C10021785 / invoice 10000

Reason: Lameness RevisitHistory: 16/02/26 Presented for left forelimb lameness. CT revealed left shoulder osteoarthritis and changes within the biceps groove. Intra-articular steroid injection performed. Mary reports that following the last steroid injection, the lameness completely resolved for 10 days. On day 11, the lameness returned. There has been no change in activity, and Winnie was kept quiet and on a lead. Meloxicam was restarted for three days but provided minimal relief. The lameness has been particularly severe for the last three days.Current medications: Meloxicam 0.8 ml as needed.OBJECTIVE:- Physical Exam:- General Appearance: Bright, alert, and responsive. - Musculoskeletal: 3/10 left forelimb lameness observed on gait analysis.  A video obtained last night showed a more severe lameness. - The response to palpation of the bicep tendon is less painful than the previous visit.ASSESSMENT:- Bicep tendinopathy and generalised osteoarthritis of the left shoulder.- Initial positive response to intra-articular steroid injection, but the effect was short-lived (10 days).- Poor response to short course of meloxicam.- Lameness has returned and is severe, similar or worse than pre-injection state.PLAN:- Diagnostic/Treatment Plan:- Trial a consistent course of meloxicam daily for up to four weeks to assess for any sustained improvement.- Dose: 0.8 ml orally once daily with food, preferably in the morning.- Instructed owner to monitor for any adverse effects such as vomiting or diarrhoea and to stop medication immediately if they occur.- Re-evaluate in 3-4 weeks via phone, email, or revisit.- If medical management with meloxicam fails, the next recommended step is surgical intervention.- Discussed surgical options: Biceps tendon release (tenotomy), to be attempted arthroscopically first. Conversion to an open approach may be necessary intra-operatively if arthroscopic access is difficult due to the patient's conformation.- Recovery from surgery is approximately six weeks, with strict rest for the first two weeks followed by a gradual return to lead-controlled exercise.- Further surgical options for non-responsive cases were discussed, including shoulder arthrodesis (fusion), which is a major salvage procedure. Amputation was discussed as a less favourable option for a forelimb in this breed.- Recommendations:- Administer meloxicam 0.8 ml daily with food for the next 4 weeks.- Restrict exercise in the short term until the effect of the meloxicam is clear.- If meloxicam is effective, a gradual increase in exercise can be attempted. If lameness recurs with increased activity, surgery is recommended.- If meloxicam is not effective after 4 weeks would advised a biceps tenotomy.- Owner to contact the clinic for a follow-up in 3-4 weeks or sooner if there are concerns.- An email summary of the consultation and options will be sent to the owner.    Vital Signs