Veterinary Rehabilitation and Hydrotherapy

Fyndar Newton – shoulder soft-tissue injury

History

Fyndar (Fyn), a seven-year-old Labrador dog, presented with bilateral forelimb lameness secondary to shoulder pain. Initially it was deemed that he had shoulder soft-tissue irritation at the biceps and was treated with intra-articular steroids, but these failed to improve the condition significantly.

Fyn was referred to James Grierson, a Specialist in Small Animal Surgery at Anderson Moores, for further investigations. X-rays showed small osteophytes (bony protrusions) around the right shoulder/biceps tendon, and the left shoulder was essentially normal. An ultrasound scan of this area revealed abnormalities in the right biceps tendon; the left appeared normal.

Fyn had an arthroscopic procedure, which revealed two main problems: right-shoulder biceps tenosynovitis, which could be cured with surgery; and medial/lateral gleno-humeral ligament damage. The surgeon believed that the left shoulder problem could not be treated surgically, but would benefit from physiotherapy.

Assessment

On assessment at Kennel & Paddock, Fyn lifted his left foreleg at rest and tried to hop at walk, causing a severe head nod (3–4/10). He had reduced muscle mass in both forelegs, and this meant more strain on his hind legs.

Range of motion of his joints was largely quite good although there was a degree of tightness around the left should joint in flexion and extension due to a combination of increased muscle tone (as a protective mechanism) and muscle weakness. He struggled getting up due to altered use of his forelimbs.

Treatment

We treated Fyn using electrotherapy to various shoulder muscle groups, soft-tissue massage and passive forelimb movements, ice massage and soft-tissue stretches around the shoulder joints and thoracic spine. Functional exercises included sit-to-stand practice/weight-transference exercises. The owners were taught simple treatment and massage techniques, plus exercises and positioning to aid Fyn’s recovery. He progressed to treadmill exercises with resistance at the Kennel & Paddock centre; these increased his stride length and pattern.

Outcome

Within a month, Fyn became noticeably stronger with normal functional daily activities, and began to weight-bear on the limbs more effectively without head-nodding. The owners reported increased success stepping cleanly over the exercise poles and obstacles at slowed speeds. Consequently his exercise programme was progressed, adding incline exercises as well as hydrotherapy, with his owners participating fully in his ongoing rehabilitation schedule.

Although balance and proprioception remain weak, Fyn has been discharged from the surgeon with positive outcomes because the operation has been very successful and he is now able to walk further with continued challenging exercises.

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