bone cyst vs. insertionopathy?

January 24, 2012

Hi!

Dickie is a 9.5 year old Terrier cross that has had a left forelimb

lameness for about 3 months now. I have offered radiographs all along,

but O just consented to doing that today. He has been minimally

responsive to rimadyl, and when tramadol was added a few days ago he

responded a little more, but is still obviously lame.

He seems to be more painful on extension of the shoulder than flexion,

and when I extend the shoulder and place pressure on the greater

tubercle he really doesn't like it. I also think that there is mild

supraspinatous atrophy. I realize that if this was just a

supraspinatous tendonopathy, that there should be some pain on

flexion.....there is mild discomfort - but it is definately worse on

extension when I put pressure on the greater tubercle. I also felt a

mild amt of crepitus one time when I took the shoulder into extension.

There is no pain on the biceps tendon - I've checked it many times and

took shoulder into flexion/elbow into extension while palpating the

biceps tendon.

The radiographs show me that there is some sort of radiolucent area on

the greater tubercle area - seen on lateral and flexed lateral views of

the left fore....not on the right fore (took for comparison). I will

post the radiographs in the photos area under Dickie Shoulder. I don't

know how to put pics/video straight into this post.

The folks on VIN say that they don't see the radiolucent area - only

that there is disc narrowing at C5-6 and that maybe this could be root

signature - which I wouldn't argue...but there is no neck pain, and he

is consistently painful on palpation of the lateral aspect of the cr.

part of the greater tubercle - right where the radiolucent area is, and

right where the supraspinatous inserts.

O won't go for CT/MRI or specialist referral - I would plan on laser/u/s

if not improving. What do you think?

Rob Tope, DVM, CCRT

January 24, 2012

Hi Rob,What about the medial compartment? Abduction angle? Medial-lateral glides?Could be supraspinatus working extra hard to support the GH joint. The pain with overpressure into pure GH extension makes me think that there is an articular irritation (in conjunction with whatever this insertionopathy-or not- thing is going on). So I would look at wondering what JOINT thing could be causing your findings that may make sense in light of your other pin point tenderness findings.So - no answer... just more things to look at and for.Cheers,Laurie

Hi!

Dickie is a 9.5 year old Terrier cross that has had a left forelimb

lameness for about 3 months now. I have offered radiographs all along,

but O just consented to doing that today. He has been minimally

responsive to rimadyl, and when tramadol was added a few days ago he

responded a little more, but is still obviously lame.

He seems to be more painful on extension of the shoulder than flexion,

and when I extend the shoulder and place pressure on the greater

tubercle he really doesn't like it. I also think that there is mild

supraspinatous atrophy. I realize that if this was just a

supraspinatous tendonopathy, that there should be some pain on

flexion.....there is mild discomfort - but it is definately worse on

extension when I put pressure on the greater tubercle. I also felt a

mild amt of crepitus one time when I took the shoulder into extension.

There is no pain on the biceps tendon - I've checked it many times and

took shoulder into flexion/elbow into extension while palpating the

biceps tendon.

The radiographs show me that there is some sort of radiolucent area on

the greater tubercle area - seen on lateral and flexed lateral views of

the left fore....not on the right fore (took for comparison). I will

post the radiographs in the photos area under Dickie Shoulder. I don't

know how to put pics/video straight into this post.

The folks on VIN say that they don't see the radiolucent area - only

that there is disc narrowing at C5-6 and that maybe this could be root

signature - which I wouldn't argue...but there is no neck pain, and he

is consistently painful on palpation of the lateral aspect of the cr.

part of the greater tubercle - right where the radiolucent area is, and

right where the supraspinatous inserts.

O won't go for CT/MRI or specialist referral - I would plan on laser/u/s

if not improving. What do you think?

