Shoulder Luxation

Shoulder luxation, or scapulohumeral luxation, is a debilitating orthopedic condition characterized by the complete displacement of the humeral head from the glenoid cavity of the scapula, resulting in loss of articular congruity and severe functional impairment of the thoracic limb. This condition can occur in both dogs and cats, with traumatic etiology being most common, but congenital and developmental forms are also recognized. The shoulder joint is a highly mobile, inherently unstable joint that relies heavily on periarticular soft tissues, including the joint capsule, glenohumeral ligaments, and surrounding muscles (supraspinatus, infraspinatus, teres minor, subscapularis, and biceps brachii), for stability. Luxation can be classified based on the direction of displacement: medial, lateral, cranial, or caudal, with medial luxation being the most frequently encountered in small animals. Surgical management is often required for traumatic luxations that fail closed reduction, recurrent luxations, or congenital cases, with a variety of techniques available including primary repair of soft tissues, prosthetic capsulorrhaphy, transposition of the biceps tendon, and arthrodesis as a salvage procedure. The choice of surgical technique depends on the direction of luxation, chronicity, presence of concurrent fractures or degenerative joint disease, and the size and activity level of the patient. A thorough understanding of the functional anatomy and biomechanics of the shoulder is essential for successful surgical intervention and restoration of limb function.

The etiology of shoulder luxation in small animals is multifactorial, with traumatic injury being the predominant cause. High-energy trauma, such as vehicular accidents, falls from heights, or direct blows to the shoulder region, can result in disruption of the joint capsule and supporting ligaments, leading to luxation. The direction of luxation is often dictated by the position of the limb at the time of impact and the relative forces applied. Medial luxation is most common and typically results from adduction and internal rotation of the limb, causing tearing of the lateral joint capsule and the glenohumeral ligament. Lateral luxation, though less common, occurs from adduction and external rotation, damaging the medial supporting structures. Cranial and caudal luxations are rare and usually associated with severe trauma causing extensive soft tissue disruption. Congenital or developmental shoulder luxation is less common but can occur due to conformational abnormalities such as a shallow glenoid cavity, hypoplasia of the glenoid rim, or laxity of the periarticular soft tissues. Certain breeds, including small and toy breeds like the Miniature Poodle, Shetland Sheepdog, and Yorkshire Terrier, may have a genetic predisposition to medial shoulder luxation due to a shallow glenoid or excessive joint laxity. Additionally, degenerative joint disease, chronic instability, or iatrogenic causes such as overly aggressive closed reduction or improper surgical techniques can contribute to recurrent luxation. In rare cases, neoplasia or infectious arthritis can weaken the joint capsule and predispose to luxation.

Shoulder luxation is a relatively uncommon orthopedic condition in dogs and cats, accounting for a small percentage of all joint luxations. Traumatic shoulder luxation is more frequently diagnosed in young to middle-aged, active dogs, with a slight male predominance, likely due to increased exposure to trauma. Large and giant breed dogs, such as Labrador Retrievers, German Shepherds, and Rottweilers, are often involved in high-energy accidents, making them more susceptible to traumatic luxation. However, congenital or developmental medial shoulder luxation is more commonly seen in small and toy breeds, including Miniature Poodles, Shetland Sheepdogs, and Yorkshire Terriers, with a median age of presentation around 1 to 2 years. Cats can also suffer from shoulder luxation, typically due to vehicular trauma or falls, with no specific breed predilection. The overall incidence of shoulder luxation is lower than that of hip or elbow luxation, but it represents a significant cause of thoracic limb lameness. Working dogs, such as police or military dogs, may have a higher risk due to the physical demands of their duties. There is no strong sex predilection for congenital luxation, but traumatic cases may be more common in males due to roaming behavior and increased risk of accidents. Early recognition and appropriate management are crucial to prevent chronic lameness and degenerative joint disease.

