shoulder sore and front leg lameness

[Guest guest]

I was wondering if I could get some feedback about this patient. He is a young, energetic Border Collie with a subtle injury. I suspect an infraspinatus or teres minor injury, but would like anyone's opinion based on my notes. I will be taking some video of this dog later this week doing some jumping and turns to see what else we may be able to see. 

Here's my notes.Comments: sedated for evaulation; measured for MSI - Goniometry: L 50 degrees,R 40 degrees. Both shoulders popped (joint mob) during evaluation. Noted during

sedated shoulder palpation that dog would pull L leg backwards and HR slightlyincreased with palpation of proximal humerus in region of infraspinatus andpossibly teres minor. Did not get this reaction with R side palpation. Asked owner

about doing x-rays. She had previously had x-rays done of elbows (I asked her tobring these in) and ok'd x-rays of shoulders. Laterals of both shoulders WNL - noflattening of humeral head, fx noted, or osteophyte formation.

Recovery Notes: uneventful1/3/2012 P 61 60.00 CAPSULE of Gabapentin 100 mg Capsules (1618)Rx #: 82909 0 Of 1 Refills Filled by: JLLGive 2 capsule twice daily for pain until gone.

1/3/2012 C 61 Medical Exam ***ADDENDUM 1/3/2012Client Concern: Loki dislocated his left shoulder during agility exercises in October.Since then owner has tried laser therapy, acupuncture, and supplements to help,

but Loki's shoulder consistently pops out again after a little exercise. He getsmuscle spasms and refuses to bend his elbow, and owner is pretty sure it's allbecause of the shoulder injury. Acupuncture helps, but nothing seems to be

treating the underlying problem of the shoulder dislocation. JLeeTemperature:103.8 - taken at end of sedation;Body Condition Score:3/5Mouth/Teeth/GumsWNL

Eyes:NormalEars:NormalNose:NormalThroat:NormalAge: 1 Yrs. 11 Mos. Sex: MaleCoat:Normal

Skin:NormalAbdomen:NormalHeart/Lungs:WNL, no murmur or arrhythmiaLymph Nodes:NormalMusculoskeletal System:No apparent lameness on exam. Took videos of walking

and circles. No pain with shoulder extension, nor with shoulder flexion/elbowextension - biceps not a problem. No pain with deep medial elbow palpation. Verystoic dog. Seemed tender with palpation on proximal humerus.

Tentative Diagnosis:Infraspinatus and/or Teres Minor strain or tearTreatment Plan:Laser shoulder and caudal scapula 3x/week, strict exerciserestriction, warm compresses, Rx Gabapentin

Recommendations:I will send out videos and x-rays to vetrehab listserv and Dr.Zink to get further ideas. Owner will bring in previous elbow x-rays for me tocopy. Owner will bring Loki in on Thursday for laser and then we will spend some

time using cavaletti's to video jumping behavior. (No charge for video session.)Technician: JLL - LeeComments:Suspect either infraspinatus or teres minor injury. Owner mentioned

that the dog is stiff and circumducts the LF leg when he first gets up, but warms outof it. Rec: sedation for shoulder x-rays and MSI measurements. Owner isconcerned with cost and ok's sedation for MSI evaluation, but wants to wait on

x-rays. See sedation template. After sedation, measurements, and x-rays (ok'dwhile dog sedated), explained that when muscle is spasmed it pulls on tendonwhich is attached on the proximal humerus and this area can be painful from

pulling on its attachment. Rec: hot packs 10 min TID (put thin towel between skinand hot pack), laser therapy on shoulder 3x/week for 2 weeks, and Gabapentin.Ownrer noted that she had previously used an Easy Walk Harness and the leash

always went to the R side which the owner was worried may have pulled on the Lshoulder. Owner was adamant that she did not start jump training with her dog untilhe was 19-20 months old because she was trying to avoid shoulder problems. In

