deltoid fibrotic myopathy

[jenrehab]

Has anyone every seen a traumatic fibrotic myopathy in a deltoid muscle before? And if so, what sort of success have you had (if any) in treatment.

This past week I saw a young lab/shepherd dog recently taken in by a rescue agengy. People had seen the dog be hit by car twice in the past year (running loose in the countryside).

The dog went to our local specialist center who took rads and found an old fractured and permanently dislocated RFL elbow and what they called an upper leg fibrotic myopathy on the LFL. They have stated that the injury to the RFL elbow is too old to operate on. I agree on this.

The dog is WB fairly well on the RFL, but is completely NWB on the LFL.

The proximal LFL is "frozen" in the following position: shoulder flexion, elbow flexion and abduction and the forepaw is deviated medially. The long head of the triceps is increased in tone. The deltoid muscle hard to palpate but seems to be firm and tight and decreased in muscle mass. I cannot move the LFL out of its current position. The dog will occasionally touch down the LFL for balance, but he needs to lower his left shoulder down to do so.

At this time I am preparing the rescue agency that this dog needs to have a front end wheel chair built in order for him to be a happy mobile dog. However I first want to investigate if there are any treatment options for the deltoid contracture. I did work on deltoid stretching at the visit, but could not make any progress at all. Worked on some active stretching, but this is going to take some real ingenious manouevers.

I would appreciate all input.
Thanks
Jennifer Stelfox

[David Lane]

It's hard to say without seeing the dog, but there is likely fibrosis of far more than the deltoid muscles going on. In general, these cases with limbs held in flexion secondary to an unresolved NWB injury have multifocal fibrosis and a poor Px for returning ROM. In this case, the lack of elbow mobility suggests that deltoid issues are not your sole concern.

If the limb is non-functional and merely extra weight, I routinely recommend amputation. For that reason, I have no experience with some sort of prosthetic for these cases (aside from heartwarming videos that I have seen on the interweb). Perhaps others can be of greater help in that regard.

[jenrehab]

Thanks for your help on this David. I'm pretty sure this dog needs a front end wheel chair for the dislocated RFL elbow alone, much less the LFL fibrotic myopathy. I'm wondering if amputation of the LFL will help or hinder the use of a front end wheel chair. Does anyone have thoughts on this?
Thanks
Jennifer

[lehughes]

Oi! That sounds like quite the case!!

So, given that the RFL is not quite 100%, I'd leave the LFL intact - for balance as he's doing now.

Might as well get a cart. Function, does not always mean 'perfect' or 'back to normal', but 'functional'! I have ordered a front wheel cart from Eddies Wheels for another patient of mine and it worked great. My patient is a now 15 yo GSP with nasty elbows - out-turned now quite severely, and the wheels allow her to go romp in the fields with the other dogs. When I looks for the different kinds, I thought this was the best one for a 'non neurologic dog' with good rear function, and the owners have dogs with front wheelchairs - so they get the needs for balance etc. Eddies was great to work with too!

https://eddieswheels.com/p/17/Front-Wheel-Carts

Best of luck!

Laurie