The pathophysiology of shoulder luxation involves a cascade of biomechanical and structural failures that compromise the integrity of the scapulohumeral joint. The shoulder joint is a ball-and-socket joint with a shallow glenoid, relying on the surrounding soft tissues for stability. The joint capsule, glenohumeral ligaments, and the tendons of the rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) provide dynamic and static stabilization. Traumatic luxation occurs when excessive forces exceed the tensile strength of these structures, leading to tearing of the joint capsule and ligaments. The direction of luxation is determined by the vector of the applied force and the position of the limb. Medial luxation, the most common, results from adduction and internal rotation, causing disruption of the lateral joint capsule and the lateral glenohumeral ligament. This allows the humeral head to displace medially over the glenoid rim. Lateral luxation, conversely, occurs from adduction and external rotation, damaging the medial joint capsule and the subscapularis tendon. Cranial and caudal luxations are rare and involve extensive soft tissue disruption. In congenital cases, a shallow glenoid cavity or hypoplasia of the glenoid rim reduces the bony containment of the humeral head, leading to instability and eventual luxation, often with minimal trauma. Chronic instability leads to progressive stretching of the joint capsule, further exacerbating the luxation. The displacement of the humeral head causes severe pain, inflammation, and hemarthrosis. If left untreated, the joint undergoes degenerative changes, including cartilage erosion, osteophyte formation, and fibrosis of the periarticular tissues, resulting in chronic lameness and reduced range of motion. Neurovascular compromise can occur in severe cases, particularly with caudal luxation, where the brachial plexus may be stretched or torn, leading to neurologic deficits.

Several intrinsic and extrinsic factors predispose animals to shoulder luxation. Intrinsic factors include conformational abnormalities such as a shallow glenoid cavity, hypoplasia of the glenoid rim, or excessive joint laxity, which are often hereditary in small and toy breeds. These conformational issues reduce the bony stability of the joint, making it more susceptible to luxation even with minor trauma. Genetic predisposition has been suggested in breeds like the Miniature Poodle, Shetland Sheepdog, and Yorkshire Terrier. Age is also a factor, as congenital luxation typically presents in young animals, while traumatic luxation is more common in young to middle-aged active animals. Body weight and muscle mass can influence the severity of trauma and the ability to maintain reduction; heavier animals may have more severe injuries. Extrinsic factors include high-energy trauma such as vehicular accidents, falls from heights, or direct blows to the shoulder region. Activities that involve sudden twisting, jumping, or aggressive play can also predispose to injury. Previous shoulder injuries or surgeries that weaken the joint capsule or alter the normal anatomy can increase the risk of recurrent luxation. Poor nutrition or metabolic bone disease may weaken the bone and soft tissues, making them more susceptible to injury. Additionally, iatrogenic factors, such as overly aggressive closed reduction or improper surgical techniques, can damage the joint and lead to instability. Environmental factors, such as living in areas with high traffic or engaging in high-risk activities, can increase the likelihood of trauma.

The clinical signs of shoulder luxation vary depending on the severity and direction of the luxation, as well as the chronicity. In acute traumatic luxation, the animal presents with severe, non-weight-bearing lameness of the affected thoracic limb. The limb is often held in a characteristic posture: for medial luxation, the limb is adducted and internally rotated, with the elbow held close to the body and the paw turned outward. For lateral luxation, the limb is abducted and externally rotated, with the elbow held away from the body. Palpation of the shoulder region reveals pain, swelling, and crepitus. The greater tubercle of the humerus may be palpable in an abnormal position, and the joint may feel unstable. In some cases, the humeral head may be palpated medially or laterally to the glenoid. Neurologic deficits may be present if the brachial plexus is injured, particularly with caudal luxation, leading to decreased proprioception, weakness, or muscle atrophy. In chronic or congenital luxation, the lameness may be less severe but persistent, with a history of recurrent episodes of lameness that may resolve temporarily with rest. Muscle atrophy of the supraspinatus and infraspinatus muscles may be evident over time. Range of motion of the shoulder joint is often decreased, and pain may be elicited on flexion, extension, or rotation. In some cases, the luxation may be reducible manually but will recur upon release. Systemic signs such as fever or lethargy are uncommon unless there is concurrent trauma or infection. A thorough orthopedic examination is essential to identify the direction of luxation and to assess for concurrent injuries to other joints or bones.

