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"Marshall", a young adult Labrador, was involved
in a road traffic accident. The initial examination was
optimistic that he had only received superficial bruising
and some minor contusions. He was however very clearly lame
on his left forelimb.
My colleague Ingrid identified a large amount of swelling
around his elbow and scheduled this area of the leg for
radiography. The x-rays didn't demonstrate any fracture
or dislocation.
Anti-inflammatory drugs were prescribed and his exercise
was restricted. A week later when Marshall was persistently
lame I was asked for my opinion.
There was indeed a very large amount of swelling around
his upper limb involving both his shoulder and elbow and
it was difficult to locate the exact area of pain. The obvious
step to take was to repeat the x-rays but include the shoulder
area with 2 different views.
Fortunately, the anterior/posterior view was able to demonstrate
the injury - "Marshall" had fractured his scapula
or shoulder blade, a very rare fracture. Usually, the scapular
fragments will displace to conform to the body wall and
remain relatively stable in this position because of the
action of the surrounding musculature. Consequently, the
bone fragments will heal without any surgical intervention.
The main concern relates to soft tissue adhesions and scar
formation. The shoulder should be returned to normal function
within 4 to 6 weeks or serious contracture of the triceps
muscle or loss of range of motion may occur. Providing this
can be achieved then the prognosis for complete return to
normal function is very good.
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