Adhesive Capsulitis in Eight Dogs: Diagnosis and Management.

Brittany J Carr,Sherman O Canapp,Lauri-Jo Gamble,Debra A Canapp,David L Dycus

doi:10.3389/fvets.2016.00055

Abstract

To describe clinical and diagnostic findings as well as management of adhesive capsulitis in dogs. Adhesive capsulitis, also known as frozen shoulder, is a syndrome defined by loss of range of motion of the shoulder and may be the end-stage manifestation of several primary conditions. This is a case series report of eight dogs with chronic forelimb lameness diagnosed with adhesive capsulitis. Medical records (June 1, 2010-September 1, 2015) including, physical examination findings, radiographic findings, magnetic resonance imaging (MRI) findings, arthroscopy findings, and treatment plans were reviewed. All dogs presented with a chronic, grade III-VI/VI forelimb lameness. On orthopedic examination, all dogs had moderate to significant discomfort on shoulder extension and flexion and severe restriction of range of motion. Six of the eight dogs had evidence of bone remodeling and sclerosis in the affected shoulder on radiographs. Six of the dogs had an initial diagnostic ultrasound performed, which revealed evidence of fibrous scar tissue. Five dogs had MRI performed that revealed moderate shoulder effusion and enhancement of the synovial lining of the shoulder. Arthroscopy was performed in five of the eight patients. Three were noted to have significant contracture, adhesions, and fibrous scar tissue of the joint capsule. Severe inflammation was noted throughout the synovium of two patients. All eight patients tried conservative management consisting of oral medications and rehabilitation therapy. Five of the eight patients received extracorporeal shockwave therapy. Three patients received regenerative medicine treatment in the affected supraspinatus and shoulder. Regardless of the treatment elected, none of the dogs were reported to have significant improvement. Adhesive capsulitis is an uncommon cause of chronic forelimb lameness. Further investigation is needed to describe the etiology and pathogenesis of adhesive capsulitis in dogs to evaluate the effectiveness of both non-surgical and surgical treatment modalities, establish treatment protocols, and evaluate short- and long-term clinical outcome of patients. Adhesive capsulitis should be considered in patients with chronic forelimb lameness and moderate to significant discomfort and restriction on shoulder range of motion.

Highlights

Adhesive capsulitis, known as frozen shoulder, is a syndrome appreciated in human sports medicine and defined by loss of range of motion of the shoulder, impairing the patient’s ability to sleep, work, perform daily living activities, or desired recreational activities [1,2,3,4,5]
Regardless of the biological cause, adhesive capsulitis is defined as thickening and contracture of the joint capsule, which results in decreased intra-articular volume and capsular compliance so that glenohumeral motion is limited in all planes [2,3,4]
There are four stages associated with adhesive capsulitis, each based on the correlation of physical examination and arthroscopic examination of affected joint(s) and lasting about 6–9 months [1, 5]

Summary

Introduction

Known as frozen shoulder, is a syndrome appreciated in human sports medicine and defined by loss of range of motion of the shoulder, impairing the patient’s ability to sleep, work, perform daily living activities, or desired recreational activities [1,2,3,4,5]. Upon examination either under anesthesia or following intra-articular injection of local anesthetic, there is a significant improvement in range of motion to normal or minimal loss [13]. Examination after intra-articular injection of local anesthetic or scalene block reveals relief of pain with only partial improvement in range of motion [13]. Stage 4, known as the “thawing stage,” is characterized by minimal pain and progressive improvement in range of motion, resulting in capsular remodeling. Since these patients rarely undergo surgery, there is little arthroscopic or histological data available for patients with stage 4 adhesive capsulitis [13]. Known as frozen shoulder, is a syndrome defined by loss of range of motion of the shoulder and may be the end-stage manifestation of several primary conditions.

Methods

Results

Conclusion