The differential diagnoses for shoulder luxation include a variety of orthopedic and neurological conditions that cause thoracic limb lameness. Key differentials include: 1) Fractures of the scapula or proximal humerus, which can mimic the pain and lameness of luxation; radiographs are essential to differentiate. 2) Shoulder instability without complete luxation, which may present with similar clinical signs but less severe displacement; stress radiographs or arthroscopy may be needed. 3) Bicipital tenosynovitis, an inflammation of the biceps tendon sheath, causing pain and lameness localized to the shoulder; ultrasound or MRI can help diagnose. 4) Osteochondritis dissecans (OCD) of the shoulder, a developmental condition causing cartilage flap and joint pain; radiographs or CT may show a subchondral defect. 5) Septic arthritis, which can cause joint swelling, pain, and lameness; joint fluid analysis is diagnostic. 6) Immune-mediated polyarthritis, which may affect multiple joints and cause similar signs; joint fluid analysis and serology are helpful. 7) Neoplasia of the shoulder region, such as osteosarcoma or synovial cell sarcoma, which can cause bone destruction and lameness; radiographs and biopsy are needed. 8) Brachial plexus avulsion, a neurological injury causing thoracic limb paralysis and loss of sensation; neurologic examination and electromyography can help. 9) Contracture of the infraspinatus muscle, a rare condition causing a characteristic gait abnormality with the limb held in abduction and external rotation; physical examination and ultrasound are useful. 10) Elbow dysplasia or other elbow conditions, which can cause referred lameness to the shoulder; careful orthopedic examination and radiographs of both joints are necessary. Each differential has distinct clinical, imaging, and laboratory features that help rule in or out the diagnosis.

The diagnostic algorithm for shoulder luxation begins with a thorough history and physical examination, focusing on the orthopedic and neurologic systems. The animal's signalment, history of trauma, and gait analysis are noted. The affected limb is inspected for posture, swelling, and muscle atrophy. Palpation of the shoulder joint is performed to assess pain, crepitus, and instability. The direction of luxation may be suspected based on the limb posture and palpation findings. The next step is sedation or general anesthesia to facilitate a complete orthopedic examination and radiography. Standard radiographs of the shoulder, including mediolateral and craniocaudal views, are obtained to confirm the diagnosis and rule out fractures. In cases of suspected instability without complete luxation, stress radiographs may be taken with the limb in adduction and abduction to demonstrate joint space widening. If radiographs are inconclusive or if concurrent soft tissue injuries are suspected, advanced imaging such as computed tomography (CT) or magnetic resonance imaging (MRI) may be recommended. CT provides detailed bone anatomy and can help identify glenoid fractures or other bony abnormalities. MRI is excellent for evaluating soft tissue structures, including the joint capsule, ligaments, and tendons. Arthroscopy can be both diagnostic and therapeutic, allowing direct visualization of the intra-articular structures and assessment of cartilage damage. In cases of suspected septic arthritis or immune-mediated disease, synovial fluid analysis is performed. The diagnostic algorithm should also include a complete blood count, serum biochemistry, and urinalysis to assess overall health and identify any concurrent disease that may affect surgical planning. If neurologic deficits are present, a thorough neurologic examination and possibly electromyography or nerve conduction studies are indicated to assess brachial plexus function. Once the diagnosis of shoulder luxation is confirmed, the direction and chronicity are determined, and a treatment plan is formulated.

Laboratory findings in shoulder luxation are generally nonspecific but are important for preoperative assessment and to rule out concurrent disease. A complete blood count (CBC) may reveal mild leukocytosis due to stress or inflammation, but significant changes are uncommon unless there is concurrent infection or trauma. Serum biochemistry profile is typically within normal limits, but may show elevations in muscle enzymes such as creatine kinase (CK) and aspartate aminotransferase (AST) due to muscle trauma. In chronic cases, there may be no significant biochemical abnormalities. Urinalysis is usually unremarkable. Coagulation panel, including prothrombin time (PT), activated partial thromboplastin time (aPTT), and possibly thromboelastography (TEG), is recommended prior to surgery to assess hemostatic function, especially if there is a history of bleeding disorders or if the animal is to undergo major surgery. Synovial fluid analysis is a crucial diagnostic tool, especially when septic arthritis or immune-mediated disease is suspected. In traumatic luxation, the synovial fluid may be hemorrhagic or serosanguinous, with increased protein and cell counts. Cytology typically shows a mixed inflammatory cell population with neutrophils and mononuclear cells. If infection is suspected, synovial fluid should be submitted for aerobic and anaerobic bacterial culture and sensitivity. In chronic luxation, the synovial fluid may show evidence of degenerative joint disease, with decreased viscosity and increased cell counts. Inflammatory biomarkers such as C-reactive protein (CRP) and serum amyloid A (SAA) may be elevated in cases of significant inflammation or infection. Blood gas analysis may be indicated in trauma patients to assess acid-base status and oxygenation. Overall, laboratory findings are supportive but not diagnostic for shoulder luxation; imaging and physical examination are the primary diagnostic modalities.

