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There will undoubtedly be weakness in the postural musculature of the shoulder complex and the atrophy may be controlled with weightshfiting and balance activities. Balance activities may be performed on a large theraball, on a rocker board, or on the ground. Leash walking is mandatory and it must be reinforced to the owners about the limitation of jumping activities. Once the lameness has subsided for at least seven days, an increase in activities may be performed and are inclusive of stepping over cavaletti rails, walking in the underwater treadmill, and a progression to jumping. In more chronic cases, transverse friction massage may be performed for longer periods of time in the attempt to recreate an acute inflammation. Typically ten minutes is adequate and should be followed by stretching of the biceps. Nonsteroidal antiinflammatories or corticosteroids are not recommended since the desire is to continue the inflammatory process. Stretching involves flexion of the shoulder combined with elbow extension. Stretching should be held for fifteen to twenty seconds and be repeated at least three times. Exercises performed in the acute stages should be performed in the chronic cases with an addition of an increase in activity and a return to function. For example, if the dog is involved in agility, a focus on a return to jumping should be a component of their rehabilitation program. Eccentric activity is required to properly strengthen the bicipital and shoulder complex. Low-level plyometrics should be initiated first. Jumping can be performed on a soft surface, such as soft matting, or sand. Additional controlled activities such as ball playing and running should also be introduced slowly. At no time during the rehabilitation process, should the lameness return. This is an indication the shoulder complex is not strong enough to handle the activity and the inflammation and irritation has returned. This will inhibit the healing process. In addition, if the lameness and irritation has not been controlled, surgical intervention and further exploration of the shoulder complex may be necessary. Medial Shoulder Instability Medial shoulder instability (MSI) has become one of the more common diagnoses seen in performance dogs and may be compared with rotator cuff injuries in overhead athletes in people. The performance dogs’ shoulder complex goes through a variety of extreme angles and forces. The angles the dogs’ shoulder goes through during a turn on the agility course are remarkable. One can see the force placed on the shoulder complex and the potential for a shoulder injury. Signs of a medial shoulder instability issue can demonstrate as problems with performance (not taking tight turns or avoiding turns), intermittent to chronic lameness, pain with shoulder extension, muscle guarding of the medial shoulder musculature, and excessive shoulder abduction. Depending upon the severity of the instability, treatment may be conservative with appropriate physical rehabilitation or surgery with appropriate physical rehabilitation after the surgical procedure. Conservative treatment should be aimed at reducing the inflammation of the shoulder and improving the stability of the shoulder through controlled exercises.
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