Shoulders, Tarsi, & L8

[lehughes]

I have a 5 year old sheltie who has had a history of MSI and she was treated at VOSM. No more shoulder issues.

He has recovered from that, but he seems to have some trouble going full out (ie an agility dog) in full straight extension.
He can do weaves and turns fine.

On physical, I found some lower back pain (rads showed an extra lumbar vertebrae- possibly some decreased space between the L-S and L-7/8 junction) Radiologist thought that extra vertebrae may predispose to more disc problems down the road

Also there was an audible click on palpation on the tarsus of the left. On Stance analysis he is normal. The tarsal joint I feel is mildly thickened, radiograph normal.

Ultrasound evaluation found:

• Tendonitis and possible subluxation of the SFFT L >> R • Bursitis of the left bursa subtendinea calcanea

INTERPRETATION OF THE FINDINGS & FURTHER RECOMMENDATIONS The US findings are compatible with bilateral SDFT tendinitis (L >> R) and associated Desmitis of their flexor retinacula. The most likely underlying cause is hyperlaxity syndrome of Shelties - an inherited collagenous fiber defect has been proposed. SDFT luxation/subluxation is likely responsible for the palpable/audible click. More than one tendon and /or ligament is usually affected. The changes are bilaterally symmetric. Traumatic injury or chronic repetitive micro trauma may play a role as well.

I am wondering if the collagenous disorder could have predisposed him to the MSI?

Wondering what you would recommend for treatment options? exercises or stretches?
Would a brace be of benefit?

At this point in time, I think he may not be cut out for agility anymore but wondering about therapeutic dance.

We have lazer, UWT, PRP options available.

Thank you so much for your time.

B

[lehughes]

Hey!

Firstly,
Question: When you say he’s having troubles going full out in full straight extension - do you mean shoulder extension, or just overall power and propelling himself forwards?

Even with surgery or RF treatments, I have found that most dogs tend to self limit full extension. I would think (as with people) that it’s based on apprehension. I find the best cure for this is an active exercise to get them to extend the shoulder willingly. My favourite if rear legs elevated and having the dog take a cooking from between its elbows or under the chest. Walking backwards on a treadmill is good too, and you could resist the unaffected limb to get more forward reach from the ‘affected’ shoulder.

I’ve found a correlation with an extra vertebra / lumbarized S1 and back pain and SIJ pain / dysfunctions. But these don’t have to mean a disc problem or progressive pathologies. I’d say on this area, he is likely a candidate for manual therapy (and laser) maintenance of these areas on a TBD basis. I’d show the owner how to do tail pulls as a preventative measure as well.

The tarsus. Here you have me thinking more! Okay, so the US findings show bilateral issues. However the click is unilateral, and WB / Stance Analysis is normal. So, it makes me feel like reserving judgement based on the US alone. (There’s a FourLeg Newsletter - Nov-Dec 2014 The Veterinary VOMIT edition. VOMIT stands for Victim Of Medical Imaging Technology). The imaging only matters if you can make it matter with your physical exam, evaluation of function, and clinical reasoning. Hence, with this topic is making me think more than the other two ‘parts of this dog’!
So… don’t put him in a brace. It will further weaken the area and he’s not ‘dysfunctional’ here. (He’s only having troubles with full out power & speed.)
A Collagenous disorder predisposing to MSI. I don’t think so there either. To be honest, I am now more surprised if an agility dog doesn’t have some degree of MSI / hypermobility of the shoulders or at least one shoulder. I think it’s a function of the sport versus a defect in the tissues.
Strengthening. Yes, absolutely, I think this is where you will make the greatest gains and improvement. I’d focus on things for the gastrocs and for power. Sit to stands facing up hill. Slow and controlled at first, and then perhaps with a burst of power (i.e. with some speed). Walking backwards is a good easy starter exercise or warm up exercise. Gradually try to incorporate more ‘power’ type exercises like jumping up onto a platform (working a bit higher as he strengthens… and maybe a ramp to go down or steps… so he’s not overusing / pounding those shoulders). Jump up from a stand and also from a sit. Burst to retrieves from a sit and also from a down. Since he’s already an athlete, you can likely progress him a bit quicker than your typical pet dog too! (Which makes it more fun!)

I don’t think PRP would have a role in this… (but I’m going to post this on the forum and hopefully Dr. David Lane will pipe in on the topic in regards to this case.)

I’d say, don’t give up on his agility career yet. I’d try the exercises, therapies listed above and re-evaluate in a month or two. You might not get rid of the tarsal click… but we still need to decide if it matters or not!

And as much as I have recommend people take up ‘Freestyle Dance’ with their dog, I have yet to have anyone seriously do it! If you have a better success rate with that, please share your ‘schpeel’ with me!

Okay, I think I answered all of your questions and purged my brain of all the little thoughts that your question triggered! Great questions by the way. These ones that make me think are always most interesting as well.

All the best!

Cheers,

Laurie

[David Lane]

One could make an argument for PRP'ing the SDFT, but like LEH, I would hesitate to do so based purely on the imaging results. I would first want evidence that I can localize pain in that area, otherwise I would rely more on laser +/- ESWT plus rehab as a first line along with treating the other affected areas. That region deserves extra monitoring, but until there is evidence of discomfort from there, PRP strikes me as overkill... it won't fix the collagen, and if there is no pain to resolve, then I'm not sure what is left.

Even then, if the whole region starts to break down and collapse, I would be thinking more about an orthotic.