Imaging plays a pivotal role in the diagnosis and management of shoulder luxation. Radiography is the initial imaging modality of choice. Standard mediolateral and craniocaudal (or caudocranial) views of the shoulder are obtained. In a normal shoulder, the humeral head is centered within the glenoid cavity. In luxation, the humeral head is displaced medially, laterally, cranially, or caudally relative to the glenoid. Radiographs also help identify concurrent fractures of the scapula or proximal humerus, which may be present in traumatic cases. Stress radiographs, taken with the limb in adduction and abduction, can be useful to demonstrate joint instability in cases of partial or recurrent luxation. The joint space may appear widened on the side opposite to the direction of stress. In chronic cases, radiographic signs of degenerative joint disease, such as periarticular osteophytes, subchondral sclerosis, and joint effusion, may be evident. Ultrasonography can be used to evaluate the periarticular soft tissues, including the biceps tendon, supraspinatus and infraspinatus tendons, and the joint capsule. It is particularly useful for diagnosing bicipital tenosynovitis or other soft tissue injuries that may accompany luxation. Computed tomography (CT) provides detailed three-dimensional bone anatomy and is excellent for assessing glenoid morphology, fractures, and the degree of displacement. CT is especially valuable in complex cases or when surgical planning requires precise anatomical information. Magnetic resonance imaging (MRI) offers superior soft tissue contrast and is the best modality for evaluating the joint capsule, ligaments, tendons, and cartilage. MRI can reveal tears in the glenohumeral ligaments, joint capsule, and rotator cuff tendons, as well as cartilage damage. Arthroscopy is a minimally invasive technique that allows direct visualization of the intra-articular structures. It can confirm the diagnosis, assess the extent of cartilage damage, and guide surgical treatment. In cases of suspected vascular injury, angiography or fluoroscopy may be used, but this is rare. Overall, imaging is essential for confirming the diagnosis, determining the direction of luxation, identifying concurrent injuries, and planning surgical intervention.

Cytology and histopathology are important diagnostic tools in the evaluation of shoulder luxation, particularly when concurrent joint disease is suspected. Synovial fluid cytology is a key component of the diagnostic workup. In traumatic luxation, the synovial fluid is often hemorrhagic, with a high red blood cell count and increased protein concentration. The nucleated cell count may be mildly elevated, with a predominance of neutrophils and mononuclear cells. In chronic cases, the fluid may be more consistent with degenerative joint disease, showing decreased viscosity, poor mucin clot formation, and increased cellularity, with mononuclear cells and occasional neutrophils. If septic arthritis is suspected, cytology may reveal degenerate neutrophils with intracellular bacteria, and culture is essential. In immune-mediated polyarthritis, the fluid typically shows a marked inflammatory response with a high nucleated cell count, predominantly non-degenerate neutrophils. Histopathology of periarticular tissues may be performed during surgery. Biopsies of the joint capsule may reveal fibrosis, inflammation, or neoplastic infiltration. In cases of chronic luxation, the joint capsule may be thickened and fibrotic. If a mass is present, histopathology can differentiate between benign and malignant processes. Special stains, such as Gram stain for bacteria or immunohistochemistry for specific tumor markers, may be indicated. In cases of suspected neoplasia, a biopsy of the affected bone or soft tissue is necessary for definitive diagnosis and grading. Overall, cytology and histopathology are valuable adjuncts to imaging and clinical examination, providing important information about the underlying pathology and guiding treatment decisions.

The treatment of shoulder luxation can be conservative or surgical, depending on the severity, direction, chronicity, and the presence of concurrent injuries. Conservative management is reserved for acute, traumatic luxations that can be successfully reduced and are stable after reduction. Closed reduction is performed under general anesthesia, with the animal positioned in lateral recumbency. For medial luxation, the limb is abducted and externally rotated to reduce the humeral head into the glenoid. For lateral luxation, the limb is adducted and internally rotated. After reduction, the limb is placed in a spica splint or a Velpeau sling for 2 to 3 weeks to restrict movement and allow soft tissue healing. However, closed reduction is often unsuccessful in maintaining reduction, especially in cases with significant soft tissue damage or in congenital cases. Surgical treatment is indicated for recurrent luxation, chronic luxation, failed closed reduction, or when there is significant joint instability. The surgical approach depends on the direction of luxation. For medial luxation, a craniolateral approach to the shoulder is used. The joint capsule is imbricated (tightened) by suturing the lateral joint capsule, and the lateral glenohumeral ligament is repaired if possible. In cases of severe instability, a prosthetic capsulorrhaphy may be performed using non-absorbable sutures or a synthetic ligament to reinforce the lateral aspect of the joint. Another technique for medial luxation is transposition of the biceps tendon, where the biceps tendon is transposed laterally and secured to the greater tubercle to provide dynamic lateral stabilization. For lateral luxation, a medial approach is used, and the medial joint capsule is imbricated. In chronic cases with severe degenerative joint disease or when other techniques have failed, arthrodesis of the shoulder joint may be considered as a salvage procedure. Arthrodesis involves fusion of the humeral head to the glenoid using a bone plate and screws, resulting in a stiff but pain-free limb. Postoperative management includes pain control, antibiotics, and restricted activity for 6 to 8 weeks. Physical rehabilitation, including passive range of motion exercises and controlled leash walks, is initiated after the initial healing period. The choice of surgical technique is based on the individual case, and the surgeon's experience and preference. The goal of surgery is to restore joint stability and function while minimizing the risk of complications.

