SA: Shoulder Injuries Flashcards
(38 cards)
Identify the anatomy of the medial shoulder
(a) scapula
(b) humerus
(c) humeral head
(d) greater tubercle
(e) supraglenoid tubercle
(f) glenoid
(g) medial glenohumeral ligament
(h) subscapularis
(i) supraspinatus
(j) biceps brachii
Identify the anatomy of the lateral shoulder
(a) scapula
(b) humerus
(c) humeral head
(d) greater tubercle
(e) supraglenoid tubercle
(f) glenoid
(g) medial glenohumeral ligament
(h) infraspinatus
(i) supraspinatus
(j) teres major
(k) teres minor
(l) acromial part of deltoideus
(m) scapular part of deltoideus
(n) lattisimus dorsi
What should be included in the physical exam for shoulder injuries?
ROM: hyperextension/flexion
Shoulder abduction
Drawer motion
Individual muscles/tendons (passive flexibility, pain, atrophy)
R/O elbow and neuro
What is the relationship between the elbow and shoulder when performing ROM evaluation?
You cannot extend the shoulder without extending the elbow BUT you can extend the elbow without extending the shoulder
Signalment: OCD
Large and giant breed (juveniles)
Clinical Signs: OCD
Unilateral lameness (but lesions can be bilateral)
Lameness may wax and wane or disappear (may be d/t dislodgement of fragment)
Etiology: OCD
Genetics
Nutrition: excessive Ca, high calorie/protein
Differential Diagnoses: OCD
Elbow dysplasia
Panosteitis (juveniles)
Diagnosis: OCD
Radiographs: multiple obliques of both legs
PE: pain on extension, flexion, and rotation of shoulder
CT: ideal, but not required if rads are obvious
Arthrogram: if rotated x-rays not helpful and CT unavailable
Treatment: OCD
Surgical!!
Osteochondroplasty (flap removal)
Osteochondral autograft transfer system (OATS)
Prognosis: OCD
W/ surgery
Excellent for caudal
Good for caudo-central lesions
MSI
Medial shoulder instability/syndrome
Pathology of medial compartment of shoulder
Etiology: MSI
Unknown
Repetitive microtrauma/overstretching suggested
Signalment: MSI
Adult athletes: agility, flyball, hunting, etc.
Clinical Signs: MSI
Mild-moderate chronic lameness
Decreased performance
Change in gait (2 vs 1 footed weaves, etc)
Diagnosis: MSI
Painful shoulder abduction (non-sedated)
Rads: mild OA or normal
Subjectively increased abduction angle
What is normal objective abduction angle measurement?
32.6 +/- 2 degrees
(26 medium to large breed dogs)
How is abduction angle measured?
Sedation
Full shoulder and elbow extension
Goniometer centered on shoulder joint
Along axis of humerus
Parallel to scapular spine
How can we confirm an MSI diagnosis?
Arthroscopy: intra-articular components of MGHL and subscapularis
MRI: all intra- and extraarticular structures (beside cartilage)
Ultrasound: technically challenging
Treatment: MSI
Radiofrequency shrinkage (controversial)
Prosthetic ligament reconstructuion
Tendon transposition (biceps)
Post-op: hobbles/rehab
Etiology: Biceps/Supraspinatus Tendinopathies
Degeneration +/- inflammation
Hypovascular areas at origin/insertion (hypoxia = fibrocartilaginous transformation of tendon)
Etiology: Primary Shoulder Tendinopathies
Repetitive microtrauma (large/active dogs)
Trauma
Overuse
Etiology: Secondary Shoulder Tendinopathies
Biceps
Irritation/inflammation due to other joint disease (OCD, supraspinatus, MSI)
Signalment: Shoulder Tendinopathies
Middle-aged, medium/large breed athletic dogs
