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

[Guest guest]

I agree with the second opinion idea. 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. It started above the shoulder and I think it would actually prevent shoulder subluxtion also. It may take some ingenuity, I'm sorry if this isn't very specific but just a thought.

Subject: 2nd Time: Medial Shoulder Instability Help! AnyoneTo: 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 labwho I have been seeing recently. Two years prior the dog had surgicalcorrection for biceps tendonitis which it recovered to fully from. Latelast year it presented with the same clinical signs on the other front legand again went for surgery. The dog has since been lame on the limb. Thesurgeon at them time said that there was not a tremendous about ofinflammation in the area which puzzled him but he still performed therelease. Since then the dog has had chronic stiffness in the limb whengetting up from laying down, limps on the limb 24/7and often it slidesout. I suggested to the owner to seek a second orthopedic option and MRIof bilat. shoulders. This surgeon Dx. Medial Gleniod Humoral ligamentinjury w/ secondary injury to the supraspinatous. The surgeon optedagainst surgical correction and suggested therapy for

the next four weekswith reevaluation. We are currently Cold Lasering and hydrotherapy. I needyour guidance on experience with these medial instability injuries and anyadditional exercise or therapy ideas. Thanks for your help.drjtopdoghealth (DOT) comwww.topdoghealth. comP: F:

[Guest guest]

,

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, MS

Diplomate ACVS

Veterinary

Orthopedic &

Sports

Medicine Group

10270

Baltimore National Pike

Ellicott City, MD

21042

Phone:

Fax:

http://www.vosm.org

From:

VetRehab [mailto:VetRehab ] On Behalf Of St.

Sent: Thursday, May 29, 2008 9:42

PM

To: VetRehab

Subject: 2nd Time:

Medial Shoulder Instability Help! Anyone

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

www.topdoghealth.com

P:

F:

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[Guest guest]

,

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, MS

Diplomate ACVS

Veterinary Orthopedic &

Sports Medicine Group

10270 Baltimore National Pike

Ellicott City, MD 21042

Phone:

Fax:

http://www.vosm.org

________________________________________

>

> From: St. drj@...

> 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:

>

[Guest guest]

Making a orthothic for the elbow is much simpler than the shoulder in humans. In animals, the shoulder is even tougher to brace because it is a weight bearing extrimity. Because there is not good geometry over the shoulder to get good purchase on to control the movement, I would say a rigid plastic custom orthosis would be futile at best. A very snug fitting neoprene vest or harness would probably be your best bet to control any of the movement in the shoulder. Basically you need to use circumferencial pressure to squeeze the shoulder to provide stability. Thus, the snugger the fit the better. Your other option would be a bilateral holster type to pull the shoulder joint up using a pull from the bilateral side. But again with the pistoning that

may occur due to more involved soft tissue this would need to be very snug both in the holster and over the back. Hope this helps.

Have a great weekend!

Ben

Ben Blecha, CPOwww.skyprosthetics.comwww.TriAmphant.com-- Those who can laugh without cause have either found the true meaning of happiness or have gone stark raving mad.~Norm Papernick

2nd Time: Medial Shoulder Instability Help! AnyoneTo: VetRehab@yahoogroup s.comDate: Thursday, May 29, 2008, 8:41 PM

Hey Everyone,I need some advice on a particular case. This is a 5 year old yellow labwho I have been seeing recently. Two years prior the dog had surgicalcorrection for biceps tendonitis which it recovered to fully from. Latelast year it presented with the same clinical signs on the other front legand again went for surgery. The dog has since been lame on the limb. Thesurgeon at them time said that there was not a tremendous about ofinflammation in the area which puzzled him but he still performed therelease. Since then the dog has had chronic stiffness in the limb whengetting up from laying down, limps on the limb 24/7and often it slidesout. I suggested to the owner to seek a second orthopedic option and MRIof bilat. shoulders. This surgeon Dx. Medial Gleniod Humoral ligamentinjury w/ secondary injury to the supraspinatous. The surgeon optedagainst surgical correction and suggested therapy for

the next four weekswith reevaluation. We are currently Cold Lasering and hydrotherapy. I needyour guidance on experience with these medial instability injuries and anyadditional exercise or therapy ideas. Thanks for your help.drjtopdoghealth (DOT) comwww.topdoghealth. comP: F: