Hi Laurie
Prior to Covid I was working with a lovely 8yo FN Retriever from another practice sent for hydro after an RTA in Nov 2018. She had a scapular avulsion and ended up with sutures anchoring to the rib that pinged at various times and other sutures tunnelled through the scapula to reattach other muscles. I am trying to get more specific details from the orthopaedic surgeon. She has done really well but we had a 4 months lapse in treatment after I broke my arm so I only started seeing her again in March. At that point she had reverted to being slightly hypermetric on the RF and then flipping the paw - her owner likened it to her dressage pony walk, lots of trigger points in her paraspinals and her core seemed to have disappeared! In stance she would stand with the RF slightly forward and abducted with her hindlimbs in the next county. Three weeks of manual, laser and acupuncture and tweaks to her home programme and she had made massive improvement, just needed to get her back in the underwater treadmill. Her owner reported she was back to trotting along on her 4 - 6 mile walks rather than lagging behind.
However Good Friday she went non weight bearing lame, and her owner could see no reason, responded well to paracetamol. Gradually increased her walks and seemed ok until 10 days later, longer walk and same again. Her vet saw her next day and could not find a cause.
I saw her last Saturday when she was as sound as she ever is - 2/10 in trot on a circle but on exam medial to the dorsal border is a 'lumpy' bit that she held her breath on palpation and then when repeated turned her head to stare. She was also worried about gentle ventral glides which is unusual. She does have slight crepitus on flexion of her elbow but good ROM and no apparent discomfort in any plane. Compared with the left carpus there is slightly more lateral / medial movement, a slight breath hold then nothing on repeat and I could feel any swelling.
Any thoughts on whether this interscapular 'lump' could be scarring from the original trauma or reaction to anchoring sutures, although that seems rather too long a time course. I have a Spectravet 810-500mW probe but decided not to use it this area in case something more sinister. I treated her globally just avoiding the immediate 'lump' and I altered my acupuncture pattern to include BL11 & 12.
I am waiting for the original specialist orthopod to get back to me with his opinion but just wondered if you had any pearls of wisdom for me? Its been try it and review from the start as it seems to be an uncommon injury.
I hope this makes some sort of sense, brain is feeling effects of being a bit sleep deprived.
Best wishes, J
Scapular avulsion
Re: Scapular avulsion
Hi J,
Firstly, I must claim ignorance to RTA… I did some googling because I figured it has to be a ‘language difference’. Okay - so road traffic accident was my best guess. Here, that is often abbreviated to HBC - hit by car. Funny! Anyways, I figured it out and onward ho!
So clinically knowing what has surgically been done there, my best guess would be that some suture material broke or loosened or stretched or rubbed or something to that effect. Sudden onset cancer lameness that went away equally quickly doesn’t add up. Reaction to sutures at this late stage, as you say, doesn’t fit either. Nor do the minor things you found down the limb either. That take us back to questioning ‘what is unique to that area?’ and ‘what could go wrong there?’
I have so say that I can’t even come up with many other differentials? (pinched nerve in neck or T1-2 region? shoulder hypermobility?) But your assessment of pain and the lump in that region doesn’t fit with those differentials.
So I am happiest to think that something moved, shifted, popped, rubbed, tore… in regards to the suture materials in the area. The ‘lump’ could therefore be scar tissue, yes, or facilitation / increased tone to help stabilize or in reaction to pain, or because of some tearing of scar tissue, or maybe even a bit of bleeding or a hematoma. As such, I would absolutely try laser on the area, and some gentle scapular mobilization to gently stretch / move the soft tissues and/or help with circulation to and around the area. I wouldn’t be concerned about using laser even if it was a presumed soft tissue sarcoma. There are more and more studies coming out showing that laser might actually be of benefit for treating cancers in vivo, that I would feel comfortable using it for presumed swelling or muscle tension even if there was a chance of being wrong!
Okay, that’s my two cents on it anyways! I hope it helps!
All the best,
Laurie
Firstly, I must claim ignorance to RTA… I did some googling because I figured it has to be a ‘language difference’. Okay - so road traffic accident was my best guess. Here, that is often abbreviated to HBC - hit by car. Funny! Anyways, I figured it out and onward ho!
So clinically knowing what has surgically been done there, my best guess would be that some suture material broke or loosened or stretched or rubbed or something to that effect. Sudden onset cancer lameness that went away equally quickly doesn’t add up. Reaction to sutures at this late stage, as you say, doesn’t fit either. Nor do the minor things you found down the limb either. That take us back to questioning ‘what is unique to that area?’ and ‘what could go wrong there?’
I have so say that I can’t even come up with many other differentials? (pinched nerve in neck or T1-2 region? shoulder hypermobility?) But your assessment of pain and the lump in that region doesn’t fit with those differentials.
So I am happiest to think that something moved, shifted, popped, rubbed, tore… in regards to the suture materials in the area. The ‘lump’ could therefore be scar tissue, yes, or facilitation / increased tone to help stabilize or in reaction to pain, or because of some tearing of scar tissue, or maybe even a bit of bleeding or a hematoma. As such, I would absolutely try laser on the area, and some gentle scapular mobilization to gently stretch / move the soft tissues and/or help with circulation to and around the area. I wouldn’t be concerned about using laser even if it was a presumed soft tissue sarcoma. There are more and more studies coming out showing that laser might actually be of benefit for treating cancers in vivo, that I would feel comfortable using it for presumed swelling or muscle tension even if there was a chance of being wrong!
Okay, that’s my two cents on it anyways! I hope it helps!
All the best,
Laurie
LAURIE EDGE-HUGHES
Re: Scapular avulsion
Hi Laurie
Yes RTA is road traffic accident in vet speak in UK, although I think the physios use RTC road traffic collision. HBC sounds pretty sensible although around here its usually hit by a tractor/ quad (or fell off & got squashed) Language difference hadn't even crossed my mind,, sorry!
Thank you, thank you! Cannot express how grateful I am to be able to bounce ideas with someone I trust.
I spoke to Peter about use of Spectravet in a soft tissue sarcoma case a few weeks ago so I do feel happier about it but was probably a bit of a rabbit in the headlights last Sat so elected to focus on assessment and acupuncture and then work a sensible plan. She did tolerate gentle glides well so will carry on. Fortunately the owner is amazing but she does come from quite a distance so don't want to waste her time either.
Best wishes, J
Yes RTA is road traffic accident in vet speak in UK, although I think the physios use RTC road traffic collision. HBC sounds pretty sensible although around here its usually hit by a tractor/ quad (or fell off & got squashed) Language difference hadn't even crossed my mind,, sorry!
Thank you, thank you! Cannot express how grateful I am to be able to bounce ideas with someone I trust.
I spoke to Peter about use of Spectravet in a soft tissue sarcoma case a few weeks ago so I do feel happier about it but was probably a bit of a rabbit in the headlights last Sat so elected to focus on assessment and acupuncture and then work a sensible plan. She did tolerate gentle glides well so will carry on. Fortunately the owner is amazing but she does come from quite a distance so don't want to waste her time either.
Best wishes, J