Re: Re: 2nd Time: Medial Shoulder Instability Help! Anyone

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Thanks for the plug, Sherman!As Dr. Canapp mentions, he and Ria Acciani are leading off a trio of talks on Thursday August 14 at the Symposium.  The theme of this lecture series is to highlight the collaborative nature of animal rehabilitation.   Doyle and Bill Liska are speaking on joint replacements and Barb Guse and Alistair McVey will be discussion a series of neuro cases and their rehab management.  (There's also a large animal parallel session.)If you haven't viewed the schedule for VetPT 2008, it's at...http://www.cvm.umn.edu/outreach/events/rehab/program.htmlJust click on the day and you'll find a more detailed schedule of the lectures.  We're really excited that this meeting will profile some "new names" in animal rehabilitation both here in North America and across the world.  As well, I think that you'll see that the content of the conference has evolved to focus on the needs of the more experienced practitioner.Also, there are only a few more openings in Lesley Goff's preconference course on the Equine SI joint and Pelvis.  Laurie Edge-' course on the Canine Spine is already full with a waiting list even!  (Breakfast forums are filling fast!!!)Hope to see you all there!Amie Lamoreaux Hesbach, MSPT,Sorry for the delay in getting back to you on this interesting subject. It is not uncommon to find dogs with a supraspinatus tendinopathy and concurrent MGL disruption. The majority of MSI cases that we see have a negative (normal) MRI, therefore for your scan to have shown pathology we know it must be significant (all of ours are confirmed/diagnosed arthroscopically and treated arthroscopically if moderate or severe). Do you know the dog's shoulder abduction angle? If this case is severe, I think hydrotherapy without surgical treatment may be a bit much. In addition, this dog should absolutely be placed in a shoulder support system (hobbles from www.dogleggs.com) asap. Unfortunately, without personally evaluating the case I can not comment on its severity, however I can offer the typical treatment breakdown we follow for MSI cases. Obviously every patient is different and there is no "cookbook" approach, however we treat many and have found it beneficial to break them into three categories. I know other surgeons around the US follow a similar program. Based on the results of the orthopedic examination, abduction angle tests, and arthroscopic scoring, patients are placed into one of three treatment categories; mild, moderate, or severe. For patients with abduction angles of 35º - 45 º and arthroscopic findings consisting of mild pathology (inflammation without fraying or disruption; or very mild laxity of the MGL, subscapularis tendon, joint capsule) patients are placed in a shoulder support system / hobbles (Dogleggs.com) and entered into a rehabilitation therapy program.We are placing dogs in the "moderate category" (moderate pathology) if they have abduction angles of 45 º - 65 º, and arthroscopic findings consisting of fraying, disruption, and laxity of the subscapularis tendon, MGL, focal synovial proliferation associated with the subscapularis tendon, and synovial hypertrophy or hyperplasia. Additional findings may occasionally include a bulge of the supraspinatus tendon with biceps impingement. For patients in this category we are performing RF and/or arthroscopic imbrication. Following this treatment, post-operative care includes a custom shoulder support system / hobbles (Dogleggs.com) for approximately 12 weeks, strict exercise restrictions; and rehabilitation therapy. Recovery for dogs in the moderate category have been ranging from 3 to 4 months with return to training occurring at 4 to 6 months.In our breakdown, dogs with severe MSI typically have shoulder abduction angles greater then 65º. Arthroscopic findings usually include complete tears of the MGL and severe disruption and the supscapularis tendon. For this type of injury, we are performing reconstruction of the medial compartment by direct tissue reapposition and synthetic capsulorrhaphy. Following surgical repair, dogs are placed in a custom non-weightbearing velpeau sling for 2 to 4 weeks followed by the shoulder support system (hobbles) for 2 to 3 months. Rehabilitation therapy is required for a longer period of time as recovery following primary reconstruction ranges in our population from 4 to 6 months. Fortunately, in our population of patients severe cases are much less common. The rehabilitation therapy program I think is just as important, if not more so, then what we do arthroscopically. We currently have a very strict and detailed rehab program that was developed by therapists throughout the mid-Atlantic states which takes them from day 1 post-op through to return-to-sport. UWTM therapy usually does not begin until 3 months post-op if indicated. Ria Acciani and I will be covering this topic as a tag-team lecture at the upcoming rehab meeting in Minneapolis. Hope this helps,Sherman Sherman O. Canapp Jr., DVM, MSDiplomate ACVSVeterinary Orthopedic &  Sports Medicine Group10270 Baltimore National PikeEllicott City, MD 21042Phone: Fax:  http://www.vosm.org________________________________________--- In VetRehab , Jeanine Freeberg  wrote:>> I agree with the second opinion idea. & nbsp; Even if this dog does goes for surgery, in the meantime, I wonder if you could have type of supportive orthotic that could prevent the shoulder from sliding out. I realize it is difficult with a weight bearing joint but I have had an orthotist make a very supportive orthotic for an issue with the elbow. & nbsp;It started above the shoulder & nbsp;and & nbsp;I think it would actually prevent & nbsp;shoulder subluxtion also. & nbsp; & nbsp;It may take some ingenuity, & nbsp; I'm sorry if this isn't very specific but just a thought. & nbsp; > > > > Subject: 2nd Time: Medial Shoulder Instability Help! Anyone> To: VetRehab > Date: Thursday, May 29, 2008, 8:41 PM> > > > > > > Hey Everyone,> > I need some advice on a particular case. This is a 5 year old yellow lab> who I have been seeing recently. Two years prior the dog had surgical> correction for biceps tendonitis which it recovered to fully from. Late> last year it presented with the same clinical signs on the other front leg> and again went for surgery. The dog has since been lame on the limb. The> surgeon at them time said that there was not a tremendous about of> inflammation in the area which puzzled him but he still performed the> release. Since then the dog has had chronic stiffness in the limb when> getting up from laying down, limps on the limb 24/7and often it slides> out. I suggested to the owner to seek a second orthopedic option and MRI> of bilat. shoulders. This surgeon Dx. Medial Gleniod Humoral ligament> injury w/ secondary injury to the supraspinatous. The surgeon opted> against surgical correction and suggested therapy for the next four weeks> with reevaluation. We are currently Cold Lasering and hydrotherapy. I need> your guidance on experience with these medial instability injuries and any> additional exercise or therapy ideas. Thanks for your help.> > > drjtopdoghealth (DOT) com> www.topdoghealth. com> P: > F: >