
How is traumatic shoulder luxation treated?
- closed reduction (recent injury, no fractures)
- open reduction + ligament repair
What is the typical signalment for congenital shoulder luxation?
- small, toy breeds
- 3-10 months of age
How is congenital luxation treated?
- open reduction/capsulorrhaphy
- glenohumeral ligament reconstruction
- if glenoid dysplasia - salvage procedures
