Treatment of Forelimb Disorders in Dogs

Supraspinatus strain Dogs with strain of the supraspinatus tendon present with a chronic foreleg lameness; some dogs will exhibit periods of non-weight bearing lameness. Although uncommon, any age or breed of dog can be afflicted; however, the condition is seen more in large breeds of dogs (Labrador, Rottweiler). Radiographic views should include standard lateral projections of both shoulders. Mineralization is seen adjacent to the greater tubercle of the humerus. Patterns of mineralization are either irregular, non-homogeneous or well circumscribed and dense foci. A “skyline” view of the bicipital groove is helpful to delineate the location of dystrophic mineralization. It is worthy to note that the mineralization of the supraspinatus insertion indicating chronic strain may be present but not be the cause of clinical dysfunction. Often mineralization is present in the shoulder in which the dog is not lame. Bilateral mineralization may be present (although different stages of mineralization can be seen between shoulders) and the dog only lame in one shoulder. Recently, MRI has been advocated as a diagnostic tool for shoulder lameness. Some surgeons believe that mineralization of the supraspinatous tendon displaces the biceps tendon causing biceps tendon pain. Although possible, ultrasound examination of the biceps tendon does not demonstrate inflammation secondary to biceps impingement. Also, the position of the biceps tendon is 3-5mm separate from the insertion of the supraspinatous tendon on the greater tubercle of the humerus. Arthrography can be used to outline the bicipital groove to determine if irregularities or filling defects suggestive of bicipital tenosynovitis are present. Diagnosis is based on clinical signs, imaging, and most importantly, ruling out other causes of forelimb lameness. Treatment is enbloc resection of the chronically inflamed section of the tendon. The tendon can be tenodesed in a position where it is exposed to less strain.