Front Matter

Chapter 12 Disorders of the Canine Thoracic Limb: Diagnosis and Treatment 297

(Figure 12.4). A study found that arthroscopy of
the shoulder revealed a supraspinatus bulge in
82% of cases, which led to bicep impingement in
39% of affected dogs (Canapp et al., 2016a). Other
abnormalities commonly revealed by shoulder
arthroscopy include subscapularis lesions (62%),
medial glenohumeral ligament lesions (45%),
labral tear (33%), cartilage defects (22%), and
bone eburnation/osteophytosis (11%). Medial
shoulder syndrome (MSS) was found in 62% of
the dogs evaluated. Pathological changes in the

biceps were noted in 38% of cases, primarily

bicipital tenosynovitis (29%). Elbow arthroscopy

revealed 55% of elbows to have elbow lesions

such as fragmented medial coronoid process

(35%), medial coronoid disease (5%), and/or end

stage medial compartment disease (15%).

Treatment

Acute cases can be treated with conservative

medical management consisting of NSAIDs, con­

trolled activity, and rehabilitation therapy (man­

ual therapy, modalities, range of motion (ROM)

with progression to stretching and strengthening

exercises). However, these cases rarely present in

the acute phase. Treatment for subacute and

chronic cases is dictated by the findings of

advanced diagnostics (ultrasound or MRI). A

recent report revealed that 75% of subacute and

chronic cases did not respond to conservative

medical management, and 45.5% did not respond

to rehabilitation (Canapp et al., 2016b).

An inflammatory response is needed to

jump‐start the healing process. Reinitiating the

inflammatory process increases circulation to

the tendon. For this reason, NSAIDs and intra‐

articular corticosteroids are contraindicated.

Rehabilitation therapies include soft tissue

massage, heat, ultrasound therapy, and pain‐

free ROM/stretching. Shock wave therapy may

also be considered (Danova & Muir, 2003).

Further details are provided in Chapter 13.

Surgical intervention may be considered for

dogs that do not respond to rehabilitation ther­

apy. Surgically excising or debulking the supraspi­

natus nodule has been reported as a treatment

option (Lafuente et al., 2009). Surgical treatment

should include arthroscopic exploration to evalu­

ate and treat concurrent MSS if indicated.

Unfortunately, whether surgical or conservative

treatment is elected, it is common for dogs to have

persistent or recurrent thoracic limb lameness.

When ST is moderate to severe, or when reha­

bilitation and conservative medical management

has failed, biological therapies may be able to pro­

duce results. Good results using ultrasound‐

guided injections of combination platelet‐rich

plasma (PRP) and mesenchymal stem cells (MSC),

such as cultured adipose‐derived progenitor cells

(ADPC) or bone marrow aspirate concentration

(BMAC), into core lesions have been reported

(Canapp, 2011). MSCs are capable of aiding tissue

regeneration, initiating chemotaxis of progenitor

Figure 12.3 Ultrasound image demonstrating
supraspinatus tendinopathy.

Figure 12.4 Arthroscopic view of a compressed biceps
tendon (asterisk) secondary to a supraspinatus bulge
(diamond).