Rob Tope, DVM, CCRT

Laurie Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRTCo-Owner,The Canine Fitness Centre Ltd.Calgary, AB, Canadawww.caninefitness.comCEO,Four Leg Rehab Inc.Past-Chair,The Animal Rehab DivisionThe Canadian Physiotherapy Associationwww.animalptcanada.comInstructor,The Canine Rehab Institutewww.caninerehabinstitute.comGuest Lecturer,Faculty of Veterinary MedicineThe University of Calgarywww.vet.ucalgary.caVice-President,International Association of Physical Therapists in Animal PracticeWorld Confederation for Physical Therapywww.wcpt.org

January 24, 2012

Thanks for the reply Laurie - I didn't get any type of instability medially to laterally and vice versa. I didn't measure abduction angle, he is a little difficult to hold still and I didn't have him sedated. We discussed medial shoulder instability as a rule out for this problem.

I will get him back in and likely do u/s or laser on this area and see how he responds. I also may see if I could sedate him at some point to check abduction (I think this is the only way that I will get a reliable measurement with him)

Thanks for the input!

Rob

Hi Rob,

What about the medial compartment? Abduction angle? Medial-lateral glides?

Could be supraspinatus working extra hard to support the GH joint. The pain with overpressure into pure GH extension makes me think that there is an articular irritation (in conjunction with whatever this insertionopathy-or not- thing is going on). So I would look at wondering what JOINT thing could be causing your findings that may make sense in light of your other pin point tenderness findings.

So - no answer... just more things to look at and for.

Cheers,

Laurie

Hi!Dickie is a 9.5 year old Terrier cross that has had a left forelimblameness for about 3 months now. I have offered radiographs all along,but O just consented to doing that today. He has been minimally

responsive to rimadyl, and when tramadol was added a few days ago heresponded a little more, but is still obviously lame.He seems to be more painful on extension of the shoulder than flexion,and when I extend the shoulder and place pressure on the greater

tubercle he really doesn't like it. I also think that there is mildsupraspinatous atrophy. I realize that if this was just asupraspinatous tendonopathy, that there should be some pain onflexion.....there is mild discomfort - but it is definately worse on

extension when I put pressure on the greater tubercle. I also felt amild amt of crepitus one time when I took the shoulder into extension. There is no pain on the biceps tendon - I've checked it many times and

took shoulder into flexion/elbow into extension while palpating thebiceps tendon.The radiographs show me that there is some sort of radiolucent area onthe greater tubercle area - seen on lateral and flexed lateral views of

the left fore....not on the right fore (took for comparison). I willpost the radiographs in the photos area under Dickie Shoulder. I don'tknow how to put pics/video straight into this post.The folks on VIN say that they don't see the radiolucent area - only

that there is disc narrowing at C5-6 and that maybe this could be rootsignature - which I wouldn't argue...but there is no neck pain, and heis consistently painful on palpation of the lateral aspect of the cr.

part of the greater tubercle - right where the radiolucent area is, andright where the supraspinatous inserts.O won't go for CT/MRI or specialist referral - I would plan on laser/u/sif not improving. What do you think?

Rob Tope, DVM, CCRT

Laurie Edge-, BScPT, MAnimSt(Animal Physio), CAFCI, CCRT

Co-Owner,

The Canine Fitness Centre Ltd.

Calgary, AB, Canada

www.caninefitness.com

CEO,

Four Leg Rehab Inc.

Past-Chair,

The Animal Rehab Division

The Canadian Physiotherapy Association

www.animalptcanada.com

Instructor,

The Canine Rehab Institute

www.caninerehabinstitute.com

Guest Lecturer,

Faculty of Veterinary Medicine

The University of Calgary

www.vet.ucalgary.ca

Vice-President,

International Association of Physical Therapists in Animal Practice

World Confederation for Physical Therapy

www.wcpt.org

January 24, 2012

Hi Rob,

I looked at the films and I would be suspicious of a lytic lesion when you

compare the other humerus. It also lookes to me like the is a mild sclerotic

ring around the lytic site. Your lesion is also present in two different

projections which makes soft tissue overlay less likely. I would also argue

that to call a narrowed disc space base on an rotated view with an obliqued disc

space could be called a stretch. If all signs point to the greater tubercle

than trust your gut and put a biopsy needle or even do an aspirate. If your