Shoulder

Question 1

Major differentials for shoulder lameness.

Answer 1

Caudal cervical lesions with nerve root compression
Brachial plexus tumour or neuritis
- Severe muscle wastage for tumour, mild neuritis
Occult thoracic limb lameness - medial Coronoid disease

Question 2

What does abduction of the shoulder test and what is the normal level of abduction?

Answer 2

Collateral ligament integrity

Normal 30 degrees max
Abnormal more than 50 degrees

Question 3

Where are common sites for enthesiophyte formation in the shoulder?

Answer 3

Bicipital bursa
Infraspinatus tendon (lateral collateral ligament)

Question 4

What does constrast arthography of the shoulder show?

Answer 4

Biceps tendon lesions
Capsular tears
OCD Fragments

Question 5

What is CT used to evaluate in the shoulder joint?

Answer 5

OA
OCD
Tendon calcification

Question 6

What can arthroscopy be used to investigate and treat?

Answer 6

OCD lesions
Glenohumeral ligament tears
Biciptal tendon tears

Question 7

What are the options for managing shoulder OCD?

Answer 7

Conservative treatment - NSAIDs and rest
- to see if the cartilage will detach - may lodge in weight bearing area and cause more severe lameness

Surgical - open / arthroscopy

• remove osteochondral flap
• debridement of the bone

Question 8

How should you manage glenohumeral ligament tears?

Answer 8

Conservative - rest, NSAIDs and time
- sling

Intra-articular corticosteroids - 50% response rate

Surgical techniques to increase the stability of the joint capsule

• thermal capsulorrhapy
• prosthetic capsulorrhapy
• subscapularis imbrication
• arthroscopic sutures

Question 9

How can you treat biceps tendon tears / chronic inflammation?

Answer 9

Conservative - rest, anti-inflammatories and time

Surgical - bicepital tenotomy

Question 10

What post operative care should be provided for a patient following shoulder surgery?

Answer 10

Complete rest of the shoulder joint capsule for 8w
Jacket that acts like a sling
Gradual return to activity
Hydrotherapy

Question 11

Differentials for disease of the shoulder.

Answer 11

Congenital luxation and dysplasia
OCD = common
Glenohumeral ligament (CL) tears = common - instability
Subscapularis tears
Biceps brachii rupture, avulsion or displacement
Bicipital tenosynovitis
Infraspinatus and supraspinatus contracture
Luxation
Fractures
Brachial plexus tumour - muscle atrophy +++