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Objective To determine the influence of low-intensity pulsed ultrasound (LIPUS) on radiographic healing and limb function after uncomplicated, stable osteotomies in dogs. Study design In vivo, prospective, randomized, double-blinded, placebo-control study. Sample population Fifty client-owned dogs. Methods Fifty client-owned dogs with naturally occurring unilateral cranial cruciate ligament rupture were enrolled prior to tibial plateau leveling osteotomy. Dogs were assigned to an active (LIPUS) treatment group or a placebo control (SHAM) treatment group via block randomization on the basis of age, weight, and affected limb. Dogs in the LIPUS treatment group underwent LIPUS treatments for 20 minutes daily: 1.5-MHZ ultrasound wave pulsed at 1 kHZ with a 20% duty cycle at an intensity of 30 mW/cm2 for the duration of the study (12 weeks). Radiographic evaluation was performed at 4, 8, 10, and 12 weeks postoperatively to evaluate bone healing. Limb function was assessed with temporal-spatial gait analysis preoperatively and at 4, 8, and 12 weeks postoperatively by using a pressure-sensitive walkway system. Results Both groups had significant improvement in radiographic score and limb use over time. However, there was no significant difference in radiographic bone healing, or limb use as measured by objective gait analysis detected between the LIPUS treatment group and SHAM treatment group at any point in the study. Conclusion LIPUS treatment did not improve healing in this stable osteotomy model. Clinical significance This study does not provide evidence to support the clinical application of LIPUS to stimulate the healing of stable, uncomplicated osteotomies to accelerate bone healing.

Objective - To report sonographic findings for dogs with a supraspinatus tendinopathy (ST) treated with an ultrasound-guided intratendinous injection of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP). Methods - Medical records for dogs diagnosed with a ST and treated with a BMAC-PRP injection were reviewed. Data collected included patient signalment, radiographic findings at the time of initial evaluation, and sonographic findings, including cross-sectional area (CSA), fiber pattern, and echogenicity. Results -Of 70 records reviewed, 41 met the inclusion criteria. Mean CSA of the supraspinatus tendon decreased by 0.06 cm2 between baseline and 45 days post-treatment (p= 0.0025), and 0.09 cm2 between baseline and 90 days post-treatment (p< 0.0001). Analysis of CSA in dogs with a unilateral ST at baseline revealed a difference of 0.08 cm2 between the affected and unaffected tendon at baseline, with the affected tendon measuring larger than the contralateral tendon (p< 0.0001). This difference became statistically insignificant by 45 days after treatment (u1-u0 = 0.04 cm2, p= 0.2855) and remained so 90 days post-treatment (u1-u0 = 0.03 cm2, p= 0.1910). In most cases (90.6%), the fiber pattern and echogenicity was considered improved 90 days post treatment. In a minority of these cases (13.8%) the fiber pattern and echogenicity abnormalities were considered resolved. Conclusions - Using qualitative and quantitative sonographic measures, BMAC-PRP was associated with an improvement in supraspinatus tendon size, fiber pattern, and echogenicity. Given the protracted nature of tendon healing, long-term evaluation may reveal continued improvements in chronic structural changes not captured during the current study. Functional studies are required to evaluate the clinical benefits of BMAC-PRP in the treatment of STs in dogs. Clinical significance - A ST is a common contributor to forelimb lameness in dogs and remains notoriously difficult to treat. Previous studies have been associated with inconsistent treatment outcomes. In the current study, BMAC-PRP is investigated as a minimally invasive treatment option, revealing positive sonographic results.

