Diagnosed "Shoulder Laxity"

Mason

Since September, my dog has been limping on his left front leg off and on, with varying severity. I took him in to be evaluated within a week after I first noticed it, along with a small lump over the wrist. A diagnosis of tendonitis was made, based on location and palpation of the entire leg. I took him to another vet, who did x-rays and came to the same conclusion. The leg was wrapped, anti-inflammatories given, and strict rest for 6 weeks. All better, until a couple weeks ago..

I noticed a very subtle limp, which disappeared for a week. Last Wednesday, I was throwing a ball for him. I started to notice a limp after about 10 minutes of play, on the same leg. It got progressively worse as he continued to chase the ball. I stopped the game and called his vet.

Saturday, he went in. They did the normal palpation and range of motion with the leg, as well as x-rays of the elbow of the affected leg, and the shoulders of both legs. Nothing on x-ray. The vet told me he'd felt some degree of laxity in both shoulders, with the left being worse. Okay, so what now? He really had nothing for me other than to tell me he needed to strengthen the shoulder more.

Has anyone had any experience with this sort of thing? What could I do to help the poor boy out? I'm trying to keep him from jumping on and off things, as well as making quick turns. I live upstairs in a house (renting the upper level), so he has no choice but to make that climb at least 2-3 times a day. The vet had mentioned swimming, but its still below freezing here, and I can't afford hydrotherapy. So, does anyone have any suggestions? Thanks in advance

alphadoginthehouse

I don't think I've ever heard of this. It will be interesting to see what others (with much more knowledge than me) have to say about it.

Not much help am I? I hope he's doing better at any rate.

lulusmom

I have no experience with this condition but I found some interesting reading on the subject. It would appear that it isn't always easy to correctly diagnose these types of problems so with me being the nervous nelly type, I'd want the diagnosis confirmed by an orthopedic specialist.

http://wvc.omnibooksonline.com/data/.../2007_V226.pdf

Mason

I wouldn't even know how to find an orthopedic specialist. There, apparently, aren't any in Kentucky, and I'm having a hell of a time finding any in Ohio (save for Ohio State) or Tennessee. Any ideas?

Mr. V

http://www.acvs.org/AnimalOwners/Fin...eoninYourArea/

Here is a way to find any kind of specialist in your area.

Kentucky should have plenty since Kentucky is a contract state with Auburn's vet school. Ohio and Tennesee should also have plenty available because they each have vet schools as well.

I can post a very long article on shoulder lameness from a veterinary conference if anyone wants. It may take quite a few posts.

Mr. V

Well, here's the shoulder part of it. I'll post the rest if anyone wants me to.

[From the Western Veterinary Conference 2007]
Laura E. Peycke
Texas A&M College of Veterinary Medicine
College Station, TX, USA

Shoulder Instability

Stability of the shoulder is derived from passive and active restraints. Passive mechanisms include the medial and lateral glenohumeral ligaments, surrounding joint capsule, joint conformation, and synovial fluid cohesion. The medial collateral ligament (MCL) commonly appears as "Y" shaped with the cranial arm coursing caudally from its origin at the medial surface of the supraglenoid tubercle. The caudal arm of the MCL originates from the medial surface of the scapular neck and joins the cranial arm to insert onto the humeral neck. The MCL and associated joint capsule is a major factor in providing joint stability; complete medial luxation occurs following transection of the MGHL. The lateral collateral ligament (LCL) originates from the lateral rim of the glenoid and extends ventrally to insert onto the humerus at the caudal region of the greater tubercle. The joint capsule originates from the periphery of the glenoid cavity. Medially, the joint capsule forms a synovial recess due to its attachment several millimeters proximal to the glenoid rim.

The concavity of the glenoid and the fit of the humeral head into the glenoid provide joint stability. This is particularly true when compression across the joint is enhanced by active muscle contraction. There is no labrum surrounding the glenoid as in man to lend further stability to the joint; rather the joint capsule attaches directly to the rim of the articular cartilage.

