Clean Run - February 2014 - 26

Elbow radiographs are also performed, especially if any elbow discomfort was
noted on physical examination. Obvious pathology may be detected, however, a
lack of radiographic evidence of pathology cannot rule out the presence of disease,
such as FMCP.

Advanced Diagnostics
Diagnostic Ultrasound
MRI is an excellent diagnostic modality for this condition; however, diagnostic
musculoskeletal ultrasound also provides a definitive diagnosis in the hands of an
experienced operator. Musculoskeletal ultrasound is a relatively new but rapidly
growing diagnostic technique for musculoskeletal injuries in small animal medicine. Therefore, it is important to seek a veterinarian proficient in small animal musculoskeletal ultrasound. Diagnostic ultrasound offers several advantages over MRI:
it is quick, more economical, and in a majority of cases, can be performed with the
dog awake. In addition, serial ultrasounds performed throughout treatment allow
ongoing monitoring of response to treatment. Common findings indicative of ST
include changes in size, shape, and echogenecity of the affected tendon. In our
retrospective study, dogs with ST had an enlarged tendon with discontinuous or
disorganized fiber pattern and non-homogenous echogenecity.

Diagnostic
musculoskeletal ultrasound
image of
supraspinatus
tendinopathy
showing
disorganized
fibers and
an enlarged
supraspinatus.

Diagnostic
musculoskeletal ultrasound
image of the
same supraspinatus post
regenerative
medicine
treatment
showing a
continuous
organized fiber
pattern and
reduction to
normal size.

Arthroscopy
Although the supraspinatus tendon is
extracapsular (outside of the joint capsule), arthroscopic exploration of the
shoulder and elbow are performed to
evaluate and treat any concurrent pathology. As previously mentioned, concurrent pathology is not uncommon.
Fortunately many of the commonly
found concurrent conditions respond
well to arthroscopic treatment.

Treatment
Regenerative Medicine Therapy
As previously stated, conservative management consisting of rest, NSAIDs and
rehabilitation therapy often fails. Rest
and NSAIDs are ineffective as there is
little to no inflammation associated
with a tendinopathy. Rehabilitation
therapy relies on "healing" through scar
tissue formation. Scar tissue does not
have the tensile strength nor the flexibility of native tendon tissue; therefore,
the tendon is prone to re-injury. Surgical excision is not recommended due
to the high morbidity and high rate of
recurrence as reported in literature.
Due to the poor outcomes of conservative medical management, rehabilitation therapy and surgical treatment, regenerative medicine therapy has been
the standard of care at VOSM for patients with ST since 2008. Research has
shown that stem cells and platelet-rich
plasma (PRP) can regenerate tissues,
increase blood supply and breakdown
scar tissue formation, replacing it with
regenerated tissue.
Regenerative medicine therapy at
VOSM consists of culture expanded
adipose-derived stem cells (ADSC) or
bone marrow-derived stem cell concentrate (BMAC) combined with platelet-rich plasma (PRP). For ADSC, adipose (fat) tissue is collected from the
patient's abdomen. This tissue is sent
to Regenerative Medicine Service at
Virginia Tech where the stem cells are
isolated and cultured (grown). A small
amount of the patient's blood is also
sent to the laboratory for processing to
obtain the PRP. The cells are combined
and returned to VOSM two weeks later
for injection. The patient's stem cells
also banked at the laboratory and can
be re-cultured should the patient reClean Run | February 14

Clean Run - February 2014

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