Surgical Disorders of the Shoulder

Question 1

Fact Frog: If something is a developmental joint dz, it’s probably…

Answer 1

Bilateral with biphasic age grouping

Question 2

What is the typical signalment of osteochondritis dissecans?

Answer 2

Large and giant breed males

4-8 months (cartilage injury) or middle age to older (secondary DJD)

Question 3

What are 4 clinical signs on PE of osteochondritis dissecans in the shoulder?

Answer 3

Forelimb lameness
Atrophy
Pain on hyperextension and flexion of shoulder
Unilateral lameness (even with bilateral dz)

Question 4

What would you expect to see on RADs of osteochondritis dissecans in the shoulder?

Answer 4

Flattened caudal humeral head

Question 5

What is conservative treatment for osteochondritis dissecans in the shoulder?

Answer 5

Rest
Reduced calorin intake
NSAIDs

Question 6

What is the recommended treatment for osteochondritis dissecans in the shoulder?

Answer 6

Surgical intervention

Question 7

How do you treat osteochondritis dissecans of the shoulder surgically?

Answer 7

Remove flap, lavage joint, debride bone to allow defect to heal with fibrocartilage

Question 8

What is the preferred surgical approach for osteochondritis dissecans of the shoulder?

Answer 8

Arthroscopy preferred over arthrotomy

Question 9

What is the prognosis of osteochondritis dissecans in the shoulder?

Answer 9

Near normal to normal fxn with surgery
Pet dog = good to excellent prognosis
Working dog = fair to good (juts because they are expected to do more)

Question 10

What is the cause of biceps brachii tendinopathy?

Answer 10

Injury with tendon fiber disruption and acute to chronic inflammation of the tendon and associated synovial tissues

Question 11

Fact Frog: If the etiology is repeptitive trauma or overuse…

Answer 11

Probably see unilaterally in adult dogs

Question 12

What is the presentation of biceps brachii tendinopathy?

Answer 12

Middle-aged, medium and large breed dogs with weight-bearing lameness

Question 13

What are 4 descriptions of the weight-bearing lameness of biceps brachii tendinopathy?

Answer 13

Chronic, intermittent
Progressive
Lameness worsens with exercise
Unilateral

Question 14

What will you find on exam on a dog with biceps brachii tendinopathy?

Answer 14

Muscle atrophy

Pain when shoulder is maximally flexed and elbow is extended

Question 15

What 4 diagnostics could you use with biceps brachii tendinopathy?

Answer 15

RADs (to r/o other issues)
US
MRI (more for research)
Arthroscopy (diagnostic and therapeutic)

Question 16

Why is arthroscopy the best way to diagnose biceps brachii tendinopathy?

Answer 16

Because it’s diagnostic and therapeutic

Question 17

What is the treatment for acute biceps brachii tendinopathy? 3 things

Answer 17

4-6 weeks confinement
NSAIDs
Physical therapy

Question 18

What is the treatment for recurrent/persistent biceps brachii tendinopathy?

Answer 18

Intraarticular corticosteroid injection
Strict confinement for 4-6 weeks
Physical therapy

Question 19

Do we risk tendon rupture when treating biceps brachii tendinopathy with corticosteroids?

Answer 19

It can be a risk because steroids are catabolic, but it’s not really something you see clinically

Question 20

What are 4 indications for surgery on biceps brachii tendinopathy?

Answer 20

Refreactory to medical therapy
Radiographic changes
Mechanical deficits
Moderate to severe lameness

Question 21

What are the 2 surgical procedures you can do on biceps brachii tendinopathy?

Answer 21

Arthroscopic evaluation and then…
Tenotomy of biceps tendon (cutting the tendon)
Tenodesis of bicipital tendon (cut the tendon and fix it in place lower down on the humerus)

Question 22

What is the prognosis of biceps brachii tendinopathy with medical treatment?

Answer 22

Good to poor

NOTE: Physical therapy improves results
NOTE: Doesn’t limit surgical treatment if you try this first

Question 23

What is the prognosis of biceps brachii tendinopathy with surgical treatment?

Answer 23

Good to excellent

Tenotomy = excellent results
Tenodesis = "classic treatment"

Question 24

What is shoulder instability?

Answer 24

Abnormally increased range of motion due to laxity in the support structures of the shoulder

Question 25

What ligaments are responsible for shoulder stability normally?

Answer 25

Medial and lateral glenohumeral ligaments

Question 26

How does shoulder instability happen?

Answer 26

repetitive microtrauma

Question 27

What is the most common type of shoulder instability?

Answer 27

~80% is medial shoulder instability