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Hello All, My favourite patient (because he is mine) is a 9 month old entire male border collie puppy. He grew like a weed and has got OCD both shoulders Right > Left . We are now 3 months post arthroscopic removal of flaps/fragments and debridement at an orthopaedic referral centre. Did 4 weeks of total crate rest with just 5-10 min toilet walks, then still crated/ penned or on lead between crates but adding 5 mins/ week to walks. We were told could go off lead at 11 weeks when we were up to 30 mins but I only started letting him off lead in a smallish room indoors. I thought he was looking a little uncomfortable and moving differently and bingo 1 week later got a bit bouncy and was acutely lame again. Being an adolescent border collie pup he is not keen to resume his prison life and neither am I. It is likely that his interpretation of lead walks is not as sedate as the vet envisaged as he was very excitable. Within our walk times I have tried to do a little bit of static postural alignment work, rhythmic stabilisations, proprioception and lately some front leg and rear leg targeting and postural transitions in alignment. Have had to limit my therapeutic ambitions because he just gets too bouncy and daft. Not on NSAIDs because he is also having some major gut issues. NO Laser or PEME because I'm erring on the side of caution with open growth plates.
So my questions are - Has anyone had experience of humeral head resurfacing? Whats the rehab likely to be?
What would you do in the meantime? Intra articular steroids been mooted but Im not keen.
Would you push for stem cell treatment (vet not convinced of benefits)?
Have you known dogs have multiple arthroscopies and be OK in the end?
What have I done wrong? How can I improve what we did this time around.? Short of having him sedated full time I think we gave it our best shot on the rest.

Thanks in advance for any help or suggestions you can give. Hard to be detached and objective with my own dog!

Hi Kay!

Great questions & wonderful case!

So, I have a dog who is recovering from a repinning of her biceps tendon. The owner was concerned yesterday that she was a bit lame when allowed to move more at the end of the flexi-leash. (She's now 8 weeks post op...) When I examined her, I found no pain. However, I found a great deal of restriction for the leg to fully extend (mostly scapulothoracic soft tissue & fascia). End range GH extension was great (not pain), as was gentle stretching of the biceps. So I figured the biggest problem was the soft tissue restrictions.

I would hazard that this is similar to what is going on with your dog. Especially at the 3-month stage. So, what I would suggest is stretches and fascial holds to help with scapular mobility and gaining end range extension. From an exercise perspective, walking backwards on a land treadmill is also great. You can have front legs only on the treadmill, or all 4. (It's not pretty in the beginning, but once the dog gets the hang of it, it's great for getting that end range extension - especially if you resist the 'unaffected' limb.) The next best exercise is 'play bow' with the hind feet elevated on a platform. First encourage them to reach down for the cookie, then draw it back towards them (keeping the cookie at ground level) to get that play bow.

As for modalities, honestly, a bit of laser once or twice a week, I really do feel is okay... and may help the joint and soft tissues.

I don't believe that stems cells would help. (Listen to Dr. Lane's most recent audio on stem cells and osteoarthritis... it fits the category of what you're asking).

I'd say carry on. I also have a patient (Bernese Mtn Dog) who's had bilateral OCD removal of the shoulders. That was 1.5 years ago. You'd never know it now. Very bouncy and crazy as well! So, I don't think you're doing anything wrong. I think you just need to start reintroducing life and be okay with minor soreness set backs. They are part of the process when gaining back strength and function.

Best of luck!

Laurie

Just to elaborate on the regen medicine aspect of this question:

Stem cells and/or PRP would have a palliative benefit, but would not actually fill the defect. They've tried to fill OCD defects with fibrin plugs impregnated with MSCs, but the scaffold doesn't stay put; it floats away to the nether reaches of the joint, dislodged by simple movement. The closest we are at is to grow the cartilage on a hydroxyapatite plug, and then surgically implant it as you would an OATS procedure... but this is very much at the experimental level right now.

Thanks Laurie and David, Reassuring words from you both re our current treatment and prognosis. Synacart was the material mentioned for resurfacing if necessary. Have you any thoughts on the evidence base for this synthetic implant?

Unfortunately, I do not.

Geez... me neither!