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Hi

I've got a strange (to me anyway ) infraspinatus case. This is an 11 ys ME Flat coated retriever. He was referred to be with a suspected supraspinatus/biceps tendinopathy due to pain with shoulder flexion increasing with simultanous elbow extension. Upon physio examination I found severe pain on palpation of the caudal infraspinatus area/caudal scapular border (the pain from biceps stretch test was due to pressure upon this area). The muscle is atrophied all the way along the spina scapula and lies in a really hard "sousage" all along the caudal border of the scapula (if that makes sense...). The caudal part of the muscle was actually so hard that I was unsure wether I felt bone or muscle when I palpated. I referred back to vet for x-rays to rule in og rule out osteosarcoma. Luckily x-rays were unremarkable.

I've only seen a couple of infraspinatus contractures previously (in hunting dogs) and they were so severe they needed surgery. They had the "infraspinatus contracture position" of the limb. This flat, however, has a normal posistion of his limb. It pussles me that the muscle is so painful and in such a bad condition without the alteration in limb position if this is actually a true contracture. I'm thinking if this could be due to the atrophy of quite a large portion of the muscle - if there is not enough "pull" from the muscle to alter the position of the limb. Would've liked to refer it for futher diagnostics but owner wants to try treatment first. Dog luckily responds well to NSAIDs and isn't lame after he started with NSAIDs and reduced activity level. However the muscle is still quite painful upon palpation. He's currently getting laser treatment 3 times a week, combined with massage within tolerance and some very gentle ROM and stretching.

Has anyone else ever come across this? Any suggestions on differentials? And treatment?

Thanks in advance for any good advice
Sunniva Morgan

Hi Sunniva!

COOL case! It jogs my memory of a paper written by Dr. Jan Steiss on the subject of infraspinatus muscle contracture. She talks about it being somewhat like a compartment syndrome. In other words, there is swelling / inflammation within the fascial confines of the muscle. What you are describing could very well fit the description of the condition.
http://www.healthline.com/health/compartment-syndrome

So, I would continue with the laser. I would change out the massage for myofascial release (slow distraction of the tissues, starting light and then building in pressure) to release the fascial tension.
Then stretch infraspinatus (i.e. lying ON the affected side, then internally rotate the leg on the side he's lying on - which would just be lifting the lower "arm" up off the ground with the elbow bend. (I hope that makes sense without a visual)... There will be a picture in your Extremity Assessment Manual!!!
And continue with the NSAIDS... maybe for longer than a typical trial.

I remember being taught that compartment syndrome was a bit of a tricky thing. You don't want to increase circulation very much, but that most of what we do has some element of increasing circulation. And what will take the swelling away? A slight increase in blood flow...

My thoughts anyways!
Thanks for posting!
Laurie

Thank you for your input I changed the massage with myofascial release and did the infraspinatus stretch (which he thought was quite uncomfortable initially). The muscle still feels a bit weird, but it is no longer painful upon palpation or stretching and only a very, very slight lameness can be seen occationally (which I think is due to early signs of OA of the shoulder and not the infraspinatus). Really happy with the outcome on this one. Thanks again for your help

Oh my gosh! Thank you so much for the update Sunniva!
That is AWESOME!

Good job and congrats for helping a case by being able to think / work 'outside the box'!

Cheers,

Laurie