Elbow? Shoulder? Dog Assessment

[lehughes]

Hi Laurie I hope you are well.
I'm writing from Portugal. We met in Porto 5 years in the course Physiotherapy in small animals.
Could you help me with a dog I'm treating?
She is a 5 year old female rottweiler (not very friendly).
She started limping from her right front leg after leaning on the wall to bark at another dog (she screams).
That was 4 weeks ago. she went to the vet who prescribed anti-inflammatories.
For a week, the owner said she was doing better, then started limping again.
She is an overweight dog.
In the assessment: Cx P/A on transverse apofise normal; right lateral glide C2 stiff. Co1 ok, A/P Co2, Co3 ok (similar to other side).
P/A Co ( need to perform again).
SH: palpation humeral head ok; palpation: biceps tendon and musculotendinous junction ; subscapularis tendon; supraspinatus tendon; LH triceps are ok.
PRM small decrease on extension.
Normal stretch capacity subscapularis; LH Triceps; biceps; supraspinatus.
Joint glides: Medial- lateral and cranial- caudal glides ok ( no hypermobility). compression throughout range ok ( no OA).
Adverse neural tests ok.
No axillary; cervical or suprascapular lymph nodes.
The positive findings were: pain on palpation and stretch the infraspinatus ( she tried bite me); discomfort palpation latissimus dorsi and teres major.
Pain on coronoid process palpation, but normal PRM of elbow and compression of the coronoid process.
Past medical History: Owner mentioned cauda equina disease ( vet told him about sacral vertebrae with problems??). The dog does not sit normal. She sit with the knee in extension and hip abduction ( right side). She has sphincter control.
She also had a surgery to remove a left finger ( tumor disease).
Palpation head of humerus and distal radio was ok.
I only treated her twice and I did not have time to properly look at the carpus and manus.
My questions ( two of a million) are: can it be a problem on the infraspinatus tendon although she does not have her Sh in external rotation and elbow in flexion? Or a metastasis disease?
Could you please give me your precious opinion?
Thank you for reading this huge text!
Happy New Year
CF

[lehughes]

So, without seeing the dog, but knowing it’s a Rottweiler, I first think Elbow. Secondly, I think medial shoulder hypermobility.
Did you test shoulder abduction in some degree of extension?

Infraspinatus injury is usually a fall with the leg under them (i.e. in Adduction). So I’m not sure about the history in this case.
However, to answer your question, Yes, you can see infraspinatus injury without (or before) the contracture, and I have one dog that has an avulsion of the infraspinatus tendon.
His shoulder needs to be mobilized to get an auto-manip on a regular basis (I think because it is less stable and pressure builds up in the joint). I put the shoulder into extension and then add some abduction, and I often get a click / clunk that gets rid of any lameness.

I suppose you could request an x-ray to look for a cancer, but it is more likely to be soft tissue (at 5 years of age). Either way, you are likely safe to do 3 treatments to see if you can improve the lameness by treating the shoulder.

The back end stuff won’t be causing the front end lameness… so everything back there is separate. Many overweight dogs sit sloppy.

Okay… so based on what you’ve told me… those are my thoughts!

Good luck!

Laurie

[lehughes]

Hi Laurie

Thank you for your help!
The past history of cancer was driving me crazy!!.
I assessed the abduction but in a neutral position (once again thank you).

Cheers,
C