Good morning!
I saw an 8 month old female border collie this weekend as a second opinion. She developed a two week progressive lameness of the left thoracic limb when she was ~5-6 months old, was diagnosed with shoulder OCD and had surgical repair shortly afterwards. The surgeon told her 4 weeks of cage rest then resume normal activity. The rehab vet said 8 weeks of cage rest and then start exercise therapy (we normally start controlled exercise at 2 weeks post-op). Approximately 2-3 weeks after surgery the owner started feeling a clunk with gentle shoulder range of motion. The rehab vet she has been seeing thought it could be MSI. My exam this weekend revealed normal abduction angle but the humeral head luxates laterally with gentle range of motion (intermittently) or with lateral pressure on the medial aspect of the proximal humerus. She does not act painful with the luxation nor with stretch of the supraspinatus or bicep. She has some restriction on extension which feels like a soft-tissue restriction. She also has severe muscle atrophy. Here are my questions:
Is it possible that the laxity is due to severe muscle weakness?
Depending on the underlying cause what is the prognosis for agility?
This owner lives 6 hours from me and is willing to drive here for rechecks but obviously it will be hard for me to follow her closely (I just happened to be at a hockey tournament 1 1/2 hours from her this weekend so I examined her there). The other major problem is she got this dog specifically for agility and mentioned she would re-home her if she cannot run agility as her husband will not let them get a 6th dog.
Thanks in advance for any advice you might have!
KP
Help with shoulder case
Help with shoulder case
LAURIE EDGE-HUGHES
Re: Help with shoulder case
Hi K,
Sorry for the tardy reply!
So, firstly, I hate being put in the place of essentially deciding the ‘fate of the dog’, and I don’t mean this one specifically, but rather as a general statement.
Okay. I think that the laxity is quite likely worsened by the atrophy… and especially since the abduction angle is sold when you test. I would however check the surgical report just to ensure that Infraspinatus was not cut through and/or was resutured if it was and/or put a call into the surgeon about that.
Tough love answer to your question about future: Not likely a great candidate for a big agility career.
I have some high end sporting folks (agility, obedience, herding)… so I understand the mindset. Likely best to find a new home, as this dog it likely to breakdown sooner than later and/or never reach the levels that the owner is likely seeking.
I too think that some exercise can begin at two weeks. I say ‘restrict’ free activity for 8 weeks, but ‘things’ can be done before then!
Again, sorry for being so slow to reply!
All the best!
Laurie
Sorry for the tardy reply!
So, firstly, I hate being put in the place of essentially deciding the ‘fate of the dog’, and I don’t mean this one specifically, but rather as a general statement.
Okay. I think that the laxity is quite likely worsened by the atrophy… and especially since the abduction angle is sold when you test. I would however check the surgical report just to ensure that Infraspinatus was not cut through and/or was resutured if it was and/or put a call into the surgeon about that.
Tough love answer to your question about future: Not likely a great candidate for a big agility career.
I have some high end sporting folks (agility, obedience, herding)… so I understand the mindset. Likely best to find a new home, as this dog it likely to breakdown sooner than later and/or never reach the levels that the owner is likely seeking.
I too think that some exercise can begin at two weeks. I say ‘restrict’ free activity for 8 weeks, but ‘things’ can be done before then!
Again, sorry for being so slow to reply!
All the best!
Laurie
LAURIE EDGE-HUGHES
Re: Help with shoulder case
Thank you - I know you are very busy!! In the meantime I had already indicated to this owner that she might want to consider finding her a new home however she elected to continue with a strengthening program for 6-8 weeks before making any decisions.
I was also wondering about surgical technique as this surgery was done as an arthrotomy - cutting of the infraspinatus would be very valuable information to have.
This dog was rechecked by the rehab therapist last week and it seems that the laxity has resolved with a strengthening program. Hopefully she continues to do well however ultimately the owner going to have to make the decision. I'm not sure if I will get to see this dog again as I live so far from her
K.
I was also wondering about surgical technique as this surgery was done as an arthrotomy - cutting of the infraspinatus would be very valuable information to have.
This dog was rechecked by the rehab therapist last week and it seems that the laxity has resolved with a strengthening program. Hopefully she continues to do well however ultimately the owner going to have to make the decision. I'm not sure if I will get to see this dog again as I live so far from her
K.
LAURIE EDGE-HUGHES
Re: Help with shoulder case
You are welcome!
I would question the infraspinatus situation as well… as I know that in conversations with vet surgeons, their attitude towards cutting IS is rather laissez-faire (at least it was for those I spoke with)! In fact there is an article that discussed weight bearing stability in regards to cutting of different tendons, and IS was found to not have an impact (on stability in a weight bearing model… but not dynamic, and not when stressed passively with med-lat glides.) So, it is quite likely that THAT is the issue! I do believe it is a standardized approach (if I were to dig out my copy of Peirmatti & Flo’s Surgical Approaches text - not for me ‘to do’, but to understand things exactly like we are talking about here!!)
Glad the dog is doing well… but I do think the owner will need to make the tough decision!
All the best and Merry Christmas to you!!
Laurie
I would question the infraspinatus situation as well… as I know that in conversations with vet surgeons, their attitude towards cutting IS is rather laissez-faire (at least it was for those I spoke with)! In fact there is an article that discussed weight bearing stability in regards to cutting of different tendons, and IS was found to not have an impact (on stability in a weight bearing model… but not dynamic, and not when stressed passively with med-lat glides.) So, it is quite likely that THAT is the issue! I do believe it is a standardized approach (if I were to dig out my copy of Peirmatti & Flo’s Surgical Approaches text - not for me ‘to do’, but to understand things exactly like we are talking about here!!)
Glad the dog is doing well… but I do think the owner will need to make the tough decision!
All the best and Merry Christmas to you!!
Laurie
LAURIE EDGE-HUGHES