Page 1826 - Cote clinical veterinary advisor dogs and cats 4th

914 Shoulder Soft-Tissue Injuries

Behavior/Exercise with increased movement of the scapula and Client Education
Muscle strengthening exercises in the later limb circumduction. Any attempts of self-mutilation or malodor
VetBooks.ir Possible Complications PEARLS & CONSIDERATIONS return for a bandage change.
associated with bandages should prompt early
recovery period, avoiding abduction/adduction
• Reluxation with closed reduction or implant
• Amputation is contraindicated with bilateral
failure Comments SUGGESTED READING
Kunkel K, et al: A review of lameness attributable
• Infection shoulder instability or dysplasia. to the shoulder in the dog: part one. J Am Anim
• Traumatic or iatrogenic nerve injury • Shoulder support brace (Shoulder Stabiliza- Hosp Assoc 44:156, 2008.
• Mid-substance biceps tearing after tion System, DogLeggs) is ideal for external
transposition support of closed and open reductions. AUTHOR: Courtney Fitzpatrick, DVM, DACVS
○ Minimal morbidity allows for longer use EDITOR: Kathleen Linn, DVM, MS, DACVS
PROGNOSIS & OUTCOME ○ Temporary removal permits passive range-
of-motion therapy.
Closed and open treatment of traumatic cases
generally results in a good outcome, with resolu- Technician Tips
tion or only occasional lameness for the majority A Velpeau sling must be applied with great
of patients. Some degree of osteoarthritis is care to avoid neurovascular damage to the
anticipated. Excision arthroplasty and shoulder distal limb.
arthrodesis can result in acceptable function

Video
Shoulder Soft-Tissue Injuries Available Client Education
Sheet

BASIC INFORMATION PHYSICAL EXAM FINDINGS • Apply direct pressure over the insertion of
The key to diagnosing soft-tissue shoulder the supraspinatus tendon on the proximal
DEFINITION lameness is a systematic forelimb lameness medial humerus: pain response suggests
Injuries to the ligaments, joint capsule, and exam. Compare the affected forelimb with the supraspinatus tendinopathy.
tendons of the shoulder. These injuries are fairly unaffected one. Perform these tests with the dog • Palpate for medial to lateral and cranial to
common in dogs but tend to be underdiagnosed. awake and again under sedation; persistence caudal laxity, comparing shoulders.
of pain under sedation makes findings more • Abduction test: with the dog in lateral recum-
Synonyms compelling. bency and with the shoulder extended, abduct
Biceps tenosynovitis, supraspinatus calcifying • Palpate shoulder for swelling. the humerus. Excessive abduction compared
tendinopathy, supraspinatus tendinopathy, • Check position of the greater tubercle of the with the normal side suggests medial gleno-
collateral ligament tears, rotator cuff injuries humerus and the acromion process of the humeral ligament injury (see second Video).
scapula relative to each other. ○ Some toy breeds have bilateral medial
Epidemiology ○ Lateral shoulder luxation: greater tubercle instability, and there is not a normal
SPECIES, AGE, SEX is lateral to acromion. contralateral side.
Adult dogs of both sexes ○ Medial luxation: greater tubercle is medial
to acromion. Etiology and Pathophysiology
GENETICS, BREED PREDISPOSITION ○ If the shoulder joint is lax, the anatomic • Biceps and supraspinatus tendinopathies can
Most common in medium to large working landmarks may or may not be out of posi- result from acute injury or chronic repetitive
and sporting dogs; toy- and small-breed dogs tion, depending on whether the shoulder strain.
are prone to shoulder instability and luxation is in a reduced or luxated position. • Infraspinatus contracture is thought to start
secondary to glenoid dysplasia. • Extend and flex the shoulder (if it is grossly after an acute injury to the muscle, which
stable), being careful to minimize manipula- may create a compartment syndrome.
ASSOCIATED DISORDERS tion of the elbow. Check for a pain response, • Glenohumeral ligament tearing can be purely
Lameness (pp. 571 and 1249) and see if the shoulder can flex and extend traumatic or associated with conformational
in a straight line. tendency for instability/luxation (toy breeds).
Clinical Presentation ○ Infraspinatus contracture causes the
DISEASE FORMS/SUBTYPES humerus to be externally rotated. DIAGNOSIS
• Supraspinatus tendinopathy ○ Pain is a feature of many shoulder injuries,
• Biceps tendinopathy but a pain response may be absent even Diagnostic Overview
• Medial and lateral glenohumeral ligament with an injury. • Physical exam: key to diagnosis of all shoulder
disruptions • Isolated full flexion of the shoulder: fully flex problems; often makes the diagnosis of
• Subscapularis tendon tears the shoulder with minimal manipulation of infraspinatus contracture, gross instabilities,
• Infraspinatus myopathy, contracture the distal limb. Many patients with shoulder and luxations
discomfort show a response to this test and • Ultrasonography: useful for diagnosis of
HISTORY, CHIEF COMPLAINT not to other tests. myopathies, supraspinatus and biceps
Forelimb lameness is the primary complaint; • Flex the shoulder while slowly extending tendinopathies
may range from mild to non–weight-bearing the elbow: pain response suggests biceps • MRI (p. 1132): useful for diagnosis of tendi-
status tendinopathy (see first Video). nopathies and glenohumeral ligament tears

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