Front Matter

Chapter 12 Disorders of the Canine Thoracic Limb: Diagnosis and Treatment 313

and inflamed joint capsule, creating a pain
response. A similar response is noted during
the biceps stretch test in which the shoulder is
flexed and the elbow is extended. Direct palpa­
tion of the proximal biceps tendon as well as
other shoulder assessment tests are necessary
to rule out shoulder conditions.
Radiographs are often unrewarding (Cook &
Cook, 2009a). In chronic cases, radiographs
may reveal secondary evidence of bony remod­
eling and, in particular, sclerosis of the ulnar
notch is a highly sensitive indicator of sus­
pected fragmented medial coronoid process
(Danielson et al., 2006).
Advanced diagnostic imaging modalities
such as CT, MRI, nuclear scintigraphy, and
arthroscopy may confirm the diagnosis
(Cook  & Cook, 2009a; Cook & Cook, 2009b).
Arthroscopic evaluation offers the advantage
of magnified direct observation of the major
intra‐articular structures, dynamic evaluation
of the tissues during ROM, and palpation of
intra‐articular tissues using arthroscopic instru­
mentation to make a definitive diagnosis as
well as allowing for treatment with one anes­
thetic event (Fitzpatrick et al., 2009a). In a small
percentage of cases, advanced imaging may
indicate fragmentation of the medial coronoid
process not found on arthroscopic observation.
In these cases, the fissures are believed to be
beneath the cartilage surface of the coronoid
process (Fitzpatrick et al., 2009a).

Treatment

Arthroscopy may include a combination of

techniques such as fragment removal, debride­

ment of injured tissues, abrasion arthroplasty,

forage, microfracture, and subtotal coronoid

ostectomy as dictated by progression and sever­

ity (Fitzpatrick et al., 2009a). Arthroscopic treat­

ment is believed to cause less soft tissue trauma,

reduce surgery time, decrease the risk of infec­

tion, and speed recovery time as compared with

traditional arthrotomy (Hoelzler et al., 2004).

Following the arthroscopy, at the time of closure,

intra‐articular injection of hyaluronic acid as a

postsurgical lavage and synovial fluid replace­

ment is recommended. This is intended to

restore the joint to a more normal physiological

condition. Injection of PRP could also be consid­

ered in place of hyaluronic acid to further help

with inflammation and joint restoration.

Postoperative bandaging is not suggested as

PROM and early return to function are recom­

mended. NSAIDs are prescribed for 14 days to

decrease inflammation and discomfort. Twice‐

weekly intramuscular injections of PSGAGs are

prescribed for 4 weeks. Oral joint protective

agents such as glucosamine, chondroitin sulfate,

and avocado/soybean unsaponifiables are recom­

mended as a daily supplement for life. Prospects

of returning to normal activity and competition

are improved with early detection and treat­

ment. Treatment for progression of elbow oste­

oarthritis will be covered later in this chapter.

Case Study 12.2 Biological therapy for supraspinatus tendinopathy with concurrent injuries

Signalment: 9 ‐y.o. F/S Labrador Retriever. Agility dog.

History: Presented with intermittent right thoracic

limb lameness. Nonresponsive to rest, NSAIDs, reha-

bilitation therapy, and activity restriction.

Examination: Gait: Shortened stride in right thoracic

limb at walk and trot.

Palpation: Bilateral discomfort in shoulder extension/

flexion. Discomfort and spasm during right shoulder

abduction and increased abduction angle. Mild dis-

comfort of bilateral supraspinatus during passive stretch.

Mild sensitivity over right medial coronoid process.

Radiographs: Right elbow: sclerosis within ulnar

notch; fragmented medial coronoid. Left shoulder:

mineralization of supraspinatus tendon. Right shoulder

and left elbow WNL.

Diagnostic ultrasound: Left shoulder: generalized,

hypoechoic, mottled fiber pattern of the supraspi-

natus with a large distinct hyperechoic focus at

the  point of insertion on the greater tubercle.

Enlargement of the supraspinatus tendon. Mild

biceps contact and impingement. Thin joint cap-

sule. Fibrous tissue deep within joint. Infraspinatus

tendon, teres minor, and biceps WNL. Right shoul-

der: generalized, hypoechoic, mottled fiber pattern

and enlargement of supraspinatus tendon. Contact

with biceps. Thickened joint capsule. Fibrous tissue

deep within joint. Infraspinatus tendon, teres minor,

and biceps WNL.

Arthroscopy: Right elbow: Single non‐displaced frag-

ment on medial coronoid process. Grade 5 cartilage

lesions on humeral condyle and radial head.

(Continued)