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Hello All,

I am seeing a 4.5 year old border collie agility dog referred with 2 week history of intermittent lameness and painful right shoulder flexion. History of difficult blood draw from RFL and then appeared lame after running down a hill and turning sharply. Seemed better next day and did an agility run seemed OK. Lameness is only evident after flat out running. Biceps test evokes a small reaction - change in demeanor, looking away, lip licking. Similar on direct palpation of biceps tendon. Some muscle guarding at 2/3 range of sh flexion and elbow extension. Joint compression, medial shoulder instability test and all other muscles appear to be normal. Started treatment for biceps tendinopathy. Gradually increasing eccentric loading and laser treatment. On second visit on gentle stretch of biceps there was a clunk in the shoulder and it appears to flick from neutral to external rotation. A similar clunk could be felt on the left shoulder so I was not sure if was significant. Today on 3rd visit biceps appears more comfortable and range is improved BUT the clunk is worse and this time I couldn't reproduce it on the left. I'm wondering if the biceps tendon is flicking out of the groove or is there another structure/ condition that causes this feel. Id appreciate your opinions and suggestions before referring back to vet and suggesting orthopaedic review.

Hey there Kay,

I'll still put money on Medial Shoulder Hypermobility - even more so given that you can get a bilateral click / clunk. I just gave a lecture on this topic to the Aussies and made a statement that I think all soft tissue injuries are likely medial shoulder hypermobility unless proven otherwise. In that I think that there can be problems / trauma to the medial compartment that is the precursor to many of the joint issues and/or soft tissue issues that we see. Additionally, there was one research paper that looked at cutting of just one of the medial G-H ligaments, which did not cause an abnormal abduction angle, but did cause inflammation and irritation of the joint. I think the sequelae is then other soft tissue inflammation & pain and/or joint irritation and possibly osteochondrosis.

The clunk to me doesn't sound like soft tissue going over a bone, but rather like the pop you get when pulling a finger to make it crack. So essentially a pressure build up and then release. In fact I am more surprised when I DON'T get this in at least one shoulder on a sporting dog.

The other thing I find is that when dogs have a chronic shoulder issue, they are VERY good at resisting abduction. So it looks normal. But if you are very nit-picky, the end feel is neither hard capsular nor soft capsular and therefore 'something else' (i.e. active muscle contraction) is stopping the motion. I would bet if you went back to evaluate the shoulder you might find an increased abduction angle if you went very slow in trying to get it. And you may also get pain with pure glenohumeral extension (caudal glide of the humeral head with the joint in extension.)

I now go over the shoulder with a fine tooth comb purposely looking for anything that would implicate medial shoulder. And I'm finding them on the dogs that I would have otherwise said, that's not bad.

I actually think the clunk is therapeutic. If it needs to 'clunk' it's good to clunk. I find on my own dogs that they can have a small head bobbing lameness that resolves when I do a caudal glide in extension in order to get a clunk. For owners, I show them how to do a medial-lateral glide (wobble the shoulder) to change the pressures within the joint.

Go back to the shoulder. Likely add some of the MSI protocol exercises. The Biceps stuff you had / have been doing will have been great for Medial shoulder as well. Just add a few others and I think you'll have it sorted!

Best of luck!

Laurie

Thanks Laurie I will see them again tomorrow and try doing shoulder abduction very slowly. She is not a very relaxed dog so I've actually had to do it in sitting so far. Ill try and get her into lateral recumbency to be more relaxed and try again and caudal do glide in extension. The first time I felt the clunk it was more of a finger popping feeling but no sound. Last time it was a large rotation movement with a very sudden flick into external rotation. I daren't repeat it too often to find out more! I will add some MSI exercises and in to the mix and see how we go for a few weeks. Thanks so much for your advice and Ill get back to you with some feedback after we have tried a few things out.

Go ahead and repeat it. I find that getting that clunk will often make the dog immediately sound! I actually TRY for it now in many dogs!!

Best of luck and keep us posted!

Laurie