Lecture 14: Sx of the Shoulder (Exam 3)

Question 1

Definition

When loss or damage of supporting structures of joint cause separation of the humerus from scapula

Answer 1

scapulohumeral joint luxation (dislocated shoulder, shoulder luxation)

Question 2

What is the etiology for a scapulohumeral luxation

Answer 2

trauma or congenital

Question 3

What is the most common deviation in a scapulohumeral luxation

Answer 3

medial and lateral (cranial and caudal are rare)

Question 4

What are the 3 supporting structures of the Scapulohumeral joints

Answer 4

• joint capsule
• glenohumeral ligaments
• surrounding tendons (supra/infraspinatous, ters minor and subscapularis)

Question 5

What are two very important structures of the scapulohumeral joint that if torn can cause humeral head luxation?

Answer 5

• biceps tendon
• medial and lateral glenohumeral ligaments

Question 6

Definition

Occur after lateral glenohumeral ligament and infraspinatus tendon rupture

Answer 6

Lateral humeral luxation

Question 7

Definition

from tearing of medial glenohumeral ligament and subscapularis ligament?

Answer 7

medial humeral luxation

Question 8

Congenital or developmental laxity of scapulohumeral capsule and ligaments is ALWAYS (medial/lateral)

Answer 8

medial

Question 9

In congenital scapulohumeral luxation what is deformed or hypoplastic leading to medial luxation

Answer 9

glenoid cavity (often bilateral)

Question 10

Signalment for scapulohumeral luxation for if it is caused by trauma? What about congenital?

Answer 10

• trauma: any dog, rare in cats
• congenital: small and miniature dog breeds(toy poodles shetland sheep dogs)

Question 11

Fill in the ?s

When testing lateral luxation the Foot is rotated ? and greater tubercle palpable lateral to the normal location

Answer 11

internally

Question 12

Fill in the ?s

When testing medial luxation Foot is rotated ? and greater tubercle palpable medial to the normal location

Answer 12

externally

Question 13

Are chronic congenital medial luxation’s of the scapulohumeral joint painful?

Answer 13

not usually

Question 14

What may make it impossible to reduce the humeral head in patients with chronic congenital medial luxation of scapulo humeral joint

Answer 14

deformed glenoid cavity

Question 15

What radiographs should you take for a scapulohumeral luxation

Answer 15

Lateral and ventrodorsal radiographs (check thorax as well if trauma)

Question 16

Which of these radiograph images is the patient a congenital medial luxation patient

Answer 16

A (no glenoid cavity)

Question 17

What is on the DDX for scapulohumeral joint luxation

Answer 17

• degenerative joint disease
• humeral osteosarcoma
• contracture of infraspinatus or supraspinatus

Question 18

What scapulohumeral luxation patients can we medically manage

Answer 18

chronic medial luxation with mild intermittent lameness and minimal djd

Question 19

Fill in the ?s

In reduction of lateral luxation:

• you apply medial pressure to the ?
• lateral pressure to the ?
• If stabilized apply ? for 10-14 days

Answer 19

• humeral head
• surface of the scapula
• lateral spica splint

Question 20

What kind of splint

Answer 20

splica splint

Question 21

Fill in the ?s

Medial luxation by trauma should be reduced then a ? sling should be applies

Answer 21

velpeau sling

Question 22

What are 3 scenarios in which you need to surgically treat a scapulohumeral luxation

Answer 22

• if unstable after closed reduction
• open reduction and stabilization needed
• congenital luxation’s with severe or persistent lameness

Question 23

What surgical treatment is being used here on a medial glenohumeral luxation

Answer 23

capsulorrhaphy/prosthetic ligament reconstruction

Question 24

What method of scapulohumeral luxation correction is seen here?

Answer 24

biceps tendon transposition

Question 25

# **Fill in the ?s** * To transpose the biceps tendon, incise **?** ligament. * Make an incision in joint capsule to free it & move tendon **?**. * Secure it to humerus w/ a bone screw & spiked washer.

Answer 25

* transverse humeral * Medially

Question 26

What splint should be used post op in a lateral luxation

Answer 26

**SPICA SPLINT**

Question 27

What splint should be used post op in a medial luxation

Answer 27

**VELPEAU SPLINT**

Question 28

After surgery on a luxating scapulohumeral joint, how long should activity be limited

Answer 28

6-12 weeks

Question 29

What is a Major complication of scapulohumeral joint luxation corrections?

Answer 29

relaxation

Question 30

# **Fill in the ?s** **Scapulohumeral luxation:** After closed reduction, Prognosis is **?** for return of limb function if joints stable during forelimb manipulation

Answer 30

Good

Question 31

# **Fill in the ?s** **scapulohumeral luxation:** After closed reduction Prognosis **?** if joints unstable

Answer 31

guarded (open reduction and joint stabilization)

Question 32

# **Fill in the?s** **Scapulohumeral luxation:** after closed reduction, Prognosis **?** w/ congenital or developmental medial luxation

Answer 32

guarded

Question 33

What is recommended when it is not possible to maintain reduction of the shoulder joint

Answer 33

salvage procedure

Question 34

Shoulder instability characterized by pathologic increase of ROM of shoulder joint

Answer 34

Shoulder instability (shoulder subluxation/ glenohumeral instability)

Question 35

What plane are shoulder instability commonly in?

