Mineralised opacity in shoulder

RE: Mineralised opacity in shoulder

Niall Taylor — Mon, 05 Jun 2017 11:12:20 GMT

[quote user="Rob Davis"]

Sorry, been away for a week so not been online.

I recently took out a trial subscription to VIN and posted these radiographs on there too. The reply from a board-certified orthopod suggested:"Discs mineralize from centrally to peripherally. When I see a hollow disc like this case, it suggests that the central portion is missing. Notice that there is a ring of mineralized material that is disc shaped. Except, it is hollow. "

[/quote]

Thanks for the clarification, I hadn't heard this idea before. I'll keep it in mind in the future

Niall

RE: Mineralised opacity in shoulder

Rob Davis — Mon, 05 Jun 2017 09:04:25 GMT

[quote user="Niall Taylor"]'m not able to see this on the pictures you have included. Can you clarify what exactly 'appears hollow' and how that would indicate herniation. Plain rads are notoriously poor at demonstrating disc disease.[/quote]

Sorry, been away for a week so not been online.

RE: Mineralised opacity in shoulder

James Dunne — Mon, 29 May 2017 21:38:45 GMT

These radiopaque lesions seem to be located at the distal aspect of each acromion process rather than involving the glenoid. As to what they are and their significance, that is up for debate. It's potentially infraspinatus tendon of insertion calcification. Injecting the lesions with triamcinolone may help resolve lameness in conjunction with physical therapy. The C4/C5 disc space appears narrowed and the C6/C7 disc may be calcified, but this radiograph is not centred on the cervical spine and the dog's symptoms do not specifically fit with a neurologic cause of lameness. Shoulder - and forelimb - lameness in general can be difficult to localise even in experienced hands; even when the correct leg and correct joint is identified, the radiographic lesions discovered are not always the significant ones. If local conservative treatment of your lesions does not resolve the lameness, consider arthroscopic inspection of the shoulders - if indeed lameness is still localised to the shoulder. If arthroscopy is negative then it is likely that the lesions present are significant and may require excision. Usually infraspinatus contracture will produce a characteristic gait, but clearly that is not present with this case. If referral is an option consider it early because many of these lamenesses grumble on ad infinitum.

RE: Mineralised opacity in shoulder

Beats — Sun, 28 May 2017 20:00:42 GMT

[quote user="Niall Taylor"]What sort of contrast radiographs do you mean?[/quote]

I was meaning shoulder arthrogram, but I think the point about considering disc disease is a good one.

RE: Mineralised opacity in shoulder

Niall Taylor — Sat, 27 May 2017 21:48:56 GMT

[quote user="Rob Davis"]It has been suggested that there is a minerlised disc at C6/7 on the left lateral view which appears hollow suggesting herniation[/quote]

I'm not able to see this on the pictures you have included. Can you clarify what exactly 'appears hollow' and how that would indicate herniation. Plain rads are notoriously poor at demonstrating disc disease.

[quote user="Beats"] I'd do contrast radiographs [/quote]

What sort of contrast radiographs do you mean?

Niall

RE: Mineralised opacity in shoulder

Rob Davis — Fri, 26 May 2017 11:29:28 GMT

It has been suggested that there is a minerlised disc at C6/7 on the left lateral view which appears hollow suggesting herniation. I had not noticed this until it was pointed out. Any thoughts on significance?

RE: Mineralised opacity in shoulder

Beats — Thu, 25 May 2017 19:45:08 GMT

Re shoulder lameness with no clear cause of radiographs (to me anyway): If it's not settling with rest and NSAIDS in 2-4 weeks, then I'd probably get in for exam after running around to exacerbate lameness and watch the gait myself (video and play back slow-motion if required) and then examine thoroughly again. If left shoulder still fits with source of lameness, I'd do contrast radiographs (medio-lateral, caudo-cranial and "skyline" of bicipital groove) and check for medial glenohumeral ligament injury with palpation of angle of abduction of shoulder with hand fixed on scapula while under GA for radiographs (comparing contralateral side). If an obvious lameness, can do "diagnostic anesthesia" (stick some local in joint as well as contrast or on separate occasion) to check does block out to that before progressing with steroid in the joint (2 injections a month apart).

RE: Mineralised opacity in shoulder

Rob Davis — Thu, 25 May 2017 15:55:03 GMT

[quote user="Lucy Fleming"]

Once referred a dog with forelimb lameness that had similar, but bilateral radiographic findings. I believe they were thought to be incomplete ossification of the caudal glenoid, probably incidental. Can't remember if they looked exactly the same though! The dog's lameness had resolved by the time he was seen at referral so no further investigation was carried out.

[/quote]

I agree that they are probably incidental (though I would have thought incomplete ossification of the caudal glenoid would be positioned more caudally, but I'm no expert!).

Anybody else have any input?

RE: Mineralised opacity in shoulder

Lucy Fleming — Wed, 24 May 2017 12:13:54 GMT