Observation Skills for Dog Owners: Cookie's Shoulder

Hubby used to think that I see ghosts. Over time he came to realize that ghosts are real.

Often I am not sure myself. Do I see a problem or is my mind playing tricks on me? Is Cookie's left shoulder dropping ever so slightly when she walks or is that just the uneven terrain?

It all started at the end of the last winter.

Last winter was the first time I noticed Cookie favoring her front left leg at times.

Hubby didn't see it. Cookie's physical therapist did see it when analyzing Cookie's gait on the underwater treadmill and was finding sore spots. The assumption was that Cookie likely injured a muscle when she busted through the deep crusty snow. It was quite nasty out there; quite deep, with three layers of ice throughout from all the thaws we had.

Cookie was getting physical therapy, laser therapy, and hydrotherapy and things improved.

Lately, though, I see her dropping the shoulder again.

The question is, why? Is it from what we thought an injury she sustained in the winter? Or is the shoulder getting sore for compensating for a problem elsewhere, namely on the hind end? We must not forget that Cookie did have issues with her cruciate ligaments.

Compensation is often the cause of lameness or soreness in weird places.

Cookie's hind legs look good, though, both to me, to her PT, and her vet. The muscles are strong, well-defined and even. There is no indication anybody can tell of a problem with Cookie's knees or hips.

Jasmine used to get strange front leg lameness which, while attributed to arthritis to her elbow, was most likely caused by problems with her neck. Cookie is, however, seeing a chiropractor regularly and while she always needs some adjustments, nothing seems to stick out enough to be suspect.

The issue has gone on long enough for me to want answers.

I had her PT write up a report, and I made an appointment with Cookie's local vet.

Here is what the report says:

Cookie Rade has been coming to Touch following a series of hind end injuries from a iliopsoas injury, to a left stifle injury for which she received a PLP injection followed by rehabilitation. We have continued with her therapy on a monthly basis to maintain muscle strength and flexibility and to monitor the left stifle for re-occurrence of the CCL injury.

In October 2017 I noticed that her gait has changed slightly but with the front left. She was slightly slower with the swing phase and not lifting as high as the other leg. She didn’t appear to show much in the way of pain or lameness when walking or running and no offloading or non-weight bearing. I massaged and stretched through the neck and shoulder in case we were seeing compensatory injuries.

It went away after this for several months but returned in February 2018, again with subtle signs in the UWTM and perhaps some subtle signs with certain movements at home. I massaged and stretched through neck and shoulders and revisited in 2 weeks to repeat massage as there was some tightness with shoulder movement. She was much improved following this and was showing no signs at home or in the UWTM following the second massage. We continued to visit monthly for maintenance and noticed the subtle gait change in June 2018. I massaged and stretched again at this visit and at this point Jana and I discusses some diagnostics as it was recurring more often.

In the last visit I noted the same delay in the swing phase and reluctancy to lift the leg as high as the other. On massage there was some muscle tension though the triceps, infraspinatus and along the trapezius. I did also find that the muscles along the neck into the shoulder were tense but she tolerated a deep massage and stretch.

I look forward to your findings in the shoulder and thought perhaps if there was Myofascial pain some acupuncture will help.

Cookie continues to do well with her therapy for the back legs and shows no signs of gait abnormalities or pain. Regular therapy using several modalities has helped her maintain her active life style with minimal difficulties.

What I wanted was a comprehensive exam to maybe figure out what is going on.

If it is muscle(s) not wanting to heal because of too much abuse, then we might want to do some dry needling. Otherwise maybe some acupuncture and whatever else comes out of the vet visit.

The veterinarian was curious about Cookie's knees knowing we used platelet-rich plasma (PRP) therapy for her partial cruciate tears. I reported I didn't observe any issues and examination didn't reveal any. There seems to be a consensus, at least for now, that the hind end is not to blame for the shoulder.

The veterinarian found the same sore areas Cookie's PT found; they are in agreement as to what areas are affected.

One thing the vet noted was that she feels Cookie's shoulder blades are bunched up closer together than they should be. She asked about Cookie's stance and the potential of repetitive stress type of issue. Interesting notion. I'm not sure if I'm buying and Cookie's PT isn't sure if she's buying, but it is a theory worth considering. Cookie does have some awkward sitting habits and hunting froggies day in and day out could qualify as repetitive.

For now, we subscribed to this theory.

Cookie did receive both acupuncture and dry needling; poor thing looked like a pin cushion. Fortunately, all the needles don't seem to bother her.

The night after the visit I didn't see any improvement, but the next day, possibly, Cookie's gait looked better. As well as the following physio appointment confirmed improvement for one reason or another.

In the meantime, I've learned some new massage techniques to do for Cookie between appointments. She seems to like the rubbies a lot. So we'll go on with that for a while and see how things go. I would include Cookie's vet's notes here too, but there is nothing other than a short recap of our findings, date, and list of TCVM points. The vet is fantastic to talk to--she listens, processes and thinks about everything I say and have wonderful discussions. Her notes-taking has much to be desired, though and I have to rely on memory.

If things don't resolve, and nobody has any further ideas, we might end up going down South for a consultation with Jasmine's vet. His x-ray diagnostic hands are always what we resort to when everything else fails.


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