Answer 35

mediolateral

Question 36

Pathophysiology of shoulder instability is commonly due to what

Answer 36

tearing and stretching of medial and lateral supportive structure

Question 37

What are the supportive structure that might be torn or stretched to cause shoulder instability

Answer 37

medial or lateral glenohumeral ligaments and subscapularis tendon

Question 38

What is the Signalment and history of a patient presenting with shoulder instability

Answer 38

* any size dogs * active * older (after years of activity) * moderate chronic lameness (acute lameness not common)

Question 39

If you suspect shoulder instability in a patient what should you do on physical exam

Answer 39

* gait analysis * orthopedic exam (check spine of scapula for muscle atrophy) * palpation of limb with increased angles of abduction

Question 40

# **Fill in the ?s** Not recommended anymore but according to the readings, **?** of the shoulder joint to evaluate for medial instability

Answer 40

abduction palpation

Question 41

How do you definitively diagnose a shoulder instability

Answer 41

arthroscopy: * Tearing or laxity of medial glenohumeral ligament, lateral glenohumeral ligament or subscapularis tendon * Tearing or inflammation of biceps tendon may also occur)

Question 42

What might you see on radiograph that would suggest a shoulder instability

Answer 42

* osteoarthritis * concurrent bicipital tendinopathy (Osteophytosis & sclerosis of bicipital groove on skyline views) * **MOST OFTEN NORMAL**

Question 43

What is the DDX for shoulder instability

Answer 43

* OCD * biceps disease * OA * trauma * neoplasia

Question 44

What is the Medical management of shoulder instability includes

Answer 44

* rest and physical therapy * stabilization orthotics

Question 45

What is designed to maintain ROM while strengthening muscles in patients with joint shoulder joint issues

Answer 45

rehabilitation

Question 46

What are the two major types of surgical treatment of shoulder instability

Answer 46

* arthroscopic * open surgery

Question 47

Arthroscopic assisted surgical techniques for shoulder instability include

Answer 47

* Arthroscopic-assisted anchor & suture techniques * Tightrope (TR) stabilization of medial shoulder instability * Radiofrequency shrinkage of ligaments & joint capsule **(DO NOT DO ANYMORE SERIOUS COMPLICATIONS)** * Arthroscopic-assisted anchor & suture techniques

Question 48

# **Fill in the ?s** **Open surgery for shoulder instability include:** Involves placement of suture anchors at sites of origin & insertion of **?**

Answer 48

medial glenohumeral ligament

Question 49

What was preformed here

Answer 49

tightrope stabilization

Question 50

**After correction of shoulder instability with tight rope stabilization:** what should be used for 6-12 weeks as well as PT management, activity restriction and passive ROM/ swimming once its removed?

Answer 50

Hobbles

Question 51

# **Fill in the ?s** Full athletic function after tight rope stabilization should be achieved in **?** weeks

Answer 51

16

Question 52

After shoulder instability surgery what splint should you place on the limb

Answer 52

velpeau sling

Question 53

What are some side effects of a velpeau sling? What can be done for the side effect?

Answer 53

* contracture of the carpus * PT management and reevaluate every 2-4 weeks

Question 54

Prognosis of shoulder instability is variable dependent on what

Answer 54

severity of soft tissue injury and OA

Question 55

What is the common cause of shoulder lameness in dogs

Answer 55

Bicipital tendon disease ( bicipital tenosynovitis historically- proposed tendinopathy)

Question 56

What kind of bicipital tendon disease is due to overuse of chronic repetitive use

Answer 56

primary (inflammation- probably not)

Question 57

What type of bicipital tendon disease is a response to other articular disease

Answer 57

secondary (loose fragment and acute trauma)

Question 58

What might you see a patient present for with bicipital tendinopathy

Answer 58

* middle to older age * medium to large breed * chronic intermittent or progressive lameness * shoulder pain on joint manipulation * **direct palpation of bicep tendon of origin**

Question 59

What diagnostic imaging technique is used most commonly to see bicipital tendinopathy?

Answer 59

* ultrasonography * radiographs in a skyline view may show mineralization and irregularities * hard to get MRI ? expensive

Question 60

Should you immediately do surgical treatment of bicipital tendinopathy patients

Answer 60

NO (medical treatment should be tried first)

Question 61

Are oral nsaids effective in treating bicipital tendinopathy

Answer 61

**NOOOOO**

Question 62

What can you use for medical management of bicipital tendinopathy

Answer 62

* 1-2 intra-articular injections of long-acting corticosteroid (Methylprednisolone acetate (Depo-Medrol),Triamcinalone) * Corticosteroids reduces inflammation * rest is critical (diseased tissue)

Question 63

# **Definition** Traditional open surgery approach to correction of bicipital tendinopathy

Answer 63

Tenodesis (generally good results)

Question 64

In a tenodesis procedure you secure the tendon to what

Answer 64

proximal humerus

Question 65

# **Definition** What surgical method for correction of bicipital tendinopathy uses arthroscopy to cut tendon at its origin

Answer 65

Tenotomy

Question 66

What is the original description for patients with supraspinous tendinopathy

Answer 66

Dystrophic calcification (found in asymptomatic dogs)

Question 67

What is the typical Signalment for supraspinous tendinopathy

Answer 67

* middle-aged large breed dogs * rottweilers and labrador retriever

Question 68

What may you see on radiographs of a patient affected with supraspinous tendinopathy

Answer 68

bilateral mineralization

Question 69

What might you find when doing a physical and orthopedic exam

Answer 69

* shoulder pain on joint manipulation * pain increased with calcification of tendon

Question 70

What is required to differentiate supraspinatus tendinopathy verses bicep tendinopathy & why

Answer 70

* MRI * clinical signs related to both conditions

Question 71

What can you use to treat supraspinous tendinopathy medically

Answer 71

strict rest and nsaids

Question 72

# **Fill in the ?s** Surgical repair of supraspinous tendinopathy includes excision of **?**

Answer 72

calcified tissue(diseased tissue if impingement on biceps tendon)