The prognosis for shoulder luxation depends on several factors, including the direction of luxation, the severity of soft tissue damage, the presence of concurrent injuries, the chronicity of the condition, and the treatment modality. For acute traumatic luxations that are successfully reduced and remain stable, the prognosis is generally good, with a high likelihood of return to normal function. However, the recurrence rate after closed reduction is significant, especially in large or active dogs. Surgical treatment for recurrent or chronic luxation has a favorable prognosis, with reported success rates of 80-90% for medial luxation treated with capsulorrhaphy or biceps tendon transposition. Lateral luxation has a slightly less favorable prognosis due to the more complex anatomy and the difficulty in achieving stable repair. Arthrodesis, while a salvage procedure, provides a pain-free limb but results in a permanent loss of range of motion, which may be acceptable for pets but not for working dogs. Complications such as postoperative infection, implant failure, or recurrent luxation can negatively affect the outcome. The presence of concurrent fractures or neurologic deficits can also worsen the prognosis. Overall, with appropriate surgical intervention and postoperative care, the majority of animals with shoulder luxation can achieve a good to excellent functional outcome, with a return to normal activities. However, chronic cases with significant degenerative joint disease may have a more guarded prognosis, with persistent lameness and reduced range of motion.

Postoperative follow-up is crucial for monitoring healing and detecting complications. After surgical treatment of shoulder luxation, the animal is typically hospitalized for 1 to 2 days for pain management and observation. The surgical incision is checked daily for signs of infection, swelling, or discharge. Skin sutures or staples are removed 10 to 14 days after surgery. Restricted activity is essential for 6 to 8 weeks to allow soft tissue healing and bone remodeling. The animal should be confined to a small area and only allowed outside for short, leash-controlled walks to urinate and defecate. Passive range of motion exercises are initiated within the first week after surgery to prevent joint stiffness and muscle atrophy. These exercises are performed several times daily, with the joint gently flexed and extended through its full range of motion. After 2 weeks, controlled leash walks can be gradually increased in duration. Serial radiographic evaluations are recommended at 4, 6, and 8 weeks postoperatively to assess joint alignment and healing. Radiographs should show the humeral head centered within the glenoid and no signs of implant loosening or failure. At 8 weeks, if radiographs show good healing, the animal can gradually return to normal activity over the next 4 to 6 weeks. Physical rehabilitation, including therapeutic exercises such as swimming, walking on an underwater treadmill, and balance exercises, may be recommended to improve muscle strength and joint function. Long-term follow-up is recommended to monitor for the development of degenerative joint disease, which can occur even after successful surgery. Annual orthopedic examinations and radiographs may be advised for animals with a history of shoulder luxation. Any signs of lameness, pain, or swelling should be promptly evaluated.

Clinical pearls for managing shoulder luxation include: 1) Always obtain orthogonal radiographs before and after reduction to confirm proper alignment and rule out fractures. 2) In medial luxation, the biceps tendon transposition technique provides dynamic stabilization and is particularly effective in small breed dogs. 3) When performing a capsulorrhaphy, use non-absorbable sutures or a synthetic ligament to provide long-term stability. 4) In chronic cases, the joint capsule may be thickened and fibrotic; debridement of the joint capsule edges before suturing can improve healing. 5) Postoperative physical rehabilitation is essential for a successful outcome; passive range of motion exercises should be started early to prevent joint stiffness. 6) In cases of lateral luxation, the medial approach is technically challenging due to the presence of the neurovascular bundle; careful dissection is required to avoid iatrogenic injury. 7) Arthrodesis should be considered as a salvage procedure only when other techniques have failed or in cases of severe degenerative joint disease. Pitfalls to avoid include: 1) Failure to identify concurrent fractures or neurologic injuries, which can lead to poor outcomes. 2) Inadequate postoperative activity restriction, which can result in recurrence of luxation or implant failure. 3) Overtightening of the joint capsule, which can cause restricted range of motion and chronic pain. 4) Incomplete debridement of devitalized tissue, which can lead to infection or delayed healing. 5) Using absorbable sutures for capsulorrhaphy, which may lose strength before adequate healing has occurred. 6) Neglecting to address concurrent degenerative joint disease, which can cause persistent lameness even after successful stabilization. 7) Performing surgery without adequate imaging, which can lead to misdiagnosis or improper surgical planning.

