Thoracic Limb Flashcards
What is the function of the rotator cuff in dogs
Prevents subluxation
What are the active/ dynamic stabilizers of the shoulder
- Subscapularis m
- Biceps tendon
- Suprapinatus
- Infraspinatus
- Teres minor
What are passive stabilizers of the shoulder?
- Joint capsule
- Medial glenohumeral ligament
- Lateral glenohumeral ligament
What are the primary stabilizers of the shoulder joint
- Glenohumeral ligaments
What direction does the biceps tendon provide stability during joint extension
- Medial stability
What is another function found in the medial GH ligament
- Has lots of mechanoreceptors for propioception
What is osteochondritis dissecans (OCD)
- A devitalized portion of articular cartilage on the head of the humerus. Should be surgically removed
What are examples of shoulder disease
- Glenoid fragmentation
- Luxation or dysplasia
- OA
- Trauma
- Neoplasia (bone, synovial, nerve root) - want to rule this out
- Neuro dz - neck disease can mimic forelimb disease
A dog walks in with a flexed and caudally deviated elbow. what is your primary differential?
Infraspinatus contracture
What should you look for on a standing forelimb palpation?
- Cervical spine and muscles
- Muscle symmetry
- Trigger points and tightness
- Elbow thickening
- Conscious propioception
- Biceps stretch test (flex shoulder and extend elbow, followed by palpating tendon)
What would a biceps tendon rupture present?
Elbow can be completely extended
What are examples of medial shoulder instability?
- Rotator cuff injury
- Damage to subscapularis tendon or medial GH ligament
What are causes of medial shoulder instability?
- Overuse/ repetitive injury
- Jumping, slipping, landing in ABduction
- Rarely traumatic
How do medial shoulder instabilities present themselves?
- Refuse tight turns
- Show weight-bearing lameness – short stride, worse after exercise, minimal response to rest + NSAID
How do you diagnose medial shoulder instability?
- Shoulder palpation
- Pectoral m spasm
- supra/ infraspinatus muscle atrophy
- Decreased range of motion on extension
- +/- Discomfort on abduction
- Abduction angle > 50 when in lateral recumbency
- Can refer for arthroscopy
What is a normal shoulder joint abduction angle?
- = 35 degrees
- not accurate in dogs < 15 kg
- Usually unilateral
What is a abnormal shoulder joint abduction angle?
- > /= 50 degrees
** not accurate in dogs < 15 kg
What is the preferred diagnostic for medial shoulder instability
Arthoscopy
How is mild medial shoulder insatbility defined and treated?
- Inflammation without fraying, diruption, laxity
- Slings or hobbles (keep them in for 4-6 weeks, only take off when in rehab)
- Can use laser too
- Timeframe 2-4 months
How is moderate medial shoulder insatbility defined and treated?
- Disruption and fraying of subscapularis tendon +/- medial GH ligament joint capsule
- Treat with radiofrequency (heats tissue, becomes stronger as it cools down) or imbrication
- Treat with hobbles for 3-4 months
- 4-6 months of intense rehab
How is moderate severe shoulder instability defined and treated?
- 65 - 90 degree abduction with complete rupture of medial support tissue
- Needs to be reconstructed
- NWB in sling for 2 weeks
- Hobbles for 3 months after
- Rehab for 6 months
What is the most common population for biceps tendinopathy?
- Medium-large breed adult active dogs
What is the presentation for biceps tendinopathy?
- Chronic intermittent lameness
- Worse after exercise
- Non-responsive to NSAIDS
- Associated with elbow disease
- Can also occur secondary to supraspinatus tendon
- More likely to be injured because it crosses two joints
How do you treat biceps tendinopathy?
- Surgery (can help but adhesions form long-term)
-
What therapies should be addressed for shoulder tendinopathies?
- Pain relief
- Stimulate tissue healing (takes long time, > 6 months)
- Collage fiber reallignment (eccentric)
- Controlled return to function
What is the presentation for Supraspinatus tendinopathy?
- Active medium-large breed dogs
- Repeat stress on tendon (eccentric loading on stretched muscle)
- Presents as chronic weight-bearing lameness
- Non-responsive to NSAIDS
- Worse after exercise
What are findings on PE that indicate Supraspinatus tendinopathy?
- Function is to extend shoulder. Flexing elbow allows differentiation between biceps and SS dz
- Supraspinatus atrophy
- Pain on shoulder flexion especially with pressure on insertion point
- Decreased muscle girth
- Decreased ROM
- On rads, mineralization is noted on supraspinatus
What are surgical therapies for supraspinatus tendinopathy?
- Removal of mineralized regions
- Longitudinal incision
- Tenectomy of SS
What are non-surgical therapies for supraspinatus tendinopathy?
- Shockwave
- Stem cell
- Rehab (eccentric training, neuromuscular training - prevents further injury)
- Activity avoidance that may predispose dogs to this condition (jumping off things, etc)
What dog is the poster child for elbow dysplasia?
Bernese Mountain Dogs
What is a common presentation for fragmented coronoid process
- Acute jump-down procedure
What is BURP
- Biceps ulnar release procedure
- Releases biceps tendon attachment to coronoid process
What are treatment options of elbow medial compartment disease?
- Surgery (arthroscopy
- Multimodal OA management
- Rehab
- Regenerative medicine
- Remember shoulder and compensation in rest of the body (biceps and long head of triceps connect elbow to shoulder)
What are clinical signs noted with elbow osteoarthritis?
- Cartilage erosion, periarticular fibrosis, decreased ROM, pain
What are treatment options for elbow osteoarthritis?
- Weight loss
- Laser
- ESWT
- UWT
- Massage
- NSAIDs
- Omega 3s
- Acupuncture
What is the common presentation for carpal hyperextension injury?
Large sporting dogs
- Usually secondary to a fall
What anatomic damage causes signs of carpal hyperextension?
- Tear in palmar fibrocartilage and short ligaments
- Avulsion and chip fractures also common
How can you diagnose carpal hyperextension?
- Palpate carpus
- Stress radiographs
How can you treat mild carpal hyperextension?
- Support and rehab
How can you treat severe carpal hyperextension?
- Arthrodesis and external coaptation
What is a common presentation of a superficial digital flexor rupture?
- Toes appear dropped
- This is due to tendon inserting on P2
What is a common presentation of a deep digital flexor rupture?
- Toes appear pulled up
- This is due to tendon inserting on P3
