Medial Shoulder Instability

[emilyfalk]

I am interested in taking an informal survey of those who have dogs that have been diagnosed with this condition, or even those who may know of dogs that have been afflicted.

 

My own 6yo underwent surgical repair 3 years ago for unilateral MSI. At the time, her surgeon reported to me that he had performed the arthroscopic procedure on over 400 other border collies; dogs that were both working and performance dogs. As a vet who is interested in orthopedics and sports medicine, and who is pursuing advanced certification in canine rehabilitation therapy, I am curious to hear more about these other 399 dogs.

 

To date, I have heard of only one other border collie to be definitively diagnosed and repaired. If you have an affected dog, I would greatly appreciate hearing from you. What was your dog’s activity (stockwork, agility, flyball, etc.)? How was your dog diagnosed? What was the severity? What treatment was pursued (if surgical – radiofrequency vs. Tightrope; if conservative, rehab regimen)? Any concurrent medical conditions (elbows, hips, other shoulder pathology)? And who did you work with? Please feel free to reply privately, as I am not looking to discuss the particular merits or shortcomings of individual surgeons publicly on the forum.

 

Thanks in advance,

 

Emily Falk

[Liz P]

What are the clinical signs and what structures are affected?

 

I've definitely had Border Collies with damage to the infra and supraspinatus tendons. One was slated for surgery until the tendon ruptured on its own.

[Blackdawgs]

My dog was recently diagnosed with this by a certified rehab vet. The dog is a ~6.5 year old apparently purebred BC. She was adopted from the county shelter when she was ~1.5 years old, so her background is unknown. She was spayed at the time of adoption.

 

I had taken her to the rehab vet because she had a long history (really as long as I owned her) of NQR in the rear end and I was never able to get a diagnosis beyond occasional "sore hips" and "feed her glucoseamine". In addition, she always had a short, stabby gait in front, which I attributed to normal for this dog. This rehab vet was a newly discovered gem that I had been working with on my other dog. The referrel came from my regular vet, who I think had simply gotten tired of listening to me complain about an odd twist that I was seeing in one of my other dog's hind legs.

 

This rehab vet was the fourth person who had seen my BC--the others being generalists and 1 chiropractor. I had toyed with the idea of taking her to an orthopod at the vet school, but her problem(s) were so subtile and inconsistant that I feared that I could spend a fortune and still not get a diagnosis.

 

I made the appt with the rehab vet because my dog started leaving the agility ring again and before attributing it to behavioral problems, I wanted to give her the benefit of the doubt. While we were waiting for the appt, she had made a very big effort over an oxer and I heard a oomph upon landing and she refused the next obstacle which was the dog walk, so I had a strong suspiscion going into the appt that she was at least sometimes uncomfortable in front.

 

Anyway, based on the rehab vet's examination, which was by far the most thorough and believable to date, the dog has: 1) an old injury to her SI joint (seen on hip/pevis xrays taken in 2008-the original vet missed the significance of this). The current idea is that the dog received a significant blow to one side of her pelvis from behind and needed (and received) a major adjustment [dx=chronic SI arthritis secondary to an injury] 2) bilateral medial compartment syndrome (probably genetic/ conformational] and 3) bilateral medial shoulder instability, but worse on one side

 

I'm telling you all of this because obviously the dog's front and rear end problems were feeding off of each other.

 

The diagnosis of the shoulder issue was based on a greater than normal lateral shoulder mobility and a very obvious "thunk" upon manipulation. The vet had suggested that this could be the reason why the dog tended to work very upright on live stock, that it was hard for her to crouch in front. The vet suggested that BCs may have loose shoulders to begin with due to the need to move laterally while working livestock.

 

I had given up on stock woerk with this dog because she was uncontrollable. She had been doing some agility, but was not competing due to temperment issues. So, I would consider her to be an active pet that does some agility.

 

The treatment for the shoulder issue turned out to be ridiculously simple. I was given a series of three strips of elastic material with decreasing elasticity. I was told to put one of the strips around the upper forearm as high as it would go and pull rapidly 25 times daily while holding the opposite foreleg in the air. I was pulling perpindicular (and laterally) relative to her trunk. I used the most elastic band in week 1, graduating to the least elastic band in week 3 and beyond. At the last recheck, the vet no longer feels the "thunk" in her shoulders, her previously non existant pec muscles were becoming more prominant, and the dog's stride in front is longer and less stabby, but the vet feels like the stride length is a function of a more properly functioning pelvis.

 

Because the dog is essentially an active pet, we are going to watch and wait on the elbows. If this was a high powered performance dog, the vet would probably refer us to an orthopod for possible arthroscopic surgery, but for now we are going to just try to reduce the concussion to her front end and hope that strengthening the rear will mitigate the front end problems.

 

The dog is doing some low jumps now and will gradually return to all agility obstacles probably in the next month or so. We are interested to see if the rehab work improves the dog's general attitude towards life and agility (she is reactive and distractable).

[Blackdawgs]

Sorry. Double post. Having technical problems with the board

[emilyfalk]

Hi Liz,

 

Clinical signs are varying degrees of persistent forelimb lameness non-responsive to rest and NSAIDS. In my own experience, lameness severity did not correlate with pathology severity. Ella became Grade 1 lame only after very strenuous physical activity - heavy sheep work or long runs with me. She was sound in agility, until the first few steps out of her crate after an extended period of rest. Her shoulder was pretty much dangling from her body upon scoping.

 

Ella was short-strided on the affected limb and did not switch lead legs at a free run as she should have (unwilling to extend the shoulder to drive forward). Others have reported difficulty making tight turns.

 

Diagnosis was made via palpation and gait analysis (force-plate system) and confirmed via arthroscopy. Laxity in the shoulder causes an increased abduction angle as well as a spasm of the triceps. There is often muscle atrophy as measured by decreased forelimb circumference when compared to the unaffected side.

 

Affected components of the joint include the medial glenohumeral ligament, subscapularis tendon, joint capsule itself, and sometimes the biceps tendon and supraspinatus tendon.

 

Will follow-up with PM.

[emilyfalk]

Blackdawgs,

 

Thank you so much for your response. I've been getting some good insight and appreciate yours very much!

 

Best wishes to your dog!