October she was beginning with McLemburg jump training exercise with 90degree turns (dog is positioned same distance from jump as jump is high andowner is on opposite side same distance from jump). She said he was having

some trouble turning on both sides, but the L side was the worst. She started at 12inches and he began having troubles at 16 inches. Then she went to a friend'shouse and there was an accident. The friend has a dog walk about 1-2 feet off

ground and set against a wall. There was a nylon mesh tunnel on the walk and thedog decided to go up the walk and thru the tunnel. The tunnel fell into the wall onLoki's L side and he was caught inside the tunnel. She didn't think there was a

problem until he swelled up the next day (owner indicated region around caudalscapula and/or caudal to scapula). Owner also mentioned she had been working 2on/2 off contacts and was teaching weight shifting back, but Loki was having

troubles with this esp. when the incline was more steep. Owner says that she hasbeen resting Loki for about 2 months now and treating with chiro and acupuncturewith only temporary improvement.

Age: 1 Yrs. 11 Mos. Sex: MaleADDENDUM on 1/3/2012 at 15:36:12 from Christie M. Carlo (AAH)owner called after she had some time to research infraspinatus injury on the

internet. She noted that the internet indicated there was no treatment forinfraspinatus problems and only surgery was treatment. I explained that this isreferring to infraspinatus contracture and at this point Loki does not have

contracture so we will be treating the strain/sprain so that hopefully it will not end upin contracture.ADDENDUM on 1/3/2012 at 15:39:39 from Christie M. Carlo (AAH)

Supplements include: Ligaplex II 1 cap/day (on for a week) and encenseRelieve Soreness-- Christie Carlo, DVM, CCRT

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[Guest guest]

Just wondering if anyone has advice or other suggestions for this patient?

Thanks.

Christie Carlo, DVM, CCRT

>

> I was wondering if I could get some feedback about this patient. He is a

> young, energetic Border Collie with a subtle injury. I suspect an

> infraspinatus or teres minor injury, but would like anyone's opinion based

> on my notes. I will be taking some video of this dog later this week doing

> some jumping and turns to see what else we may be able to see.

>

> Here's my notes.

>

> *Comments: sedated for evaulation; measured for MSI - Goniometry: L 50

> degrees,*

> *R 40 degrees. Both shoulders popped (joint mob) during evaluation. Noted

> during*

> *sedated shoulder palpation that dog would pull L leg backwards and HR

> slightly*

> *increased with palpation of proximal humerus in region of infraspinatus and

> *

> *possibly teres minor. Did not get this reaction with R side palpation.

> Asked owner*

> *about doing x-rays. She had previously had x-rays done of elbows (I asked

> her to*

> *bring these in) and ok'd x-rays of shoulders. Laterals of both shoulders

> WNL - no*

> *flattening of humeral head, fx noted, or osteophyte formation.*

> *Recovery Notes: uneventful*

> *

> *

> *1/3/2012 P 61 60.00 CAPSULE of Gabapentin 100 mg Capsules (1618)*

> *Rx #: 82909 0 Of 1 Refills Filled by: JLL*

> *Give 2 capsule twice daily for pain until gone.*

> *1/3/2012 C 61 Medical Exam ***ADDENDUM 1/3/2012*

> *Client Concern: Loki dislocated his left shoulder during agility exercises

> in October.*

> *Since then owner has tried laser therapy, acupuncture, and supplements to

> help,*

> *but Loki's shoulder consistently pops out again after a little exercise.

