more on wellness exams

[rita]

Hi! I hope that this is not one of those silly questions, but I would like to take a chance and ask/discuss anyways. There is no debate about the value of routine hands on wellness evaluations. Do you feel that there is any merit to screening the shoulders on agility dogs with soft tissue ultrasound. I realize that there are a lot of undertones to this and the STUS would not be meant to replace the physical evaluation. Just want to have the conversation.....

Thank you for you time and thoughts.

[David Lane]

I for one would like to see one of the reports being generated by the practitioners doing this. I am curious how much stake they put in imaging findings over physical exam findings. We know from elbow, hip and stifle rads that severity of lesions cannot be used to predict severity of Cx.

It is not something I recommend or perform on a prophylactic basis simply because we often see ultrasonographic changes in asymptomatic dogs. It is analogous to taking a spinal rad and seeing spondylosis or slightly narrowed discs etc. - am I going to treat the image, or the patient?

There has been 3 or 4 times over the years that I personally experienced dogs that presented with a minor issue, and no examination findings that suggested a shoulder problem, but when we imaged, we found major and very concerning pathology. So one could argue that prophylactic screening might have identified problems earlier...

Because we have no normal values for SST cross sectional area, baseline imaging does help for taking initial measurements for individual dogs, looking for changes later. But we also have no data about the repeatability of such measurements, or how much of a change in size reflects true pathology...

When all the above rambling is done, I currently fall in the camp of "skeptical, but not completely dismissive", and would like to hear arguments for situations where it makes a clear difference.

[lehughes]

I quite like David's well thought out response here!

I think that if you were to US, X-ray, or MRI any dog (or joint), you will find a number of 'clinically irrelevant' findings.

I think that I see supraspinatus tendons that thicken and are tender on palpation that then proceed to normalize throughout the year based on what the owner is doing or training. For example up here, Fall (starting of classes again) seems particularly bad for supraspinatus tendons... by this time of year (December-ish) the tendons have settled.

Would it be interesting?... sure! Would it be a cool research project?... Indeed!
Would it guide what you did with dog over and above your physical exam?... No likely!
Imaging is limited without the physical exam to back it up.
Would it be good for marketing? Yep. Would people pay for it? Yep.
But then it's up to you to decide what you will do with the information... Ethically!

I have come to decide that the majority of agility dogs have some degree of shoulder hypermobility. It's a tough sport on their bodies!

I think it would be interesting to check on these shoulders once a year or every second year... for interest sake.

From a physio perspective, there are a number of human physio clinics in Canada, the US, Australia... and likely some other countries as well, that use diagnostic ultrasound to see how their tendon rehab is going. (We have to call it 'Real-Time Ultrasound up here...) Anyways, from that perspective it would be interesting. But... it's not a huge expense - it's something thrown into a physio session / consult. So, in my head, that's the other consideration. If it's inexpensive and easily done... I bet there are folks that would be interested in it. But you may have to talk those people out of doing something major if anything is 'seen' on imagine that your physical findings don't deem to be relevant!

Good discussion question!!!

Laurie