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tvpjournal.com | January/February 2016 | Today's VeTerinary PracTice PracTice To PracTice Peer reviewed 119 MEDIAL SHOULDER INSTABILITY Medial shoulder instability is a common cause of forelimb lameness in dogs. diagnostics and treatment options have been well documented (Figure 6). 5-7 However, postoperative rehabilitation programs and nonsurgical treatment options are not well described. depending on the severity of the instability, conservative treatment using a rehabilitation therapy program or surgical intervention followed by rehabilitation therapy may be considered. Indications some surgeons and rehabilitation therapists use a commercially available neoprene shoulder stabilization system to protect the shoulder during the rehabilitation period. no published studies have compared recovery with and without a shoulder support system following medial shoulder instability surgery. However, thousands of arthroscopic procedures to address medial shoulder instability have been performed at our institution, and use of a stabilization system is considered the standard of care following arthroscopic or open medial shoulder instability repair. Types The shoulder stabilization system consists of removable, breathable neoprene/polyester sleeves that are placed over the shoulders of the patient and attached securely via Velcro to each forelimb. FIGURE 4. At the ftting appointment, proper ft and alignment are confrmed. Have the patient walk around to ensure that the brace does not slip or slide, which could lead to rub sores and impaired function. FIGURE 5. Owners should be informed that the stife brace may contact some areas of the skin, and the hair may rub off and form a callus. This occurs most commonly if the brace extends distally toward the hock, as in this patient. This patient also exhibits an area of erythematous at the distal aspect of the callus. If left untreated or not monitored, this area of erythematous could progress into an open wound that would require more intense management. Individual companies use different criteria for determining the correct ft of their devices. We encourage practitioners to contact the specifc company directly in order to determine correct ft. FIGURE 6. Shoulder arthroscopy of a patient with medial shoulder syndrome; note disruption of the subscapularis and medial glenohumeral ligament. Fitting & Using Custom Stife Braces When the brace arrives, schedule a ftting appointment to confrm proper ft for that particular device to the patient (Figure 4) and show the owner how to properly place and remove the device. Instruct the owner to: • Adjust and check the brace frequently in the first 72 hours to help find the best fit. It usually takes 24 to 72 hours for the patient to become accustomed to the brace, and during this time its gait may be altered. • Remove the brace at night while the animal sleeps to help reduce risk for swelling. • During the first 2 weeks, check the brace and areas of contact at least twice daily for sores or damage to the device. • Schedule re-evaluation appointment 2 weeks after the initial brace fitting to ensure that the brace still fits appropriately and there are no concerns or problems. In addition: • Explain that there may be some areas where the hair may rub off and form a callus (Figure 5); this is not unusual but should never progress to an open sore. • If an open sore is noted, have the owner schedule re-evaluation as soon as possible. • Should the brace become wet, instruct the owner to remove it immediately and allow it to dry before placing it back on the patient.