Laurie's Blogs.

Hi Laurie,

Hope all is well with you. I have a tricky case and thought I would run it by you to get your opinion and what to be careful of. I assessed a Labrador last week with pain in the R shoulder and R front limb lameness. The pain has been off and on for months. The vet initially thought it was her neck, but x-rays were clear. She then thought it was the dog's shoulder, but is still not sure what is causing the pain and lameness. The owner reports she is lame one day and then fine the next. She is a very stoic dog and doesn't show pain unless it is bad. At one point the dog wouldn't bend down to eat out of her food dish and cried in pain, but that has been fine. There was an incident two years ago when the dog was tied on outside and she started crying in a lot of pain. The owner thinks she may have pulled really hard to run after something. They took her to the emergency vet, but they couldn't find anything.  

My assessment revealed pain and tenderness in the CT junction area on the R as well as muscle spasm throughout this area. She hesitates slightly to turn her head to the R. She had 80% shoulder range into extension, but full shoulder flexion. She resisted first with the flexion, but then allowed the movement into full range. The supraspinatus and biceps tendons were slightly thickened, but no real reaction on palpation. She did have increased pain with compression of the shoulder joint. She did yelp in pain when I palpated the 1st rib on both sides. The surrounding muscle on the R was thickened and in spasm. The R rib felt like it was sitting cranially. Quick neural scan was clear.

My conclusion is a 1st rib that is sitting cranial causing secondary muscle spasm. Just wondering if this would cause her to be lame in her R front limb? Also, the owner called me 2 days after the assessment and said her dog was a lot more lame than she had been and will only get up to go outside and then would just come in and lie back down. 

If it is all because of the 1st rib and it has been stuck for possibly 2 years, how would you suggest I proceed? Just the small amount of mobilization I did all ready on the 1st rib caused her to have increased lameness and pain. The dog appears to be in a lot of discomfort even though the owner doesn't think she has been in much pain. The whole time she was in the room for the assessment, even before we started, she was panting and restless. 

Thanks in advance!

Cheryl

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Hi Cheryl,

A couple of ideas.  So it could be first rib and C7-T1 and Medial shoulder compartment syndrome.  You would proceed with mobs away from the sore side and if too tender to play on Rib 1 much, then stretching / MFR of scalenes and just some gentle rubbing in and around the area + scapular mobilizations & nerve glides.  And shoulder mobs into extension + general medial-lateral glides in neutral.

However in the back of your head, I want you to think of Nerve sheath tumour.  It may take a neurologist to find it and/ or diagnostics that include CT/ MRI / Ultrasound - as it won't show otherwise.  I've been fooled by a case that sounds like this once before and have advised others (where the history was similar) - where the issue turned out to be the tumour.

You may want to plant that seed with the vet right away.  You could try treating, but let the vet know that if things don't improve quite quickly that you'll be sending it back with the concern of a neuroma.

Laurie