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Q: How common is MSI? What are the causes? A: MSI is the most common sports-related injury of the forelimb we see. It is typically the result of overuse or repetitive chronic stress on the ligaments and tendons of the shoulder. Sport or activity that requires pivoting on the shoulder is probably the biggest contributing factor. Sports like agility, fly ball, herding, and Frisbee create such a scenario.
Q: What breeds are most affected? Dr. Peter Lotsikas, DVM, Dipl. ACVS. Photo courtesy of CARE.
A: For MSI, over-represented breeds are those mostly likely to participate in such activity. In agility, that breed is the Border Collie and, for the general population, the Labrador Retriever. However, any breed that is active can develop these conditions.
Q: How is MSI diagnosed? A: A presumptive diagnosis of MSI is made from the history and physical examination findings. Typically, these patients will exhibit discomfort on abduction (movement of the leg away from the midline of the body) of the shoulder and muscle spasm upon abduction and flexion of the shoulder. Confirmation of the condition requires either advanced imaging either in the form of an MRI or direct visualization with an arthroscope.
Dr. Faith Lotsikas, DVM, CCRT Photo courtesy of Dr. Faith Lotsikas.
Q: Does medial shoulder instability always require surgery? A: No. In fact, the majority of cases seen in our practice can be managed conservatively with rest and rehabilitation. However, success with conservative management requires proper diagnosis, appropriate patient selection according to severity of the condition, and a rehabilitation therapist familiar with how to treat and progress the patient. The therapist must have an understanding of the job the dog does to create a plan so that he or she can return to athletic ability. Also, owner compliance is very important to conservative management! Conservative/Rehab management entails use of manual techniques (i.e. massage and stretching), laser, ultrasound, and therapeutic exercise programs coordinated to the various stages of healing. Many patients also benefit from use of specially-made shoulder stabilization system (hobbles). You can learn more about hobbles from www.dogleggs.com.
Q: If it is a surgical case, what does surgery entail? A: In our hospital, surgery is performed arthroscopically. We use the most sophisticated arthroscope on the market (Arthrex Synergy HD3) to visualize
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The Virginia–Maryland Dog
and assess the structures of the shoulder. Depending on what we see, the injury can be repaired by tissue shrinkage via radio frequency, tissue repair using suture and bone anchors, or replacement of ligaments with a prosthetic material.
Q: How successful is surgery? Will my pet recover well? How long will it take to recover? A: Surgery is generally very successful. While the recovery is long (typically 16 weeks until the pet is allowed to return to full activity), we expect 90 percent of dogs to return to sport at a preinjury level.
Q: Would pet rehabilitation help my dog to recover from surgery better? A: Rehabilitation is not only imperative to a proper recovery, but a requirement for all of our patients that are treated surgically for this condition.
Q: How can I prevent my dog from having a shoulder injury? A: The canine that is playing or working hard could be viewed the same as a human athlete. Proper warm ups and cool downs, conditioning and fitness, and maintenance of good body mechanics and suppleness all play a role in injury prevention. Regular visits with a rehab therapist to learn proper warm up and stretching techniques, as well as an at home conditioning exercise program will also be helpful. Knowing “normal” for your dog (i.e. “What does my dog’s shoulder extension look like?”) can allow for earlier detection of a problem, even before overt lameness is evident.
Q: Just for fun, what hobbies do you have outside of surgery? A: We moved to Frederick to raise our three daughters on a small hobby farm. My Border Collie, Kelsea, and I are learning herding together (Kelsea is the teacher). Peter can be found on his tractor or fishing in the pond with the girls at any spare moment. We both feel so fortunate to be raising our girls in a rural area with a great education. We have truly found balance in our personal and work life!