Medial Shoulder Instability Rehabilitation
Overview
Medial shoulder instability (MSI) is a common cause of forelimb lameness in active and sporting dogs. Injury to the medial glenohumeral ligament, joint capsule, and subscapularis tendon results in shoulder laxity, pain, and reduced athletic performance. Successful rehabilitation emphasizes protecting healing tissues while progressively restoring dynamic shoulder stability.
Key Clinical Points
Diagnosis requires more than an abduction angle
Shoulder abduction testing is helpful but should never be used alone.
Clinical examination and advanced imaging provide a more accurate diagnosis.
Conservative treatment is the first choice
Most Grade I and II injuries respond well to rehabilitation.
Surgery is generally reserved for severe or non-responsive cases.
Dynamic stability is the goal
Rehabilitation focuses on restoring muscular control rather than simply reducing pain.
Progressive loading helps protect the healing ligament while improving shoulder function.
“Successful medial shoulder instability rehabilitation restores shoulder stability through controlled loading, progressive strengthening, and protection of healing tissues.”
Rehabilitation Priorities
Protect injured medial shoulder structures.
Control pain and inflammation.
Restore dynamic shoulder stability.
Progress strengthening without increasing instability.
Return to pain-free functional activity.
Evidence Snapshot
Conservative rehabilitation is recommended as first-line treatment for most dogs with MSI.
Clinical rehabilitation programs report excellent return to function in appropriately managed cases.
There is currently no evidence that one surgical technique consistently produces superior outcomes.
Successful outcomes depend on matching treatment progression to tissue healing and shoulder stability.
Clinical Pearls
Treat instability before progressing strengthening.
Grade the injury to guide rehabilitation progression.
Monitor the entire kinetic chain for compensatory dysfunction.
Return to sport should be based on function—not time alone.
Continue Learning
View the complete rehabilitation protocol.
Deliver home exercise programs and client education.
Watch clinical demonstrations, treatment techniques, and practical applications.
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Alva BM, Pechette Markley AR, Shoben AB, Kieves NR. Owner-reported treatments and outcomes of perceived injuries to the thoracic and pelvic limb of agility dogs. Front Vet Sci. 2024;11:1409199. doi: 10.3389/fvets.2024.1409199
Arena I, Valentini S, Nundini L, Dalmonte T, Spinella G. Physiotherapy treatment of musculo-tendinous disorders of the canine shoulder: A clinical study. Vet J. 2025;313:106379. doi: 10.1016/j.tvjl.2025.106379
Gemignani F, Harel M, Livet V, Barthelemy A, Segard E, Cachon T, et al. Pilot study of the ultrasonographic examination of the intact and transected medial glenohumeral ligament in dogs. Vet Radiol Ultrasound. 2023;64(2):306-313. doi: 10.1111/vru.13164
Hammer M, Grand JG. Inverted V-shaped extracapsular stabilisation technique and arthroscopic findings in six dogs with medial shoulder instability. J Small Anim Pract. 2021;62(9):795-804. doi: 10.1111/jsap.13347
Hebrard L, Copet A, Blondel M, Cachon T. Video-assisted ligamentoplasty effectively treats medial shoulder instability in dogs: a retrospective study of 6 cases. Am J Vet Res. 2025;86(8). doi: 10.2460/ajvr.24.12.0388
Jones SC, Howard J, Bertran J, Johnson B, Pozzi A, Litsky AS, et al. Measurement of shoulder abduction angles in dogs: an ex vivo study of accuracy and repeatability. Vet Comp Orthop Traumatol. 2019;32(6):427-432. doi: 10.1055/s-0039-1692410
Kieves NR, Jones SC. There is no superior treatment method for medial shoulder instability in dogs. Vet Evid. 2020;5(1). doi: 10.18849/ve.v5i1.249
Livet V, Harel M, Taroni M, Carozzo C, Viguier E, Sonet J, et al. Stress radiography for the diagnosis of medial glenohumeral ligament rupture in canine shoulders. Vet Comp Orthop Traumatol. 2019;32(6):433-439. doi: 10.1055/s-0039-1692469
Pechette Markley AR, Shoben AB, Kieves NR. Internet-based survey of the frequency and types of orthopedic conditions and injuries experienced by dogs competing in agility. J Am Vet Med Assoc. 2021;259(9):1001-1008. doi: 10.2460/javma.259.9.1001
Rocheleau PJ, Dycus DL, Lotsikas PJ, Robson A. Internet-based survey on diagnosis and treatment recommendations for medial shoulder syndrome and instability in dogs. Can Vet J. 2024;65(8):781-790.
Woolley ELE, Collyer TA, Finch SJ, House AK. Medial shoulder instability: prevalence and treatment outcomes in 17 poodles and 31 dogs of other breeds. VCOT Open. 2023;6:e107-e113. doi: 10.1055/s-0043-1774372
Medial Shoulder Instability Rehabilitation FAQ
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Rehabilitation should begin as soon as therapy is ordered by the veterinarian. Early treatment helps control pain, protect healing tissues, and reduce compensatory movement patterns.
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Maybe. Many Grade I and Grade II injuries respond well to conservative management with activity modification, rehabilitation, and, when needed, external support. More severe injuries may require surgical stabilization.
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High-impact activities such as repetitive ball chasing, jumping, rough play, sharp turns, and uncontrolled running should be avoided until healing is well underway, usually more than 8 weeks.
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Rehabilitation typically takes 8–12 weeks for mild to moderate injuries. More severe injuries or dogs returning to athletic activities may require 3–6 months, with progression based on shoulder stability, strength, and function rather than a fixed timeline.
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The primary goal is to restore dynamic muscular shoulder stability so the dog can return to comfortable, pain-free function while minimizing the risk of reinjury.
To learn more, download the Medial Shoulder Instability Treatment Protocol Workbook today.