Objective: Iliopsoas injury and strain is a commonly diagnosed disease process, especially amongst working and sporting canines. There has been very little published literature regarding iliopsoas injuries and there is no information regarding the ultrasound evaluation of abnormal iliopsoas muscles. This manuscript is intended to describe the ultrasound findings in 73 canine agility athletes who had physical examination findings consistent with iliopsoas discomfort. The population was chosen given the high incidence of these animals for the development of iliopsoas injury; likely due to repetitive stress.Methods: Medical records of 73 agility performance canines that underwent musculoskeletal ultrasound evaluation of bilateral iliopsoas muscle groups were retrospectively reviewed. Data included signalment, previous radiographic findings, and ultrasound findings. A 3-tier grading scheme for acute strains was used while the practitioner also evaluated for evidence of chronic injury and bursitis.Results: The majority of pathologies were localised to the tendon of insertion, with the majority being low grade I-II strains (80.8%). Tendon fibre disruption (71.2%) and indistinct hypoechoic lesions (91.8%) were the most common of acute changes noted. Hyperechoic chronic changes were noted in 84.9 percent of cases. Acute and chronic changes were commonly seen together (62.8%).Conclusion: Diagnostic musculoskeletal ultrasound was used to identify lesions of the iliopsoas tendon consistent with acute and chronic injury, as well as identifying the region of pathology. The majority of agility performance dogs had low grade acute strains based on the tiered system, with mixed acute and chronic lesions being noted frequently.Application: Diagnostic musculoskeletal ultrasound provides a non-invasive diagnostic modality for patients suspected of having an iliopsoas strain.

Objective: To report clinical findings and outcomes for 55 dogs with supraspinatus tendinopathy treated with adipose derived progenitor cells and platelet rich plasma therapy. Methods: Medical records of client-owned dogs diagnosed with supraspinatus tendinopathy that were treated with adipose derived progenitor cells and platelet rich plasma (ADPC-PRP) combination therapy were reviewed from 2006-2013. Data collected included signalment, medical history, limb involvement, prior treatments, physical and orthopedic examination, objective temporospatial gait analysis findings, diagnostic imaging results (radiography, magnetic resonance imaging, musculoskeletal ultrasonography), arthroscopy findings, and outcome. Results: Following ultrasound-guided injection of ADPC-PRP, objective gait analysis was available on 25 of the 55 dogs at 90 days post ADPC-PRP therapy. Following treatment, a significant increase in total pressure index percentage (TPI%) was noted in the injured (treated) forelimb at 90 days post treatment (p = 0.036). At 90 days following treatment, 88% of cases had no significant difference in TPI% of the injured limb to the contralateral limb. The remaining 12% of cases had significantly improved (p=0.036). Bilateral shoulder diagnostic musculoskeletal ultrasound revealed a significant reduction in tendon size (CSA) in the treated tendon at 90 days following treatment when compared to the initial CSA (p=0.005). All cases showed significant improvement in fiber pattern of the affected supraspinatus tendon by the ultrasound shoulder pathology rating scale. Clinical Relevance: These findings suggest that ADPC-PRP therapy should be considered for dogs with supraspinatus tendinopathy. Abbreviations: ST: supraspinatus tendinopathy ADPC: adipose derived progenitor cells MSC: mesenchymal stem cells PRP: platelet rich plasma TPI%: total pressure index percentage

Objective: To report clinical findings and treatments for dogs with supraspinatus tendinopathy (ST).Background: ST is a term used to describe tears, calcifying tendinopathy, tendinosis and/or injuries in and around the tendon of the supraspinatus muscle, and is a cause of forelimb lameness, especially in sporting and performance dogs.Evidentiary value: This is a retrospective study of 327 dogs diagnosed with ST.Methods: Medical records (2006 to 2013) were reviewed for history, signalment, prior treatments, physical examination findings, diagnostic imaging and arthroscopic findings, concurrent shoulder and elbow pathologies, and treatments performed.Results: Dogs aged 4 months to 14 years (average 6.5 years; median 6 years) were diagnosed with ST. Performance and sporting dogs were 39.4% of the population, with 58.1% of them being agility dogs. Pain was elicited on palpation of the supraspinatus tendon in 49.3% of dogs. Shoulder radiographs in 283 dogs showed mineralisation in 13% of cases. MRI of the shoulder was performed in 31 cases and revealed findings indicative of ST, including hyperintensity of signal on T1 weighted image (or “spin-lattice”) and Short T1 Inversion Recovery (STIR) sequences of the supraspinatus tendon at its insertion on the greater tubercle and mineralisation of the supraspinatus tendon. Common ultrasonographic findings included increased tendon size (76%), irregular fibre pattern (74%), and non-homogeneous echogenicity (92.5%). The most common findings on shoulder arthroscopy were supraspinatus bulge (82.2%) and subscapularis pathology (62.4%). Elbow pathology was recorded in 54.5% of dogs. Treatment outcomes showed 74.6% of dogs failed to respond to non-steroidal anti-inflammatory drugs (NSAID) and 40.8% failed to respond to rehabilitation. Conclusions: These findings suggest concurrent shoulder and/or elbow pathology is not uncommon in dogs with ST. Further, ST often fails to respond to NSAID therapy and rehabilitation therapy. Application: Other treatments such as regenerative medicine should be considered. Future studies are still needed to assess the use and efficacy of regenerative medicine for ST.

