Page 258 - Canine Lameness

230 15 Shoulder Region

and 15.9). Fractures close to the shoulder joint more commonly consist of scapular fractures.
Avulsion fractures of the supraglenoid tubercle (the origin of the biceps brachii) become more
obvious when performing a fully flexed view of the shoulder with the elbow extended, causing
greater displacement of the fracture due to the pull of the biceps tendon. Physical exam findings
usually reveal moderate to non-weight-bearing lameness, soft tissue swelling that may range from
minimal to severe, and significant pain on shoulder range of motion (ROM) and/or direct palpa-
tion of bony structures.
As a general note, it is important to realize that the shoulder can be a challenging joint to
isolate during manipulation and ROM, making it difficult to distinguish it from the elbow as
the source of pain. This caveat particularly applies for less painful conditions (e.g. osteochon -
drosis and mild arthritis), though it may also pertain when minimally displaced fractures are
present. When the shoulder is passively extended, the elbow also extends passively (Figure 15.6)
and while it is most convenient to flex the shoulder joint by grasping the antebrachium, this
approach simultaneously flexes the elbow. However, with conscious recognition of anatomy, it
is possible to eliminate flexion of the elbow by intentionally grasping the humerus when flexing
the shoulder joint.
Most fractures can be diagnosed with radiographs but scapular fractures can sometimes be
difficult to identify (Figure 15.5). Given the frequent traumatic nature of presentation, they may
first be identified on thoracic radiographs obtained during initial assessment and stabilization of a
traumatic patient. If the fracture is complex, a CT scan is valuable to clearly assess the extent of the
fracture as well as formulate therapeutic planning. Articular fractures and proximal humeral
fractures (including SH fractures) generally should be surgically stabilized. Minimally displaced
scapular body fractures are frequently amenable to external coaptation for management. Severely
comminuted fractures involving the articular surfaces may require arthrodesis.

(A) (B) (C) (C)
SHOULDER REGION

Figure 15.6 Physical examination of the shoulder: flexion of the joint to assess for a pain response
attributable specifically to the shoulder requires intentional isolation of the joints. This is best
achieved by (A) grasping the humerus and drawing it caudodorsally toward the body of the scapula,
rather than (B) grasping the antebrachium. Note that it is impossible to isolate the elbow from the
shoulder during extension, so that (C) passive extension of the shoulder joint results in passive
extension of the elbow.