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PhoneNumber number required! Typically a bony fracture can heal to the point of vigorous use in 12 weeks, soft tissue injuries will take up to 6 months sometimes.
This can be extremely challenging especially if the lameness is only occasionally. Because the patients are usually middle aged larger breed dogs ruling out elbow problems is also very important. Because the injury is usually to a ligament or tendon there may be no changes visible on an X ray. The diagnostic process for shoulder injuries follows the same path as any other injury. First and foremost we must get a comprehensive history, this will provide clues as to the cause and also provide important information to help provide advice in the healing phase.
Dogs that are in active sporting competition will not recover without a substantial period of rest followed by recuperation and rehabilitation followed by return to training. A major shoulder injury will take a dog out of competition for a year. The next process is clinical examination and as shoulder injuries will often only cause a low grade lameness most of the time, seeing video of the dog at home when it is lame can be very useful.
Specific shoulder structures can be assessed with palpation tests, unfortunately none are specific and most just confirm that it is the shoulder that is the cause of lameness. Ruling out the elbow is important as these two joints can mimic each other and especially in some of the large breed dogs we see. Once we know that it is the shoulder that is the cause of lameness and we have a fair idea of what is injured then we can think about confirming the diagnosis and so determine a treatment plan by imaging the structures.
Traditionally X rays have been used to assess bony structures and in some cases where soft tissues have significantly degenerated and calcified, these changes may be seen on X rays. CT will allow us to see more detail in the shoulder and CT is very useful to rule out the elbow. Diagnostic ultrasound is then hugely beneficial in the shoulder as most of the structures on the side and front of the shoulder can be seen and typically this is done at the same time as the CT, assessing shoulder stability and so the integrity of ligaments under the same anaesthetic plays an important part as well.
Once this is done we would then talk about the results and findings and decide upon the next step, in some cases we can make a diagnosis and start a conservative treatment straight away such as a minor medial ligament injury in other cases we may need to image structures inside the joint by arthroscopy and in other cases we may elect to consider arthroscopy for diagnosis and also perform a surgical procedure reconstruction of a traumatic ligament injury, debridement of a biceps tendon impingement, removal of a fragmented caudal glenoid.
The arthroscopic procedure is done on a different day so that we have an opportunity to discuss the condition and options and also prepare for the post operative management. In some cases we may want to fit your dog into a shoulder support brace in advance of surgery.
In very severe cases shoulder arthrodesis Fusion may have to be the only option available. This is clearly a very big undertaking and is a last resort procedure however the surgery and potential for problems has been improved considerably by using CT data and custom made cutting and reduction guides. We are actively working on developing shoulder replacement but this is not yet to a point in which we can use clinically yet The strength of normal, healthy bone resists these forces.
A bone breaks when it is subjected to a force that is greater than its own strength. Once it is broken, it must be immobilized sufficiently to allow the bone to heal back together. This is where veterinary treatments, like those listed below, are used to ensure quality bone healing and good leg use. External coaptation : a splint or cast ; applied to the outside of the limb; good at resisting bending forces and fair at resisting torsion and compression forces. External fixation : a surgically applied device that is attached to the bone with pins that thread into the bone, but come out through the skin.
This method is very good at resisting bending, compression and torsion forces Figure 4. Internal fixation : surgically applied devices implanted inside the bone or on the surface of the bone.
Various devices are available and offer different results against the various forces such as plates, screws, nails, pins, wires Figures 5 and 6. Several factors go into making up a final treatment plan for a fracture. We use this scale of information to come up with the best repair options for an individual pet. Old Bouncy, active Sick, debilitated Giant or toy size Other injuries. After all is considered, you may be faced with choices for fracture repair; one option might be best for your home environment, time investment, and possible financial constraints.
Splints need frequent evaluations and changes and complications may result in a longer overall healing period, whereas some fixation methods improve the chance of successful outcomes without demanding post-operative care. As a general rule, follow all instructions provided to you by your veterinary surgeon. Some of those instructions may include the following recommendations:.
If your pet has splint or cast for final fracture treatment or if a bandage was applied after surgery to help with pain and swelling, careful monitoring and maintenance is necessary for safe and effective bandage wear. Major problems can result from simple bandages; please do not hesitate to call your veterinary surgeon if any problems are noted. Monitor the bandage for slipping or damage from chewing , etc.
If it changes position or becomes wet or loses its integrity, serious problems may occur with healing or new problems with pressure sores may develop. Please call your veterinarian if any changes in bandage position occur; the bandage may need to be replaced. If the end of the bandage is open, check the two central toenails twice daily. They should be close together. If they are spreading apart, this indicates toe swelling which can result in serious complications , and the bandage needs to be assessed by your veterinarian within hours.
Please call your veterinarian if any swelling is noted. The bandage must be kept clean and dry. Place a plastic baggy on the end every time your pet goes outside. Remove the plastic covering when indoors. If the bandage gets wet or you notice any bad odor coming from the bandage, it will need to be evaluated within hours; serious skin problems may develop. We strongly advised that you do not modify the bandage in any way. If you are concerned about the security or integrity of the bandage, please return to your veterinarian or veterinary surgeon for re-evaluation and re-application as needed.
Please know that bandages and splints can cause very serious complications. They can be an effective treatment tool for fracture healing and pain control, but careful monitoring and appropriate follow-up must occur. Your pet cannot tell you that the bandage hurts or is uncomfortable; you need to be attentive to any change. Confine your pet as directed by your veterinary surgeon; this often includes confining him or her to one section of the house on carpeted floors. Use baby gates, etc.
Confine to a small area, room, or crate when unattended. Do not allow any playing, running, or jumping. For dogs, use a short leash when going outside for bathroom breaks.
The best way to confined cats is to have a large dog crate where food and liter can be place. The biceps brachii tendon provides minimal cranial support to the normal shoulder but is commonly transposed to provide medial or lateral support after traumatic joint luxation. The scapula is a broad, flat bone with a prominent spine and numerous muscle origins and insertions.
It is loosely attached to the chest wall through the insertions of a number of muscles, including the rhomboideus, subscapularis, and trapezius. Scapular areas can be anatomically divided into the body, spine, neck, and glenoid cavity, with differing surgical approaches and treatments recommended for fractures in each area Fig.
In immature animals, the dorsal border of the scapula serves as a physis for long bone growth. The distal scapula has no physis for long bone growth, but the supraglenoid tubercle is a secondary center of ossification in the immature dog and this apophysis is often misdiagnosed as a fracture in dogs until radiographic closure from 6 to 7 months of age.
Figure Percentage of canine scapular fractures occurring in various regions of the scapula from a study of scapular fractures.
The proximal humerus has a number of defined tubercles with important muscle insertions. The greater tubercle provides insertions for the supraspinatus tendon cranially and the infraspinatus and teres minor tendons laterally.
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