Objective: To describe clinical and diagnostic findings as well as management of adhesive capsulitis in dogs. Background: Adhesive capsulitis, also known as frozen shoulder, is a syndrome defined by loss of range of motion of the shoulder and may be the end-stage manifestation of several primary conditions. Evidentiary Value: This is a case report series of eight dogs with chronic forelimb lameness diagnosed with adhesive capsulitis. Methods: Medical records (June 1, 2010 to September 1, 2015) including, physical examination findings, radiographic findings, magnetic resonance imaging findings, arthroscopy findings, and treatment plans were reviewed. Results: All dogs presented with a chronic, grade III-VI/VI forelimb lameness. On orthopedic examination all dogs had moderate to significant discomfort on shoulder extension and flexion and severe restriction of range of motion. Six of the eight dogs had evidence of bone remodeling and sclerosis in the affected shoulder on radiographs. Six of had an initial diagnostic ultrasound performed, which revealed evidence of fibrous scar tissue. Five dogs had magnetic resonance imaging performed that revealed moderate shoulder effusion and enhancement of the synovial lining of the shoulder. Arthroscopy was performed in five of the eight patients. Three were noted to have significant contracture, adhesions and fibrous scar tissue of the joint capsule. Severe inflammation was noted throughout the synovium of two patients. All eight patients tried conservative management consisting of oral medications and rehabilitation therapy. Five of the eight patients received extracorporeal shockwave therapy. Three patients received regenerative medicine treatment in the affected supraspinatus and shoulder. Regardless of the treatment elected, none of the dogs were reported to have significant improvement. Conclusion: Adhesive capsulitis is an uncommon cause of chronic forelimb lameness. Further investigation is needed to describe the etiology and pathogenesis of adhesive capsulitis in dogs to evaluate the effectiveness of both non-surgical and surgical treatment modalities, establish treatment protocols, and evaluate short- and long-term clinical outcome of patients. Application: Adhesive capsulitis should be considered in patients with chronic forelimb lameness and moderate to significant discomfort and restriction on shoulder range of motion.

Physical rehabilitation modalities such as therapeutic ultrasound (TU), transcutaneous electrical neuromuscular stimulation (TENS), neuromuscular electrical stimulation (NMES), cold or low-level laser therapy (LLLT), and pulsed magnetic field therapy (PMF) can all, when used properly, assist in treating orthopedic injuries, neurological conditions, and chronic conditions brought about by normal aging in our small animal companions. TU uses sound waves to produce both thermal and nonthermal effects that aid in tissue healing, repair, and function. TENS uses different frequencies of electrical current to decrease pain and inflammation. NMES also uses an electrical current to stimulate muscle contraction to assist in normal neuromuscular function in postorthopedic and neurological injuries. LLLT uses light energy to reduce pain, decrease inflammation, and stimulate healing at a cellular level. PMF uses magnetic field to stimulate normal cellular ion exchange and oxygen utilization and promote generalized healing of tissues. These modalities are discussed in detail covering mechanism of action, parameters, settings, and indications/contraindications of use in our small animals. Although these modalities are important in the physical rehabilitation of small animals, they need to be incorporated with a proper diagnosis, manual therapy, and home exercise program into a specific and individualized patient treatment protocol.