What is it?

Biceps tenosynovitis is a degenerative or failed healing response of the tendon and tendon sheath of the biceps brachii muscle in the forelimb of your pet.

Causes:

• ~ Repetitive strain of the tendon
• ~ Overuse injury
• ~ Found in performance dogs (landing vertically on front limbs from missing a jump, overstretching, quick turns)

 Signs and symptoms:

• ~ Inflammation is not consistently present
• ~ Acute trauma or repetitive loading
• ~ Middle to old dogs, large breed dogs
• ~ Gait non weight bearing lameness
• ~ Most common injuries seen in performance dogs
• ~ Weight-bearing lameness that is insidious in onset that gets worse with exercise
• ~ Pain is not a consistent finding
• ~ Secondary issues include calcification of the supraspinatus tendon, shoulder joint instability

Conservative Treatment options:

• ~ Usually recommended
• ~ Ice/heat
• ~ Eccentric exercises
• ~ 2-4 weeks of rest
• ~ NSAIDs or intraarticular corticosterioids

Surgical Treatment Options:

• ~ recommended for dogs that do not respond to medical treatment or have significant tears
• ~ The surgical procedure involves completely cutting the biceps tendon.
• ~ In some cases, the tendon is reattached to the humerus with a bone screw.
• ~ Some surgeons do not reattach the tendon. Instead, the tendon is allowed to heal naturally.

Goals for physiotherapy in the treatment of bicep tendinitis:

• ~ Decrease pain levels
• ~ Decrease swelling and inflammation
• ~ Encourage weight-bearing
• ~ Prevent muscle atrophy and increase muscle mass
• ~ Decrease compensatory muscle pain and tightness
• ~ Maintain function and range of motion of the frontlimb
• ~ Provide a structured exercise plan

What is it?

Injury to the carpus can include carpal hyperextension, angular limb deformities, fractures, contracture of the flexor muscles, and luxation.

Carpal hyperextension:

• ~ involves spraining/tearing the ligaments and tendons behind the carpus.
• ~ dogs are lame and walk with the carpus hyperextended. In severe cases the carpus may touch the ground. General healing may take months and occurs by the formation of fibrous scar tissue.

Angular limb deformities:

• ~ Developmental abnormality or because of trauma to a growth plate when they are still puppies.
• ~ Carpal valgus is deviation of the carpus laterally
• ~ Carpal varus is deviation of the carpus medially
• ~ Most common is carpus valgus and is often found in small breed dogs.
• ~ Most dogs manage this quite well if they are a small breed but, it may develop into osteoarthritis or ligament strain later on in their life.
• ~ Larger breed dogs do not manage as well as small breeds.
• ~ However, if it is severe surgical correction involves and osteotomy of the affected bones with stabilization (bone plate/external fixator).

CARPAL VAGUS IN THE DOG

Fractures of the carpus are not common:

• ~ Some fractures may result in medial or lateral instability if the fracture involves the insertion of the respective collateral ligament

Contracture of the flexor muscles

• ~ can occur after the limb has been immobilized or prolonged disuse (in a cast). T
• ~ The flexor muscles atrophy and shorten.
• ~ This could result in limited extension of distal joints and may impair weight bearing

Luxation’s

• ~ can occur secondarily to fracture, angular limb deformities and ligament strains.
• ~ It is when the carpal joint is not stabilized by its surrounding muscles, tendons and ligaments
• ~ Excess movement occurs.

Signs and symptoms:

• ~ Trauma to the area
• ~ Excess movement from the joint
• ~ Lameness
• ~ Holding the limb up and not wanting to place weight on it

CARPAL ARTHRODESIS SURGERY

Treatment options:

• ~ Hyperextension of the carpus is a condition that will not minimize with therapy due to the nature of the overstretched or damaged ligaments.
• ~ Rehabilitation exercises will maintain the condition and help treat the compensatory issues so that we can better deal with the condition.

• ~ A surgical procedure called a partial arthrodesis which is a fusion of the middle and distal joints might be worth visiting your vet to discuss this option.
• ~ The vet can X-ray the carpus to tell us exactly the extent of the damage and provide a second opinion on the best way forward
• ~ If carpal valgus is severe an ulna osteotomy may be performed
• ~ Ulna osteotomy is usually performed in younger dogs and are performed when the radius and ulna are incongruent
• ~ It is when they remove a piece of the ulna below the elbow joint to help the alignment of the elbow joint.
• ~ It allows the radius to grow freely without the restriction of the ulna
• ~ It relieves pressure off the medial coronoid process
• ~ If carpal varus is severe and does not resolve on its own, severing the tendon sheath surgically may be an option

• ~ Fractures can be treated with a cast and immobilization.
• ~ However, if severe surgical stabilization may be warranted.
• ~ This may include screw, plates, and external fixators.

