RF lameness agility dog

[Kriszty]

Thanks for your thoughts Laurie, I really appreciate it!

[David Lane]

I agree with Laurie's comments, and wouild like to add that I do not use a full hobble system until I have ruled out supraspinatus involovement, as I think it creates too much resistance work that has the potential to worsen the supra issue (I've seen it happen). If there is no medial compartment instability, and the dog is reasonably controllable, then I use no bandage. Otherwise I use a tensor bandage to serve as a reminder to not abduct so much. Unless of course the shoulder is so drastically unstable that it needs the brace, at which time I may have to tackle the supra once the MSS is resolved.

In my experience, pain on medial compartment palpation does not automatically mean MSS. You are a finger width away from the biceps tendon and I've had plenty of dogs that palpated sore on the medial compartment (and I know for sure I was not on the biceps tendon at the time), but were stable and subsequent imaging indicated a primary biceps issue. If you are unable to image, then just carpet bomb the area (SST, BT, medial compartment) with the modalities and assume everywhere has some degree of something going on.

David Lane DVM
ACVSMR

[lehughes]

I love the carpet bombing approach on this!!
Thanks David!

Laurie

[Kriszty]

Thank you David.
She had her 1st shock wave treatment yesterday, and had no pain on the medial component but was uncomfortable laterally. I am trying to minimise the restrictive hobbles as much as possible and just using the ace bandage.

[Kriszty]

I hope it is OK to post an update and some xrays.
She was doing OK, in her ace hobbles most of the time, shoulder strengthening exercises, had 4 shockwave treatments of both lateral and medial shoulders, PEMF mat twice daily. I have just bought a blow up spa do do some underwater walking in. Then I took her on a slightly longer walk (on lead, some hills, approx 15mins) and she went into her crate when we got home and came out limping RF for the 1st 3-4 strides. That was very disappointing as she hasnt limped since this all started 6+ weeks ago.
She was speyed yesterday, and I asked the surgeon to take some views of her shoulders. Specifically, I wanted to rule out OCD (again) or anything surgical.
Please can you let me know what you think?
TIA!

Zen R shoulder.jpg (198.56 KiB) Viewed 16740 times

Zen L shoulder.jpg (197.38 KiB) Viewed 16740 times

[lehughes]

Well I'm not a vet - so I defer to those who read more x-rays than I do... but I don't seen anything 'limp-worthy' on those rads!

However, on the note of lameness for a step or two after the long walk. That might be okay! We know in people that when we work with soft tissue injuries and push them a little with exercise, they will be sore after. It's normal, it's expected, and it's beneficial. The body doesn't heal and soft tissue fibres don't grow unless there is a stimulus. So, carry on and don't worry too much about a couple lame-steps after a tougher 'work-out'.

Laurie

[Kriszty]

Yes the ortho surgeon said he couldnt see anything either
I have just rewatched your biceps vid and note that you said that there too, a very different concept for me to get my head around!
She is about 7 or 8 weeks in to rehab now so I am starting to introduce some basic agility stuff again- no jumping but foot targetting on the flat and maybe the dogwalk (she has running contacts) in another week or so (if that sounds ok, I am completely making this up as I go along!) No jumping or free running planned until 12 weeks. I had to take the ace hobbles off as she was getting rub sores. I am very excited she no longer has pain on stretching extension !
As always thanks for your help!
Kriszty

[Kriszty]

OK so I watched your 2 vids on glenohumeral hypermobility last night, Laurie, and I think this is definitely what Zen has. It would explain why she would fidget and not allow full shoulder extension, but then after I mobilised the joint caudally, she would allow it with no issues. So good to know! I still think she has injured her R shoulder though sadly. But no longer think she has bilat MSS, just RHS.
Love this site (although I really wish you lived in Perth!)
Kriszty

[lehughes]

I think your 'game plan' is sound. And yes, being okay with exercising causing some soreness during the rehab is a novel concept - especially for the vet industry. However, I see it also in the human field (that's where I found literature quite recently) where the main conclusions are that exercise needs to be uncomfortable in order to make gains. So you're not alone in trying to make that mind shift!

You'll have to keep her really strong to continue with agility. And I like to do shoulder mobs on a semi regular basis as well with these kids (along with laser etc.)

Hang in there!

Laurie

[David Lane]

The radiograph of the right shoulder shows subchondral sclerosis of the bicepital groove (see fancy graphics arrows that I added) indicative of, but not pathognomonic for, biceps tendon pathology. It does suggest IA inflammation.

I don't wish to embarrass whoever took the rads, but I also don't want to miss a teaching opportunity. As far as positioning goes, the right view was ok, but the left is too poorly positioned to be of value. In both, it looks like the dependent limb was not put under any traction - you really need to fold the upper limb back in shoulder flexion and pull the lower limb out in a "T" shape to get the entire proximal humerus clear of other structures in order to detect subtle details. In the case of the left limb, the trachea causes too much contrast.

David Lane DVM
ACVSMR