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Shoulder instability - medial and lateral insufficiency
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Disorders of the shoulder joint are common causes of forelimb lameness in dogs. After localizing the pain on the shoulder, a definitive diagnosis may not be identified because many shoulder conditions involve the soft tissues and therefore not visualized with this diagnostic tool. The first comprehensive report on shoulder instability was in 1998 (1). It was described as the most common disorder of the shoulder in mature dogs. At that time tenosynovitis of the biceps tendon was recognized as the most common cause of shoulder lameness in dogs. The concept of shoulder instability was initially challenged or rejected and continue to be a source of interest and debate but numerous studies were published the last 15 years. The purpose of this presentation is to review, in a collective source, what currently is understood about shoulder instability.
Anatomy and biomechanic of glenohumeral instability
The glenohumeral joint is suited for mobility. The large spherical head of the humerus articulates with the small shallow glenoid fossa of the scapula. The glenoid provides little coverage of the humeral head. It has been suggested that glenohumeral stability results from a hierarchy of mechanisms, including those that do not require the expenditure of energy by muscle (passive mechanisms) and those that do (active mechanisms). The shoulder joint is capable of movements in any direction, but ist chief movements are flexion and extension.
Passive mechanisms
Muscle activity is not required to hold the shoulder together. The intact shoulder of a fresh, anatomical specimen is quite stable. It appears appropriate to discuss the « passive » mechanisms of the glenohumeral joint which include ligamentous and capsular restraints, joint conformity, glenoid labrum, finite joint volume and adhesion/cohesion. [...]
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