• ~ Contracture of the flexor muscles can be treated conservatively with physiotherapy but, if this fails and surgical procedure which involves excision or partial excision of the tendons

• ~ Luxation’s may need surgical repair if severe and will be splinted for 2-3 weeks to minimize movement

• ~ If there is failure of surgical repair or prognosis of surgical interventions are poor your vet may advise arthrodesis which is mentioned above.

Goals of physiotherapy:

• ~ improve extension range in shoulders
• ~ improve stability in elbows
• ~ increase strength and proprioception in carpals
• ~ improve gait
• ~ improve range of motion
• ~ manage compensatory pain
• ~ enhance healing phases

What is it?

• ~ Is when the humerus and the radius/ulna that form the elbow joint come out of alignment.
• ~ This is usually the result of trauma.
• ~ This can also damage the ligaments that stabilize the elbow

Signs and symptoms:

• ~ Non-weightbearing lameness
• ~ Holding the front limb up
• ~ Previous trauma of the limb

Treatments option:

• ~ If the luxation is acute, it can often be manipulated back into normal position with the dog under deep anaesthesia.
• ~ The leg is then placed in a splint in a slightly extended position for 2 weeks to allow fibrous tissue to develop 

• ~ If the luxation is chronic or if other pre-existing disease or bony abnormalities of the joint are present, surgery must usually be performed.
• ~ If significant damage to the elbow is present, arthrodesis ( surgical fusion) of the joint or amputation of the limb may be the best solution
• ~ Arthrodesis is the fusion of the joint, so no movement occurs in the area

General goals of physiotherapy:

• ~ Rehab occurs once splint is removed
• ~ Range of motion must be restored
• ~ Controlled exercise for at least 3months

What is it?

• ~ Elbow dysplasia means abnormal development of the elbow joint where the conjoining bones do not fit well together.
• ~ This causes damage to the cartilage surface of the joint
• ~ Elbow dysplasia can include a
  • 1. fragmented coronoid process
  • 2. ununited anconeal process
  • 3. incongruency
  • 4. osteochondrosis dissecans (OCD)
• ~ Fragmented coronoid process is a piece bone in the elbow that chips off.
• ~ Ununited anconeal process is a piece of bone that fails to fuse to the ulna.
• ~ OCD is a cartilage flap that occurs within the elbow joint.
• ~ Elbow dysplasia can be caused by;
  • 1. genetics
  • 2. poor nutrition
  • 3. trauma
• ~ It can usually be found in both elbows but one may be more severe than the other

Signs and symptoms:

• ~ Mild to moderate weight-bearing lameness noted between 4-7months of age
• ~ Swelling on the elbow
• ~ Holding limb up
• ~ Lameness worse after laying down

Treatments options:

Conservative management:

• ~ Pain management
• ~ Holistic therapies like physiotherapy, hydrotherapy and acupuncture

Surgical intervention:

• ~ High incidence of post-surgical complications.
• ~ Vets only seem to do it, if it is the only option or amputation.
• ~ If surgery fails, amputation of the limb will mostly like be the best option.
• ~ Even after surgery, your dog will most likely develop arthritis in the joint and therefore it is imperative to maintain your dog's elbows throughout their life.
• ~ Dog's with elbow dysplasia do really well in a hydrotherapy setting, since the weightbearing joint, they often feel better after having the weight off of their joints.

General goals of physiotherapy:

• ~ Diminish pain
• ~ Maintain range of motion
• ~ promote soft tissue healing
• ~ improve muscle extensibility
• ~ muscle strengthening
• ~ reduce swelling
• ~ normalize joint mobility
• ~ balance & strengthening exercises
• ~ Elbow dysplasia usually follows a course of acute flare ups where animal is more tender and then remission where animal is more comfortable.
• ~ During these periods of pain decrease exercise and concentrate on heat, icing and massage.
• ~ It is NB to remember that this is a lifelong commitment.
• ~ If rehabilitation exercises are discontinued your animal will deteriorate even faster.
• ~ Regular rehabilitation can minimize the occurrences of flare-ups

Types of fractures?