> He gets*

> *muscle spasms and refuses to bend his elbow, and owner is pretty sure it's

> all*

> *because of the shoulder injury. Acupuncture helps, but nothing seems to be*

> *treating the underlying problem of the shoulder dislocation. JLee*

> *Temperature:103.8 - taken at end of sedation;*

> *Body Condition Score:3/5*

> *Mouth/Teeth/GumsWNL*

> *Eyes:Normal*

> *Ears:Normal*

> *Nose:Normal*

> *Throat:Normal*

> *

> *

> *Age: 1 Yrs. 11 Mos. Sex: Male*

> *

> *

> *Coat:Normal*

> *Skin:Normal*

> *Abdomen:Normal*

> *Heart/Lungs:WNL, no murmur or arrhythmia*

> *Lymph Nodes:Normal*

> *Musculoskeletal System:No apparent lameness on exam. Took videos of walking

> *

> *and circles. No pain with shoulder extension, nor with shoulder

> flexion/elbow*

> *extension - biceps not a problem. No pain with deep medial elbow

> palpation. Very*

> *stoic dog. Seemed tender with palpation on proximal humerus.*

> *Tentative Diagnosis:Infraspinatus and/or Teres Minor strain or tear*

> *Treatment Plan:Laser shoulder and caudal scapula 3x/week, strict exercise*

> *restriction, warm compresses, Rx Gabapentin*

> *Recommendations:I will send out videos and x-rays to vetrehab listserv and

> Dr.*

> *Zink to get further ideas. Owner will bring in previous elbow x-rays

> for me to*

> *copy. Owner will bring Loki in on Thursday for laser and then we will

> spend some*

> *time using cavaletti's to video jumping behavior. (No charge for video

> session.)*

> *Technician: JLL - Lee*

> *Comments:Suspect either infraspinatus or teres minor injury. Owner

> mentioned*

> *that the dog is stiff and circumducts the LF leg when he first gets up,

> but warms out*

> *of it. Rec: sedation for shoulder x-rays and MSI measurements. Owner is*

> *concerned with cost and ok's sedation for MSI evaluation, but wants to

> wait on*

> *x-rays. See sedation template. After sedation, measurements, and x-rays

> (ok'd*

> *while dog sedated), explained that when muscle is spasmed it pulls on

> tendon*

> *which is attached on the proximal humerus and this area can be painful from

> *

> *pulling on its attachment. Rec: hot packs 10 min TID (put thin towel

> between skin*

> *and hot pack), laser therapy on shoulder 3x/week for 2 weeks, and

> Gabapentin.*

> *Ownrer noted that she had previously used an Easy Walk Harness and the

> leash*

> *always went to the R side which the owner was worried may have pulled on

> the L*

> *shoulder. Owner was adamant that she did not start jump training with her

> dog until*

> *he was 19-20 months old because she was trying to avoid shoulder problems.

> In*

> *October she was beginning with McLemburg jump training exercise with

> 90*

> *degree turns (dog is positioned same distance from jump as jump is high and

> *

> *owner is on opposite side same distance from jump). She said he was having*

> *some trouble turning on both sides, but the L side was the worst. She

> started at 12*

> *inches and he began having troubles at 16 inches. Then she went to a

> friend's*

> *house and there was an accident. The friend has a dog walk about 1-2 feet

> off*

> *ground and set against a wall. There was a nylon mesh tunnel on the walk

> and the*

> *dog decided to go up the walk and thru the tunnel. The tunnel fell into

> the wall on*

> *Loki's L side and he was caught inside the tunnel. She didn't think there

> was a*

> *problem until he swelled up the next day (owner indicated region around

> caudal*

> *scapula and/or caudal to scapula). Owner also mentioned she had been

> working 2*

> *on/2 off contacts and was teaching weight shifting back, but Loki was

> having*

> *troubles with this esp. when the incline was more steep. Owner says that

> she has*

> *been resting Loki for about 2 months now and treating with chiro and

> acupuncture*

> *with only temporary improvement.*

> *

> *

> *Age: 1 Yrs. 11 Mos. Sex: Male*

> *

> *

> *ADDENDUM on 1/3/2012 at 15:36:12 from Christie M. Carlo (AAH)*

> *owner called after she had some time to research infraspinatus injury on

> the*

> *internet. She noted that the internet indicated there was no treatment for*

> *infraspinatus problems and only surgery was treatment. I explained that

> this is*

> *referring to infraspinatus contracture and at this point Loki does not have

> *

> *contracture so we will be treating the strain/sprain so that hopefully it

> will not end up*

> *in contracture.*

> *ADDENDUM on 1/3/2012 at 15:39:39 from Christie M. Carlo (AAH)*

> *Supplements include: Ligaplex II 1 cap/day (on for a week) and encense

> *

> *Relieve Soreness*

>

> --

> Christie Carlo, DVM, CCRT

>