Shoulder

Question 1

What is the typical signalment of shoulder OCD?

Answer 1

• biphasic age distribution: young (cartilage injury), mature (DJD)
• male
• large to giant breeds

Question 2

Describe the physical exam findings of a dog with shoulder OCD

Answer 2

• forelimb lameness (head bob, muscle atrophy)

- pain on hyperextension and flexion of shoulder joint

Question 3

What are the indications for conservative management of should OCD?

Answer 3

• small defect
• minimal to no lameness
• young dogs

Question 4

How can shoulder OCD be managed conservatively?

Answer 4

• rest
• diet: control energy, vitamin D, and Ca intake
• NSAIDs

Question 5

Describe the typical surgical procedure done for shoulder OCD

Answer 5

• flap removal and lavage
• debridement of bone
• defect heals with fibrocartilage

Question 6

What is the prognosis for a dog with shoulder OCD?

Answer 6

• good to excellent with surgery (fair to good for working dogs)
• DJD expected (mild with surgery)

Question 7

Describe the pathogenesis of biceps brachii tendinopathy

Answer 7

• repetitive strain microtrauma
• tendon fiber disruption
• acute to chronic inflammation of tendon and associated synovial tissue

Question 8

Describe the anatomy of the biceps brachii tendon

Answer 8

• origin: supraglenoid tubercle
• travels through intertubercular groove
• contained by transverse retinaculum
• insertion: proximal-medial radius

Question 9

What is the typical signalment/presentation for biceps brachii tendinopathy?

Answer 9

• adult, median to large breeds
• weight bearing lameness
• chronic, intermittent

Question 10

Describe how you would assess pain in a patient with biceps brachii tendinopathy

Answer 10

maximally flex shoulder and extend elbow
- deep palpation over intertubercular groove
- apply tension to biceps insertion
standing exam
- palpate insertion of tendon
- pressure applies tension to  biceps

Question 11

How is acute biceps brachii tendinopathy treated?

Answer 11

• confinement
• NSAIDs
• physical therapy

Question 12

How is recurrent/persistent biceps brachii tendinopathy treated?

Answer 12

• intra-articular corticosteroid injections
• strict confinement
• physical therapy

Question 13

What are the indications to surgically treat biceps brachii tendinopathy?

Answer 13

• refractory to medical treatment
• radiographic changes
• mechanical deficits
• moderate to severe lameness

Question 14

What surgical procedures are used to treat biceps brachii tendinopathy?

Answer 14

• tenotomy of biceps tendon

- tenodesis of bicipital tendon

Question 15

Describe the pathophysiology of shoulder intability

Answer 15

• abnormally increased range of motion
• laxity in support structures of the shoulder
• repetitive microtrauma

Question 16

What are the physical exam findings of a dog with shoulder instability?

Answer 16

• muscle atrophy
• pain on joint manipulation
• medial: increased abduction angle (50 degrees)

Question 17

What is the treatment for moderate shoulder instability?

Answer 17

• arthroscopic thermal capsulorrhaphy

- rest, PT, hobbles

Question 18

What is the treatment for severe shoulder instability?

Answer 18

• medial glenohumeral ligament reconstruction

- velpeau sling

Question 19

Define contracture

Answer 19

muscle shortening not caused by active contraction

Question 20

Describe the pathogenesis of infraspinatus contracture

Answer 20

• acute, traumatic disruption of muscle fibers
• fibrosis and contracture secondary to necrosis
• non-painful, non-weight bearing lameness
• acute lameness subsides, then chronic lameness appears

Question 21

What is found on physical exam of a dog with infraspinatus contracture?

Answer 21

• elbow adducted, antebrachium abducted
• scapula elevates when shoulder is rotated
• limited range of motion
• usually no pain on manipulation

Question 22

How is infraspinatus contracture treated?

Answer 22

• tenectomy of infraspinatus tendon
• release of other capsular adhesions
• physical therapy

Question 23

What is found on physical exam of a dog with traumatic shoulder luxation?

Answer 23

• non-weight bearing lameness
• pain on shoulder palpation
• malpositioning of greater tubercle
• M luxation: limb abducted
• L luxation: limb adducted

Question 24

How is traumatic shoulder luxation treated?

Answer 24

• closed reduction (recent injury, no fractures)

- open reduction + ligament repair

Question 25

What is the typical signalment for congenital shoulder luxation?

Answer 25

- small, toy breeds | - 3-10 months of age

Question 26

How is congenital luxation treated?

Answer 26

- open reduction/capsulorrhaphy - glenohumeral ligament reconstruction - if glenoid dysplasia - salvage procedures