Examination of the shoulder for stability should be done under anesthesia or heavy sedation. Flexion, extension, abduction, craniocaudal translation, and rotational stability of the shoulder joint should be assessed. Normal range of flexion and extension are 40 degrees for flexion and 165 degrees for extension. Circumduction of the shoulder should not give rise to subluxation. Cranial and caudal translation should be similar in both shoulders. A normal abduction test is approximately 23 degrees; abnormal abduction is considered present when abduction exceeds this degree and there is a difference in abduction angle between the injured side and the normal side. When performing the abduction test, it is essential to maintain the limb in extension with the elbow in neutral position. If the elbow is externally rotated with the limb in extension, the shoulder joint will be internally rotated. The latter will give a false positive abduction test. To maintain the elbow in neutral position, the examiner should place his/her thumb on the lateral surface of the olecranon caudal to the humeral epicondyle. Maintaining the thumb facing upward assures that the elbow remains in neutral position.

Interpretation of shoulder laxity should be done carefully. It is not uncommon to appreciate abnormal abduction and cranial translation in cases of chronic unilateral forelimb lameness and interpretation of shoulder laxity is often attributed to muscle and ligament atrophy secondary to other underlying pathology. In some cases, the shoulder laxity is secondary to long standing shoulder pathology such as OCD. Other cases are referred to our centers for treatment of shoulder pain. The pain is noted when the shoulder is placed in extension. By and large these cases are latent elbow dysplasia and the pain in fact arises from extension of the elbow when the shoulder is placed in extension.

Dynamic shoulder stability is possible with contraction of the cuff muscles of the shoulder. These muscles include the biceps brachii, subscapularis, supraspinatus, infraspinatus and teres minor muscles. Active contraction of all or selective cuff muscles induce compression across the shoulder joint as well as increasing tension in the joint capsule. While maintaining a neutral position of the shoulder, transection of the biceps brachii tendon permitted greater movement of the humerus in the lateral, medial and cranial directions. In the extended position, the medial translation of the humerus was significantly increased after biceps tendon transaction.

Forelimb lameness attributed to shoulder instability has become more prevalent in the veterinary literature. There appears to be differences in the frequency of presentation of medial shoulder instability and this has led to disagreement between diagnostic techniques, criteria for diagnosis and guidelines for recognizing intra-articular pathology associated with instability. Some surgeons believe it is possible to detect increased intra-articular volume and redundant capsular/ligament structures (primarily medially) within the joint while others believe this cannot be accurately detected arthroscopically. Further, the significance of intra-articular lesions remains controversial. While some surgeons believe small tears of the cranial arm of the MCL result in instability and require treatment, others believe these small tears are insignificant and most likely iatrogenic. The gutter medial to the cranial arm of the MCL adjacent to the insertion of the subscapularis is often diagnosed as a site of trauma. However, this area can show nonspecific changes such as synovial proliferation in association with such conditions as OCD. Treatment for cases of shoulder instability (based on clinical signs, muscular changes, consistent palpation, abduction measurements and arthroscopic findings) have been performed using radiofrequency-induced thermal capsulorrhaphy

Binkalette

Hmm... this is interesting. I just made an appointment for Maggie earlier today to see the vet tomorrow because she has been limping on her front left leg. It's not very consistent though, she's been doing it right after she gets up from laying.. and seems to get better after that. It could be a million different things I suppose.. but I had never heard of this.

Mason

Well, now you have me scared of elbow dysplasia. He did have a radiograph taken of the elbow on the affected leg, and it appeared normal. BUT! A clean elbow x-ray can be seen in younger mature dogs with elbow dysplasia. Mason is 20 months old. Wonderful. I guess if things don't clear up with straight line exercise (it's been suggested to walk him more frequently, closer to my body, as well as try out the swimming), I'll take him in for more x-rays, and perhaps see about getting a referral to an Ortho.

Binkalette: What did the vet say about Maggie? Hope she's doing well.

Binkalette

The vet thinks she has a soft tissue injury.. She said all her bones and joints felt normal, but when she would try to extend Maggie's elbow all the way she got very uncomfortable with it. She prescribed an anti-inflammatory and told me to restrict Maggie's activity for 7-10 days. No running around playing with Zoe, no Jumping off the furniture, no going down the stairs. If there's no improvement by next week she wants me to come back and we'll do Xrays, but she seemed very confident this would take care of it.

Oh and she mentioned lyme disease, but Maggie hasn't had any ticks or anything.. but she said if she gets lethargic or starts throwing up at all she wants me to bring her back asap.