Eastie-Westie front end

[lehughes]

Hi, Laurie!
Let me start this by saying – I suck at shoulders! I can narrow things down to the shoulder but what exactly it is after that is always a mystery to me.

I have a new White Shepherd patient, 10 months old, female who was a swimmer puppy. The breeder of the dog came along for the initial appointment but apparently she did not know the whole history and the woman who purchased the puppy doesn’t want her to know…
The breeder was away for a dog show and her daughter who lives next door was taking care of the dogs. The breeder’s 2 year old granddaughter supposedly picked up this 2 week old puppy and threw it on the floor. The next day was when the puppy was called a “swimmer”; it had been fine up until then. (For some reason the breeder wasn’t told what her granddaughter had done but the woman who purchased the puppy was?)

Over the past couple months, the dog has become “eastie-westie”. Adducting her elbows and turning out at the carpi. She is a total fruit loop so I did not force her to sit/lie still for measurements. She has pretty decent range of motion in her shoulders but near end-range she is painful in extension. Not sure about flexion. She wasn’t a fan of the biceps stretch but no reaction when I played in the groove. When I “strum” her tendons I don’t get any reaction. And I don’t think she is a medial instability case.

The RDVM took rads which were reviewed by a surgeon. He said “that the rads of the elbows and shoulders appear normal. No signs of OCD or elbow dysplasia. Based on the reported signs, I am concerned that this dog is developing bilateral frozen shoulders and needs aggressive PT and walks on good footing. Also consider shoulder harness from DogLeggs.”

So, I freaked when I read the report before seeing the dog. I couldn’t find any reason for bilateral frozen shoulders. And I’m struggling to find a cause for a bilateral shoulder issue at all in a dog this age and who has normal rads. We are just doing low impact front limb exercises, laser, and UWTM until I can figure out something more specific. When she comes out of the UWTM, she is obviously less eastie-westie.

Any thoughts? Any diagnostic testing/manipulating I should be doing? I HATE shoulders. I was supposed to take one of your courses in NJ but that was the time that Animal Planet came to video our rehab center so I couldn’t stay on Sunday for my scheduled courses… I haven’t made it to another and I know I need to!

Thanks for your help! You still amaze me with all that you accomplish.
Safe travels.
Janine


Gait Video: https://youtu.be/pdS_92NVvE8

[lehughes]

Hey Janine!

Okay… very interesting case! And I love that you call the dog a fruit loop. I call dogs ‘fruit loop’ all the time!

What is interesting to me is that the dog moves / tracks fairly normally (not externally rotated, and not lame), it’s just when stationary that you bet the Eastie-Westie appearance.
It has me thinking a couple of things.

1. I’ve seen this before in dogs that look like this, where their legs grow disproportionately faster than their chest drops / grows / fills out. Until then, there is nothing that keeps their elbows from knocking each other under their chest and they look narrow, or in this case narrow and externally rotated.
So, from that perspective what I have suggested in the past are exercises to strengthen the front legs. You’re good to start with the UWT. Give them some other ones as well “push ups”, maybe digging, swimming if available. I have on breeder who believes that cardiovascular exercise is critical to building depth of chest via improving lung capacity. I don’t know… but it’s not too crazy of an idea. So to that end, use your UWT sessions to push the dog to build up cardiovascular capacity. Otherwise it’s a waiting game to see when the chest will ‘drop’.

2. The shoulder thing. The good news is that nothing was seen on x-ray. If the owner (or breeder) is willing to pursue more, they might be able to get a better idea with diagnostic ultrasound to look at all of the soft tissue components. The good thing is that the dog isn’t lame. Perhaps there is some joint inflammation from pounding through the limbs. Or maybe it’s because she’s a shepherd… oh and a white shepherd at that. Pile on the whines and cries!! ;0 I jest, but it’s also true. So why not just do some very basic shoulder mobilizations - a simple wobble of the glenohumeral joint. Grab the humeral head and pull it laterally, then push medially. But in a rhythmical fashion so as to be a joint mob - not a test of end range. I’m sure you know what I mean! In no way would I put this dog in hobbles.

But the good news is that I think you can stop thinking of this as a shoulder issue. I think it’s a chest issue / lack of ‘fore-chest’ development. What I don’t want to think of, is whether or not the ‘splat on the ground’ as a puppy could have impacted any of the rib growth plates. But I think she’s look way more abnormal now if that was the case… but we can’t rule it out. So keep that in the back of your mind.

My goals would be to strengthen strengthen strengthen… and do a couple minutes of mobs on each shoulder, maybe a wee bit of laser… but strengthen, strengthen, strengthen!

Best of luck!
Oh, and I’m putting this up on the forum as well. Fascinating case!

Cheers,

Laurie

[David Lane]

About you "sucking at shoulders"...

I think the reality is that we all suck at shoulders. I used to think I was awesome at them, being able to pinpoint sources of pain... until I started ultrasounding my patients. Then I realized that I sucked at identifying the specific anatomic structure involved. I don't think we can reliably make a specific shoulder diagnosis on examination alone. If you can detect shoulder pain somewhere, then you don't suck at shoulders; that is all that can be expected. Similarly, without sedation, many MSI's will go missed. Also though, you will see lots of SST pathology on ultrasound that have nothing to do with the dog's discomfort. IMHO, we have no gold standard test.

If you find shoulder region pain, image them. If you can't image them, then carpet bomb treat everything - assume all the structures are involved - leave no anatomic feature untreated. Doing so however, does not mean that you suck at shoulders.