Based on clinical insights from Dr. Matt Brunke, DVM, DACVS-SA, DACVSMR, CCRT in his webinar, “Empowering Vets to Treat More with Less Risk”*
Shoulder tendinopathy in dogs often goes undiagnosed in veterinary practice, overshadowed by more common elbow pathology. Yet for sporting dogs and working canines, canine shoulder injury represents a significant cause of performance decline and chronic pain. Unlike obvious conditions like cruciate ruptures, shoulder problems present with subtle lameness and normal elbow examinations that can leave practitioners searching for answers.
Dr. Matt Brunke emphasizes that while most thoracic limb lamenesses are elbow in origin, when the elbow examination is completely normal and forelimb dysfunction persists, the shoulder becomes the primary suspect. This is particularly true in dogs with repetitive activity histories—agility competitors, dedicated fetch players, and working dogs whose jobs demand repetitive shoulder motion.
Understanding Canine Shoulder Anatomy
The canine shoulder presents unique challenges that differentiate it from human shoulder pathology. Dogs lack functional clavicles, meaning the entire forelimb is suspended from the trunk by muscular attachments rather than bony connections. This arrangement places enormous stress on shoulder soft tissues.
The glenohumeral joint relies heavily on muscular support for stability, with primary motion occurring in flexion-extension planes rather than the multidirectional movement seen in humans. This biomechanical difference makes dogs particularly susceptible to overuse injuries from repetitive activities.
The Big Five Tendons: The supraspinatus serves as the primary lateral stabilizer and is most commonly injured in sporting dogs. The infraspinatus, responsible for external rotation, frequently suffers damage in agility dogs making sharp turns. The biceps brachii tendon, running through the bicipital groove, is prone to chronic tenosynovitis in fetch-playing dogs.
Canine Shoulder Pathophysiology Patterns
Shoulder tendinopathy typically develops through chronic repetitive stress rather than acute trauma. Dogs engaging in high-intensity, repetitive activities gradually develop microscopic tendon tears that create inflammation cycles. Unlike acute injuries that heal with rest, these chronic microtraumas often lead to tendon degeneration.
Secondary compensation mechanisms create challenging diagnostic scenarios. When dogs develop elbow arthritis, they alter gait mechanics to avoid pain, placing abnormal stress on shoulder structures. This secondary shoulder tendinopathy won’t resolve until the primary elbow problem is addressed.
Physical Examination Protocol
Visual Inspection and History Begin by observing natural movement patterns. Dogs with shoulder tendinopathy often show subtle weight shifts and altered foot positioning. The history typically reveals gradual onset rather than acute injury, with “warm-up lameness” being characteristic—dogs appear stiff initially but improve with activity.
Complete Scapular Evaluation Start by locating the scapular spine, which should form a straight line from dorsal to ventral. Any deviation suggests fracture or deformity requiring radiographs. Palpate the entire scapular body systematically, assessing supraspinatus and infraspinatus muscle bellies for atrophy or asymmetry.
Critical Safety Point: If the scapular spine isn’t straight or painful, radiographs are mandatory to rule out osteosarcoma or fractures.
The Gold Standard: Biceps Stretch Test
This two-phase test represents the most reliable functional assessment for shoulder tendinopathy:
Phase 1 – Shoulder Flexion: Flex the shoulder to 90 degrees while maintaining neutral elbow position. This tests supraspinatus and infraspinatus tendons. Positive signs include pain response or muscle guarding.
Phase 2 – Elbow Extension: Extend the elbow while maintaining shoulder flexion to engage the biceps tendon. Dogs with biceps tendinopathy show clear pain responses. In severe cases with complete rupture, you may observe “loss of end feel” where the radius and ulna can be positioned parallel to the spine.
Safety Considerations: Avoid direct biceps tendon palpation due to bite risk. The medial insertion lies close to the dog’s face, and painful responses can be defensive. Functional testing provides better information without safety concerns.
Diagnostic Imaging Strategy
Sedated orthogonal radiographs remain the foundation of shoulder diagnosis, primarily to rule out serious conditions rather than directly visualize tendon pathology. Standard views include lateral and caudocranial projections with proper positioning being critical for interpretation.
