DOI
https://doi.org/10.18849/ve.v5i1.249Abstract
PICO question
In dogs with medial shoulder instability, what treatment option results in the best patient outcomes medical vs. surgical management?
Clinical bottom line
Category of research question
Treatment
The number and type of study designs reviewed
10 papers were critically reviewed. Whilst one study was prospective in nature, it was performed in research dogs that were then euthanised to evaluate outcome of various surgical procedures. Of the remaining nine papers reviewed, six were retrospective studies, two were case reports, and one was a combination of a cadaveric project with case report
Strength of evidence
Weak
Outcomes reported
Surgical and medical treatment of medial shoulder instability can be successful. There is no strong evidence to support one surgical treatment over another
Conclusion
Dogs diagnosed with medial shoulder instability may be treated successfully with either medical or surgical management
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
References
Becker, W., Kowaleski, M.P., McCarthy, R. & Blake, C.A. ‘Extracorporeal shockwave therapy for shoulder lameness in dogs’. Journal of the American Animal Hospital Association. 2015; 51(1): 15–9. DOI: https://doi.org/10.5326/JAAHA-MS-6175
Cook, J.L., Tomlinson, J.L., Fox, D.B., Kenter, K. & Cook, C.R. ‘Treatment of Dogs Diagnosed with Medial Shoulder Instability Using Radiofrequency-Induced Thermal Capsulorrhaphy’. Veterinary Surgery. 2005; 34: 469–475. DOI: https://doi.org/10.1111/j.1532-950X.2005.00071.x
Fitch, R.B., Breshears, L., Staatz, A. & Kudnig, S. ‘Clinical evaluation of prosthetic medial glenohumeral ligament repair in the dog (ten cases)’. Veterinary and Comparative Orthopaedics and Traumatology. 2001; 14: 222–228. DOI: https://doi.org/10.1055/s-0038-1632702
Franklin, S.P., Devitt, C.M., Ogawa, J., Ridge, P. & Cook, J.L. ‘Outcomes Associated With Treatments for Medial, Lateral, and Multidirectional Shoulder Instability in Dogs’. Veterinary Surgery. 2013; 42: 361–364. DOI: https://doi.org/10.1111/j.1532-950X.2013.01110.x
O'Donnell, E.M., Canapp Jr., S.O., Cook, J.L. & Pike, F. ‘Treatment of medial shoulder joint instability in dogs by extracapsular stabilization with a prosthetic ligament: 39 cases (2008–2013)’. Journal of the American Veterinary Medical Association. 2017; 251(9): 1042–1052. DOI: https://doi.org/10.2460/javma.251.9.1042
O’Neill, T. & Innes, J.F. ‘Treatment of shoulder instability caused by medial glenohumeral ligament rupture with thermal capsulorrhaphy’. Journal of Small Animal Practice. 2004; 45(10): 521–4. DOI: https://doi.org/10.1111/j.1748-5827.2004.tb00199.x
Penelas, A., Pozzi, A., Stanczyk, E. & Gutbrod, A. ‘Arthroskopisch-assistierte Stabilisation einer medialen Schulterinstabilität bei einem Zergpudel’. Schweizer Archiv fur Tierheilkunde. 2018; 160(9): 533–538. DOI: https://doi.org/10.17236/sat00174
Pettitt, R.A., Clements, D.N. & Guilliard, M.J. ‘Stabilisation of medial shoulder instability by imbrication of the subscapularis muscle tendon of insertion’. Journal of Small Animal Practice. 2007; 48: 626–631. DOI: https://doi.org/10.1111/j.1748-5827.2007.00340.x
Pucheau, B. & Duhautois, B. ‘Surgical treatment of shoulder instability a retrospective study on 76 cases (1993–2007)’. Veterinary and Comparative Orthopaedics and Traumatology. 2008; 21: 368–374. DOI: https://doi.org/10.3415/VCOT-07-06-0058
Vasseur, P.B., Pool, R.R. & Klein, K. ‘Effects of tendon transfer on the canine scapulohumeral joint’. American Journal of Veterinary Research. 1983; 44(5): 811–5.
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