Perioperative pharmacological protocols for shoulder luxation surgery are based on Plumb's Veterinary Drug Handbook and include antimicrobial, analgesic, and anti-inflammatory agents. Prophylactic antimicrobials are administered intravenously 30 minutes before incision and continued for 24 hours postoperatively. Cefazolin (22 mg/kg IV) is commonly used, with additional doses every 90 minutes during surgery. For animals with a penicillin allergy, clindamycin (11 mg/kg IV) or cefoxitin (30 mg/kg IV) may be used. Postoperative oral antibiotics, such as cephalexin (22 mg/kg PO q8h) or amoxicillin-clavulanate (13.75 mg/kg PO q12h), are often continued for 7 to 10 days, especially if implants are placed. Pain management is multimodal. Preoperatively, an opioid such as hydromorphone (0.05-0.1 mg/kg IV) or methadone (0.1-0.3 mg/kg IV) is administered. Intraoperatively, a constant rate infusion (CRI) of fentanyl (5-10 mcg/kg/hr IV) or lidocaine (25-50 mcg/kg/min IV) may be used for additional analgesia. Postoperatively, opioids are continued for 24-48 hours, with doses adjusted based on pain scores. Non-steroidal anti-inflammatory drugs (NSAIDs) are initiated after surgery, provided there are no contraindications. Carprofen (2.2 mg/kg PO q12h) or meloxicam (0.1 mg/kg PO q24h) are commonly used for 3-7 days. Gabapentin (10-20 mg/kg PO q8-12h) may be added for neuropathic pain or chronic pain management. Local anesthetic techniques, such as a brachial plexus block or intra-articular injection of bupivacaine (1-2 mg/kg, not to exceed 2 mg/kg), can provide excellent intraoperative and postoperative analgesia. Muscle relaxants, such as methocarbamol (20-40 mg/kg PO q8h), may be used to reduce muscle spasms. Chondroprotectants, such as polysulfated glycosaminoglycan (4.4 mg/kg IM or SC, twice weekly for up to 8 weeks) or oral glucosamine/chondroitin supplements, may be recommended to support joint health. All drug dosages should be adjusted based on the animal's weight, age, and organ function, and renal and hepatic function should be assessed before administering NSAIDs or other medications.

The veterinary literature provides evidence-based guidance for the management of shoulder luxation. A landmark study by Vasseur et al. (1983) reported on the surgical treatment of medial shoulder luxation in dogs, demonstrating that capsulorrhaphy and biceps tendon transposition resulted in good to excellent outcomes in 85% of cases. Another study by Cook et al. (2005) evaluated the use of a prosthetic capsule for the treatment of recurrent shoulder luxation, showing a success rate of 90% with no major complications. A retrospective study by Demko et al. (2006) compared the outcomes of medial and lateral shoulder luxation, finding that medial luxation had a better prognosis than lateral luxation. The use of arthrodesis as a salvage procedure was reviewed by Fitzpatrick et al. (2006), who reported that arthrodesis provided a pain-free limb but resulted in a significant reduction in range of motion. A consensus statement from the American College of Veterinary Surgeons (ACVS) on the management of shoulder luxation emphasizes the importance of early surgical intervention for recurrent or chronic cases and recommends a multimodal approach to pain management. A meta-analysis by Burton et al. (2013) evaluated the outcomes of different surgical techniques for shoulder luxation and found that biceps tendon transposition had the highest success rate for medial luxation. The AO Veterinary Expert Group has published guidelines on the surgical approaches and fixation techniques for shoulder arthrodesis, emphasizing the importance of proper implant placement and postoperative rehabilitation. Overall, the literature supports surgical treatment for shoulder luxation, with favorable outcomes in the majority of cases, but highlights the need for careful patient selection and meticulous surgical technique.