11 month old Retriever with chronic forelimb lameness--infraspinatus injury?

September 9, 2010

Hello, this is my first post. I am very new to the practice of rehab medicine

and would greatly appreciate advice on this case.

I recently saw a 10 month old F/S retriever with a chronic RF lameness of about

5 months duration. She has been examined by a specialist surgeon and had rads

and CT run of both forelimbs--all WNL. There was no specific incident

associated with the onset of the lameness. It was quite subtle initially, but

seemed to come on acutely, then worsened rapidly. She is much better now than

she was at one point previously when she could barely walk (according to owner).

So she has improved, but a chronic lameness persists. Exercise does make her

worse, but the lameness is always present. They walk/run her 1/2 hour per day,

and she is more sore afterwards. She has trouble getting onto couch (they saw

her once pull herself up with her neck and good leg, poor girl). She is on

Rimadyl prn. She never licks at the limb and never holds it up. Have on

occasion noticed tremoring of the LF. Does stairs both up and down slowly (but

of course can race up or down them if excited). They have also noticed that she

seems to favour one hind leg at times when full out running.

My primary exam findings were: resented palpation of the distal infraspinatus

muscle and down to its insertion. The infraspinatus muscle in its entirely

feels round and tight, and the scapular spine feels a little more prominent on

this side. She resisted shoulder extension, but was fine with flexion. I did

feel a clunk once with extension and twice with abduction (like a postive

Ortaloni feels like). Scapulo-humeral angle was 15 bilaterally. Biceps tendon

palpation and biceps stretch WNL. Normal neck PROM and no pain with cervical

vertebral palpation bilaterally. Reflexes WNL all 4 limbs. Resisted hip

extension and quad stretch RH.

Posture--RF is externally rotated/toed out--owner says she always stands this

way. I will post a picture.

Gait--reaches out laterally with RF, with entire limb always externally rotated.

I will post a video.

I was convinced that this was an infraspinatus tendinopathy, but when speaking

with the surgeon, he commented that she seemed too young for this injury, given

that it is usually a repetetive strain injury. She does live with another lab

and they play agressively+++. Could this not be an acute injury involving

either the muscle, the tendon or both?

All comments much appreciated.

Jody , DVM, CCRT Pending

Edmonton Veterinary Rehabilitation Clinic

Recommended Posts