Chapter 12 Disorders of the Canine Thoracic Limb: Diagnosis and Treatment 307(Abrams, 2001). The radiofrequency energy
delivered during treatment causes DNA wind‐
up and collagen contracture, which shrinks
and tightens the tissues on contact. Second‐
look arthroscopy has revealed increased vas
cularity, tissue tightening, and a more normal
fiber pattern in the treated tissues. Optimal
shrinkage without necrosis of the tissue occurs
between 65 and 75 °C (Abrams, 2001).
For the initial 2 weeks following treatment,
the mechanical stiffness of the tissue is sig
nificantly decreased. The mechanical proper
ties return to near normal by 6–12 weeks
postop, after the tissues have undergone
active cellular repair from the surrounding
uninjured tissue (Miniaci & Codsi, 2006).
Dogs are placed in a shoulder support sys
tem/hobbles (Figure 12.17) for 3 months
while carrying out a rehabilitation therapy
program. To prevent recurrence, a shoulder‐
strengthening program and a preventative
maintenance program are used.
During the initial phases of the postopera
tive period, treatment to the shoulder is mini
mal. Following radiofrequency treatment, the
tissues must be allowed to heal. Modalities or
medications that are anti‐inflammatory are
not recommended since the inflammatory
process is required as part of the healing
process.
Biological therapies (PRP and stem cell com
bination therapy) may be used with arthro
scopic treatment, based on severity. Other
reported treatment options include suture
imbrications or stabilization using a specialized
fiber band and buttons technique (Abrams,
2001; O’Neill & Innes, 2004; Cook et al., 2005b;
Marcellin‐Little et al., 2007; Sager et al., 2009).Severe MSS and medial shoulder instability
Severe MSS, which is much less common, is
often associated with trauma. Patients typically
have signs of craniomedial compartment laxity
with shoulder abduction angles greater than 65
degrees. Complete tears of the medial gleno
humeral ligament and severe disruption of the
subscapularis tendon, joint capsule, and labrum
may be noted on arthroscopic evaluation.
In these cases, reconstruction of the medial
compartment by direct tissue reapposition
using synthetic capsulorrhaphy, bone/soft tis
sue anchors, and/or TightRope® stabilization
(Arthrex Inc.) is indicated (Figure 12.18).
Postoperative management consists of a spica
splint for 2 weeks followed by the application
of a shoulder support system for 2–3 months.
Biological therapies (PRP and stem cell ther
apy) may be considered to augment the surgi
cal repair in severe cases. Rehabilitation therapy
is required for 4–6 months.Figure 12.17 Dog with medial shoulder syndrome in a
forelimb hobble system.Figure 12.16 Arthroscopic image of moderate
disruption of the subscapularis tendon (arrow) (moderate
medial shoulder syndrome).