Key Radiographic Patterns:
- Biceps tenosynovitis: Mineralized bodies along the bicipital groove with osteophytes at the supraglenoid tubercle
- Shoulder arthritis: Caudal humeral head osteophytes and corresponding glenoid changes
- Osteosarcoma: Moth-eaten lytic lesions requiring immediate attention
Quality positioning is essential—small changes dramatically alter joint appearance. Veterinary radiologist review provides objective interpretation and catches subtle abnormalities.
Advanced Imaging Options
Musculoskeletal Ultrasound offers dynamic tendon assessment and cost-effective evaluation of fiber architecture. However, it requires significant training and experience for accurate interpretation. The learning curve is steep, but practices investing in training can achieve excellent diagnostic value.
CT and MRI provide the highest soft tissue detail but require anesthesia and may not be readily available. These are typically reserved for surgical planning or unclear diagnoses after thorough clinical evaluation.
FAQ: Shoulder Tendinopathy Diagnosis
How do I differentiate shoulder pain from elbow pain?
Key differences include pain location during manipulation, range of motion patterns, and radiographic findings. Shoulder issues show pain on shoulder flexion/extension with normal elbow ROM, while elbow problems demonstrate the opposite pattern. Both conditions can coexist in chronic cases.
What breeds are predisposed to shoulder tendinopathy?
High-risk breeds include Border Collies (agility activities), Labrador Retrievers (fetch, swimming), German Shepherds (working activities), and Golden Retrievers (sporting activities). Any dog with repetitive activity exposure can develop these conditions.
When should I refer to a specialist?
Referral indications include suspected complete tendon rupture, failed conservative management after 6-8 weeks, concurrent neurological signs, or need for advanced imaging and arthroscopy.
How reliable is the biceps stretch test?
The biceps stretch test has high sensitivity for biceps tendinopathy when performed correctly. False positives are rare, though concurrent elbow pathology can complicate interpretation. Proper technique is essential for accurate results.
Can shoulder tendinopathy be bilateral?
Yes, bilateral presentation occurs in approximately 20-30% of cases, especially in working dogs with repetitive activities. Always examine both shoulders systematically, even when lameness appears unilateral.
Treatment Integration
Treatment success requires understanding that shoulder tendinopathy represents chronic inflammatory conditions needing comprehensive management rather than quick fixes.
Initial Phase (0-2 weeks): Focus on controlling inflammation through rest, activity restriction, and appropriate NSAIDs. Cold therapy provides additional anti-inflammatory benefits during this acute management period.
Rehabilitation Phase (2-8 weeks): Controlled exercise progression, physical therapy protocols, and PulseVet® shock wave therapy become crucial. The 3-5 weekly shockwave treatments target cellular-level inflammation while promoting tissue healing and proper fiber alignment.
Multimodal Approach Benefits
Combining pharmaceutical management (NSAIDs, amantadine) with non-pharmaceutical modalities like PulseVet shock wave technology provides synergistic effects. This approach addresses multiple aspects of the inflammatory cascade while promoting natural healing mechanisms.
Prognosis Factors: Favorable outcomes depend on early diagnosis, acute versus chronic presentation, owner compliance with activity restrictions, and absence of concurrent elbow pathology. Most acute cases resolve in 4-8 weeks with proper management, while chronic cases may require 8-16 weeks and ongoing maintenance.
Key Takeaways
✅ Shoulder tendinopathy often mimics elbow disease – systematic examination is essential
✅ Biceps stretch test is the gold standard for functional assessment
✅ Always palpate the entire scapula – rule out fractures and neoplasia
✅ Radiographs are essential for differential diagnosis
✅ Early intervention improves outcomes – don’t wait for severe lameness
Implementing systematic shoulder examination protocols improves diagnostic accuracy and patient outcomes while providing valuable specialized services for your veterinary practice. For advanced training in PulseVet shock wave therapy protocols, visit pulsevet.com
* Dr. Matthew Brunke was paid by Zomedica, Inc. to provide the webinar.
