Foreleg lameness painful teres major

[Nancytp]

I just saw a 2 yr old field trial intact male lab with a 10 month LF forelimb lameness. Owner has continued to train the dog but feels he is just off on the leg. Thinks may be worse after exercise. Never carries the leg but off loads.

He has trouble holding still put on palpation a think there is mild discomfort on the medial compartment of the left elbow. No pain on hyperextension of the shoulder but cries on palpation of the teres major. What concerns me is that he has supraspinatus and infraspinatus m on the same leg. Visable from anterior chest and 2 cm different measurement. The spine of the scapula is more easily palpable. If he wasn't so heavily muscles on the other side I wouldn't call it atrophy.

I wouldn't except that with a teres major injury. Does he need advanced imaging or do you see that atrophy after a 10 month duration?

Nancy Peterson, DVM CCRT, CVA, CVSMT
Pawsitive Strides Veterinary Rehabilitation & Therapy
Des Moines, Iowa

[lehughes]

Hi Nancy!

So this doesn't sound like your typical Teres Major case or Medial Elbow compartment case.

What gives me the greatest concern is the atrophy you describe... that is always a red flag for me. And makes me think of a nerve sheath tumour. So keep that in the back of your head.

But, since that is not a recoverable condition, let's focus on the Teres Major. The first dog I ever found it on was a boxer who had substantial atrophy of his shoulder muscles and leg, had been lame for several months - was a bit of a wiggly nut-bar as well, and had the most painful Teres Major I have ever found (mind you it was my first one, so I perhaps didn't ease into palpation like I could have... ).
I treated with stretches, ultrasound (as I didn't have a laser at the time), acupuncture, and relative rest. He recovered. Try focussing on treating the Teres Major (yes, double check the neck and cranial thorax, and shoulder)... but try a few (i.e. 3) treatments directed at the Teres Major and see. Cross your fingers.

If that doesn't change anything, then imaging might be in order.

Best of luck!

Laurie

[David Lane]

The age and history puts primary elbow disease highest on my rule out list, with secondary "shelbow" muscular issues appearing in the shoulder... Is there any reduction in elbow flexion, even without pain? Based on the history, I would be pushing for an elbow CT, and include the shoulders as well at the same time, but this sounds all the world like an elbow case to me.

[Nancytp]

I have started laser, acupuncture stretches, e stim and most difficult for the owner no field training!
He is off-loading less than before but I only have him for 10 days prior to them leaving for field training in Texas A&M (they swear they won't train him!!) just the other dogs. I'm in Iowa so haven't referred there before.
He is still vocally painful on palpation at the teres major but the brachial plexus isn't to far away and yes have been worried about a nerve sheath tumor and talking with the owner about that. Would you expect that with a 10 month duration?
No pain in the elbow today but we have been treating that with laser also.
Referring him to Texas A&M close to their training and said advanced imaging may help rule out other problems.

Thanks for your input

Nancy Peterson

[lehughes]

Keep us posted to what any imaging might find.
In regards to the duration of limping and nerve sheath tumour... yes, they can go on that long - (10 mos_.
I have heard of practitioners treating dogs for that long even, with waxing and waning of symptoms, before asking more questions / thinking outside the box / referring for imaging.

All in all however, it's not a case that is presenting as at typical anything. Too bad he's not 'sticking around' for you to work with more: Rule in & Rule out the various pathologies!

Laurie