• ~ Incomplete
• ~ Complete
• ~ Transverse
• ~ Oblique
• ~ Comminuted
• ~ Butterfly
• ~ Open/ closed – whether there is an open wound or not
• ~ Inter-articular – affecting a joint

 Causes:

• ~ Trauma

Signs and symptoms?

• ~ Depended on fracture
• ~ Unable to bear weight
• ~ Unable to stand
• ~ Swelling
• ~ Pain
• ~ Movement at fracture ends

Healing factors:

• ~ Age
• ~ Disruption of muscle and blood vessels
• ~ Surgical trauma
• ~ Stabilization of fracture ends

Recovery time:

• ~ Young puppies – minimum of 4 weeks
• ~ Adults – minimum of 8 week
• ~ It is NB that there is a slow return to function over the course of 12 weeks depending on the case

Treatment options:

• ~ Depends on the type of fracture and the severity thereof
• ~ Some may be able to be treated conservatively but most commonly there is some sort of intervention involved

What is it?

• ~ It is not a common condition
• ~ It is usually caused by repetitive trauma, or blunt trauma
• ~ Mostly seen on one limb but can be seen on both limbs 
• ~ Contracture is shortening of tendon-muscle unit that is not caused by active muscle contraction.
• ~ Muscle-tendon is replaced by fibrous tissue.

Signs and symptoms:

• ~ Shoulder swelling 
• ~ Holding the affected limb out at the elbow (abducted)
• ~ Most cases have a history of acute injury with lameness and inflammation that subsides with supportive care
• ~ Initial pain and lameness may resolve within in 1-4 weeks with supportive treatment 
• ~ Contracture may appear within days or weeks after initial trauma
• ~ Weeks to months later the animal is presented with clinical signs, which may include pain, weakness, firmness within muscle and an abnormal posture/gait

Treatment options:

• ~ If it is not severe – splinting the tendon in tension and stretching activities may lengthen it. 
• ~ Early treatment focused on surgical decompression by fasciotomy. 
• ~ In many cases surgery is recommended to lengthen or transect the tendon
• ~ Surgery immediately restores ROM and prognosis is good (tenotomy) 

Physiotherapy goals:

• ~ Physical rehab is beneficial if diagnosed early
• ~ Increase weightbearing
• ~ Improve range of motion 
• ~ Maintain movement 
• ~ Maintain and lengthen muscle with stretching
• ~ General conditioning to return muscle to normal size

What is it?

• ~ It is when there is too much medial movement of the shoulder causing instability.
• ~ Chronic, repetitive activity or overuse such as jumping can be the cause.
• ~ The structure involved in stabilizing the medial side of the shoulder are the capsule, subscapularis tendon and the medial glenohumeral ligament.
• ~ Most cases of medial shoulder instability (MSI) involve outdoorsy, active, medium to large breed dogs.
• ~ Normal abduction is 30 degrees
• ~ Mild cases have 35-45 degrees
• ~ Moderate cases have 45-65 degrees
• ~ Severe cases have > 65 degrees

Signs and signalment:

• ~ It is not uncommon for owners to describe episodes of severe lameness with later periods of mild lameness.
• ~ It can be nonresponsive to treatment with pain medication and anti-inflammatories

Treatment options:

• ~ In mild cases the shoulder is supported with a sling.
• ~ Then strengthening of medial shoulder muscles is achieved with physiotherapy or hydrotherapy.
• ~ In moderate/severe cases it is treated surgically with reconstruction.
• ~ Post-surgery, the dog is supported with a sling and strict rest for approximately 3 weeks and physiotherapy begins
• ~ Function usually improves within 3-4months, optimal function 5-6months

Physiotherapy:

• ~ Strengthen shoulder muscles
• ~ Decrease pain
• ~ Limit ROM out of the sagittal plane
• ~ Maintain and return function

What is it?

