Laurie's Blogs.

Hi Laurie

I have been watching your video on supraspinatus and biceps tendonopathies and understand that usually by the time we see these it is  chronic -OSIS and not -ITIS.  I have a case such as this but may have an acute on chronic?  Cried at palpation of musculotendinous junction of L supraspinatus but not at the insertion on the greater tuberosity.  Is this an -ITIS?  Should I be completely resting this dog at this point or should he have some mild walks and early exercises?  What exercises would you recommend at this point?

This is a 12yo Wheaton.  Tucker had an MRI for cervical neck pain.  Neck was ok but there was a supraspinatus tendonopathy with secondary biceps compression. No significant joint effusion.

Looks full weight bearing but gingerly walks at beginning of first home visit just after a short walk around the neighborhood.  Sounds like he is worse after rest.   Very tentative about being handled at all which makes evaluation difficult. Cried at palpation of musculotendinous junction of L supraspinatus but not at the insertion on the greater tuberosity. Wasn't even able to get a palpation of the biceps.  Very vocal and suspicious of me.  When he lies, he has LF abducted and elbow flexed  I think to avoid flexion of shoulder.  Going up stairs goes diagonal leading with the RF.  Going down, uses both front together and lifts LF.  Very vocal and guarded with mom there so didn't get any PT done really, just did Acupuncture today.  When leaving standing with LF forward and slightly out to side. That is how he lies down too.  

I am hoping this owner will be taking him to a PT facility when she is back home, but for now I will visiting this dog twice weekly for the next 2 wks, alone, while owner is away on vacation.  During my visits I hope to be able to do glides/traction but not sure as he is very very guarded and vocalize and could snap maybe, some passive range of motion within the pain free range, some warm compressing, try an exercise or two with him and follow up with massage, stretching if not painful (but he probably will be), icing and acupuncture.    I have a small inflatable disc, Cavaletti's, no laser.  

 For now I think he should have short leash walks during the day, but no off leash play.  Controlled activity and mild/moderate amount.  If he is more lame afterward I would cut it back then.  Minimize stair use.  The dog sitter can ice the shoulder at night for 10min with au dry towel between the ice and the skin.  Consider  a ramp or small stairs for the bed/window seat/car etc.  Avoid jumping down at this point.

Any guidance from you would be greatly appreciated.  I don't do a lot of rehab in my house calls, usually acupuncture.

Thanks, 

J.

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Hi J,

Alright... good job on finding some of this.

Firstly - when you can, try doing a deep palpation over the supraspinous fossa of the scapula.  Age of the dog - you may want to have osteosarcoma in the back of your mind as a differential.

Secondly - when able, see what the abduction angle looks like... to see if there is an underlying Medial Shoulder Instability issue.  

(What you describe sounds like the dog is more sore than a traditional supraspinatus issue... but I might be misinterpreting your descriptions).

Now, as for a true supraspinatus.

Mild walks.  No play.  No off leash.  no jumping yet.

Specific exercises:

•walking down hill or down stairs if he uses the leg.

•3-Leg standing (if he's not using it well)

•AND, it's okay is he is lame after specific exercises...

•Perhaps 'push ups' and/or playbow

Stretches

•Biceps & Supraspinatus - to discomfort.

Don't bother with ice - not really worth it.

Acupuncture:

•If you can get the dog to lie down and stay still, then I'd also do some dry needling into the supraspinatus musculotendinous junction.

Massage:

•General massage wouldn't do much, but if you were able to do some 'myofascial-type techniques' - deep dragging along the supraspinatus muscle.

•You could end with a bit of massage just for a relaxation / pain relief

Good luck!

Cheers,

Laurie