Sx Diseases of the Shoulder Objectives Flashcards
Describe the typical presentation for OCD of the shoulder in the dog
Young, male, large/giant breed dog
Either 4-8 months or middle-age to old
Forelimb lameness (head bob-down on the sound), muscle atrophy
Pain on hyperextension and flexion of shoulder
Why might a dog with bilateral OCD only appear lame on one side?
One side could be worse, and it is disguising the other side
How do you diagnose OCD of the shoulder?
Radiographs- will see flattening of the caudal humeral head
When is conservative management appropriate for OCD of the shoulder?
If animal is young, defect is small, and there is no/minimal lameness
What are the typical recommendations (medical vs. surgical) for
OCD of the shoulder?
Medical: rest, diet control, NSAIDs
Surgical: The STANDARD OF CARE!
Flap removal and joint lavage with bone debridement
What is the prognosis for OCD of the shoulder?
Pet dog: Good to excellent
Working dog: Fair to Good
What is the typical pathogenesis of biceps brachii tendinopathy in the dog?
Repetitive strain microtrauma→
injury with tendon fiber disruption→
Acute AND chronic inflammation of tendon and synovial tissues
Typically UNILATERAL
What is the typical presentation of biceps brachii tendinopathy in the dog?
Older adult dog, Medium or large breed
Weightbearing lameness that is chronic, intermittent, and progressive
Lameness worsens with exercise and is unilateral
Muscle atrophy
Pain when shoulder is maximally flexed and elbow is extended
Pain when standing under load due to tension to biceps
Pain with palpation of proximal medial radius (insertion of tendon)
Why is pain elicited when shoulder is maximally flexed and elbow is extended in a dog with biceps brachii tendonopathy?
This results in deep palpation over the intertubercular groove,
which is where the tendon runs,
as well as tension to the biceps insertion on the proximal medial radius
What is the value of “standard” craniocaudal and lateral radiographic views
in relation to diagnosis of Biceps Brachii Tendonopathy?
These standard views rule out other diagnoses (like osteosarcoma)
What is the value of using Ultrasound in diagnosis of
Biceps Brachii Tendonopathy?
It is non-invasive,
but requires experience and is less accessible
What is the value of using MRI in diagnosis of
Biceps Brachii Tendonopathy?
It provides the cross-sectional anatomy of all soft tissues, so it can
identify any concurrent problems
But over/underinterpretation is possible
What is the value of using Arthroscopy in diagnosis of
Biceps Brachii Tendonopathy?
Arthroscopy is both DIAGNOSTIC AND THERAPEUTIC!
Best method, when used in conjunction with standard rads
How would you treat ACUTE Biceps Brachii Tendonopathy?
Confinement for 4 - 6 weeks
NSAIDs
Physical therapy
How would you treat PERSISTENT/RECURRENT
Biceps Brachii Tendonopathy lameness non-surgically?
Intraarticular corticosteroid injection (Methylprenisolone acetate)
Strict confinement (4 - 6 weeks)
Physical therapy
What are the indications for surgical treatment of
Biceps Brachii Tendonopathy?
Refractory to medical tx
Radiographic changes seen
Mechanical deficits are present
Moderate to severe lameness present
How is Biceps Brachii Tendonopathy treated surgically when indicated?
Tenotomy (cut) or
Tenodesis (fix)
of the bicipital tendon
What is the prognosis for Biceps Brachii Tendonopathy
and how does prognosis relate to treatment?
Medical tx: Good to poor
Surgical tx: Good to excellent
Prognosis for Tenotomy vs. Tenodesis: Both have similar success rates!
What is the definition and etiopathogenesis of shoulder instability?
Definition: Abnormally increased ROM of the shoulder
Pathogenesis: Repetitive microtrauma (overuse injury)
What are the support structures of the shoulder?
Glenohumeral ligaments (medial and lateral)
Joint capsule
Subscapularis tendon (medial)
Teres minor (lateral)
Supraspinatus and Infraspinatus (lateral)
What is the most common direction of shoulder instability?
MEDIAL
What is the typical signalment and history of a dog with shoulder instability?
Medium/Large breed adult dog
Active with variable lameness (subtle, intermittent)
and poor response to rest and NSAIDs!
What are the tests that may be used during orthopedic exam to detect shoulder instability?
Awake exam: Palpation and manipulation = pain
Sedated exam: Medial instability = increased abduction angle!
How is the sedated exam interpreted for a dog with
shoulder instability?
For medial instability, abduction angle:
Normal = 30 degrees
Abnormal = 50 degrees
Must compare to contralateral limb
What imaging techniques are used to diagnose shoulder
instability?