• ~ OCD is a developmental disease of the growth plates and joints cartilage.
• ~ Abnormal endochondral ossification of the deep layers of articular cartilage results in thickened areas that are prone to injury.
• ~ Stress to this may cause a cartilage flap. Can occur in a few joints in the dog such as, the shoulder, elbow, hock and stifle.
• ~ It does not commonly occur in the stifle and hock
• ~ Elbow OCD can also be a contributing factor to elbow dysplasia

Signs and symptoms:

• ~ Young, large and giant breeds, rapid growth and excess calcium consumption
• ~ Mild to moderate weight-bearing lameness between 4-8 months of age
• ~ Many bilateral
• ~ Muscle atrophy
• ~ Pain elicited in extreme flexion and extension
• ~ Decreased ROM
• ~ Effusion, thickening of joint
• ~ Crepitus (crunching) of the joint

Treatment options:

• ~ Diagnosed early – decreased activity may prevent cartilage flap formation with Cryotherapy, PROM and pain management
• ~ Surgery is usually treatment of choice which involves removing the defective cartilage
• ~ Large OCD are sometimes fixed in place in an effort to preserve joint incongruency but OA is inevitable
• ~ Nutraceutical/Joint supplements may help long term management

Physiotherapy goals:

• ~ Pain management
• ~ Strengthen periarticular muscles
• ~ Limit excessive stress on joints
• ~ Maintain/improve ROM
• ~ Maintain/improve cartilage

What is it? 

• ~ It is when there is too much movement of the shoulder causing instability. 
• ~ Trauma
• ~ Congenital malformation.
• ~ Luxation is when the shoulder is permanently out of the joint
• ~ Sub-luxation is when the shoulder joint is able to luxate out of the joints normal position but can still return to its normal position
• ~ Laxity is when there is an abnormal amount of movement in the joint but the joint does not come out of its position.

Signs and signalment:

• ~ Front limb ‘giving way’ when weightbearing
• ~ Previous evidence of trauma
• ~ Visibly seeing the shoulder luxate

Treatment options:

• ~ Conservative management involves immobilizing the shoulder for 1-3 weeks
• ~ After the sling is removed, gentle PROM
• ~ Surgical stabilization is advised if conservative fails or fractures are involved
• ~ Shoulder is immobilized for 2 weeks post-surgery
• ~ Full recovery may take 1-3months
• ~ OA may develop later stages in life
• ~ If severe, amputation may be the best protocol

Physiotherapy:

• ~ Strengthen shoulder muscles
• ~ Decrease pain
• ~ Limit ROM out of the sagittal plane
• ~ Maintain and return function 

What is it?

• ~ The supraspinatus muscle is responsible for extension of the shoulder joint.
• ~ Injury to the tendon of the supraspinatus muscle causes inflammation.
• ~ Tearing of the tendon fibres and the resulting inflammation can lead to mineralization and calcification of the tendon.
• ~ Injury of this muscle is usually caused by overuse and repetitive trauma

Signs and symptoms:

• ~ Medium to large breed dogs
• ~ Mild to moderate lameness, chronic, intermittent, unilateral
• ~ In performance dogs repeated strain could be caused by hitting the ground, slipping, overstretching, contact with agility jumps, quick turns, etc.
• ~ Dogs usually have a weightbearing lameness that worsens after exercise and is often resistant to treatment

Treatment options:

• ~ Medical treatment – NSAIDs, Passive range of motion, local steroid injection,
• ~ If medical treatment is inadequate surgical incision of the mineralization is recommended
• ~ Surgery is warranted for chronic cases, involves removing abnormal tissue.

Physiotherapy goals:

• ~ Pain management
• ~ Heat/cold therapy
• ~ Deep massage
• ~ Ultrasound
• ~ Extracorporeal shock wave therapy may decrease size of mineralization

What is it?

Is the strain of the teres minor muscle found in the dog’s front limb?

Causes:

• ~ Repetitive strain of the tendon
• ~ Found in performance dogs

Signs and symptoms:

• ~ Front limb lameness that improves with rest but recurred with exercise
• ~ Shoulder painful on extension and direct palpation of muscle

Conservative Treatment options:

• ~ Usually recommended
• ~ Ice/heat
• ~ Strengthening and balance exercises
• ~ 2-4 weeks of rest
• ~ NSAIDs or intraarticular corticosteroids

Most dogs return to normal level of  activity.

Goals for physiotherapy in the treatment of bicep tendinitis:

• ~ Decrease pain levels
• ~ Decrease swelling and inflammation
• ~ Encourage weight-bearing
• ~ Prevent muscle atrophy and increase muscle mass
• ~ Decrease compensatory muscle pain and tightness
• ~ Maintain function and range of motion of the front limb
• ~ Provide a structured exercise plan