Forelimb lameness in the dog is commonly encountered in general practice and, most of the time, diagnosing these cases is relatively easy; the dog with a torn nail or an obvious site of pain. But sometimes cases can prove more challenging. In my experience dogs with shoulder lameness fall into this ‘challenging’ category and trying to ascertain that pain is associated with the shoulder seems to be the hardest part. Despite lameness and orthopaedics not being my favourite subject, I jumped at the opportunity to improve my skills in this area by tuning into last week’s veterinary webinar covering ‘shoulder lameness in the dog’

Richard Whitelock led this veterinary webinar and started by explaining why diagnosing problems within the shoulder can prove difficult. There are limitations imposed upon us by the shoulder joint which we just don’t see with other joints in the forelimb. Movement of the shoulder causes reciprocal movement of the elbow and a significant portion of the shoulder joint sits medially, making this area impossible to palpate.

There are however some tests that are helpful for diagnosing shoulder pain. This includes flexing the shoulder whilst  simultaneously extending the elbow. This stretches the biceps tendon and any sign of pain indicates a problem in this area.

Radiography can be a useful tool when trying to diagnose an obvious lesion such as those seen with some OCD presentations. However a lot of shoulder conditions tend to involve soft tissues, and Mr Whitelock suggested performing positive contrast arthrography by identifying the acromion and greater tubercle and inserting a needle at 90 degrees to the surface of the skin about 1 cm distal to the acromion. Joint fluid should be aspirated to ensure you are in the right place and also for analysis. A water soluble contrast material such as omnipaque should be used but diluted with 50% sterile water to prevent white out. Mr Whitelock went on to demonstrate a number of cases where  positive contrast medium proved useful including ascertaining the presence of a subchondral flap and assessing  the bicipital tendon sheath.

There were, of course, a number of shoulder conditions Mr Whitelock went on to discuss but as we entered the finishing stages of this veterinary webinar he offered one final piece of advice. Other conditions that aren’t associated with bone, muscles or tendons should also be considered. Neurogenic causes of lameness are sometimes forgotten about but can be an extremely painful with peripheral nerve sheath tumours being a potential cause. There tends to be marked muscle atrophy and a dog may continually lick at the limb due to altered skin sensation. Look at the panniculus reflex which won’t be present on the affected side and check for Horner’s syndrome. Palpate the axillae but remember to always do it gently as these conditions are extremely painful.

This veterinary webinar has armed me with a great deal more information about shoulder lameness that I was previously oblivious to and I am confident that diagnosing these cases won’t be quite the challenge they once were.