Radiographs (to rule out other conditions)
Arthroscopy (BEST for evaluating joint, therapeutic AND diagnostic!)
which modality is best for evaluating joints for shoulder instability?
ARTHROSCOPY
How is MILD shoulder instability treated?
Rest, PT, and Hobbles
How is MODERATE shoulder instability treated?
Arthroscopic thermal capsulorrhapy +
Rest, PT, and Hobbles
How is SEVERE shoulder instability treated?
Medial Glenohumeral Ligament Reconstruction (MGHL) +
Rest, PT, and VELPEAU sling (not hobbles!)
What is the definition of muscle contracture?
Abnormal muscle shortening not caused by active contraction
What is the pathogenesis of infraspinatus contracture?
Acute traumatic disruption of muscle fibers
leads to
fibrosis and contracture secondary to necrosis
Describe the pathognomonic stance of a dog with infraspinatus contracture
Elbow tucked close to body with the arm (antebrachium)
held up and away from body (abducted)
An active adult hunting dog presents to you
with a history of acute lameness that lasted about 2 weeks and then subsided for about a month before it presented again.
On physical exam, dog has nonpainful nonweightbearing lameness
and looks like he can’t put his paw or arm down.
What is your primary differential?
Infraspinatus contracture!
Is conservative treatment helpful in cases of infraspinatus contracture?
NO! Surgery is the ONLY option!
What surgical treatment is indicated for
Infraspinatus contracture?
Tenectomy of the infraspinatus tendon
Physical therapy post-surgery is essential
What is the prognosis following surgery for infraspinatus contracture?
Excellent!
Describe the palpation findings in a dog with
traumatic shoulder luxation
Non weightbearing lameness with pain upon shoulder palpation
Palpation reveals malpositioning of the greater tubercle
What limb position would you see in a dog with
medial traumatic shoulder luxation?
Distal limb is ABducted (held out and away)
What limb position would you see in a dog with
lateral traumatic shoulder luxation?
Distal limb is ADDucted
and greater tubercle is more prominent
Describe the nomenclature of traumatic shoulder luxation
Named for the position of the humeral head relative to the glenoid
What is the most common direction of traumatic shoulder luxation?
MEDIAL
What are the indications for closed reduction of traumatic shoulder luxation?
A recent injury with NO fractures and joint is STABLE
Which form of coaptation is required after closed reduction of a
medial shoulder luxation? Why?
Velpeau Sling
Takes tension off the medial aspect of the joint and holds it in place
Which form of coaptation is required after closed reduction of a
lateral shoulder luxation?
Splica Splint
Maintains limb in standing position
Which form of coaptation is required after closed reduction of a
cranial or caudal shoulder luxation?
Splica Splint
What are the indications for surgical reduction of a
traumatic shoulder luxation?
If luxation is chronic, recurrent, or unstable
If there are accompanying fractures
What is involved in surgical reduction of a traumatic shoulder luxation?
Open Reduction + Glenohumeral Ligament Repair
- Simple arthrotomy
- Imbrication/repair of capsule
- Glenohumeral ligament reconstruction (GHL)
Medial GHL repaired for medial luxation
Lateral GHL repaired for lateral luxation
What is the expected functional outcome following shoulder luxation
Good to excellent for open and closed!
What is the most common direction of congenital shoulder luxation?
MEDIAL
What is the signalment and history of the
typical dog with congenital shoulder luxation?
SMALL and TOY BREEDS! (YOUNG!)
3 - 10 months old
Also: Shetland Sheepdog, Collie, Elkhound
History: minimal or no trauma reported, chronic lameness beginning at early age, and lameness may be intermittent
How is does congenital luxation present differently from
traumatic luxation on PE?
Both: Greater tubercle is medial to glenoid in medial luxation and lateral in lateral luxation
Traumatic- PAIN present on manipulation
Congenital- Pain minimal or not present at all on manipulation
What is glenoid dysplasia and how does it relate to
congenital shoulder luxation?
Glenoid Dysplasia refers to an abnormality in the development of the glenoid portion of the scapula (the socket bone of the shoulder joint).
What are your treatment options for congenital shoulder luxation
if there is glenoid dysplasia?
Can only do a SALVAGE procedure:
Arthrodesis (fusion of joint with tons of screws)
or
Glenoid excision (removing glenoid) *best*
Outcomes similar, but excision less challenging
How is congenital shoulder luxation treated surgically
if the glenoid cavity is normal?
Similar to traumatic luxation:
Open reduction/capsulorrhapy
Glenohumeral ligament reconstruction
