DIAGNOSIS OF SHOULDER LAMENESS. 
525 
(6) In addition, shoulder lameness may undoubtedly be produced by 
nervous disease, though reliable observations on this point are not to 
hand. The case of intermittent lameness reported under the heading 
“Paralysis of the Eadial Nerve ” cannot be viewed as of nervous origin 
without further evidence. 
The diagnosis of “ shoulder lameness ” chiefly depends on the negative 
results of local examination; the more careful the local examination, the 
rarer will be the diagnosis shoulder lameness. The practitioner should 
avoid basing his opinion on single symptoms, or attaching too great 
weight to the indications of palpation. As the striding movement is 
chiefly dependent on the action of the shoulder muscles, it is naturally 
much interfered with, and therefore shoulder lameness is generally 
characterised by difficulty in advancing the swinging limb. The stride 
is shortened, and, as a rule, uncertain. The foot is imperfectly lifted ; it 
tends to strike the ground, especially when the surface is uneven, or 
when the foot meets with obstacles. In leading the horse uphill, or in 
circling (especially if the lame leg is outwards), lameness is generally more 
marked. The limb, when being advanced, is not infrequently turned 
outwards. Lameness appears equall} T on hard and soft ground—in 
fact, may even be more marked on the latter. When trotting, the head 
is often nodded in a pronounced way, but even this symptom is not 
constant. It is generally present, however, in disease of the levator 
humeri, and of the other levators of the shoulder, because of the pain 
induced by extension of the affected muscle. In moving backwards, 
the lame leg is often not lifted, but slid over the ground. Disease in the 
levators of the fore arm produces marked pain when the foot is passively 
moved either forwards, backwards, inwards, or outwards. In chronic 
lameness, too great stress must not be laid on atrophy of muscle or of 
the hoof. Both are secondary symptoms, and do not always indicate 
the seat of disease. 
Prognosis and course. Our ignorance of the nature of this lameness 
renders prognosis uncertain, and the chief indication is the course which 
the disease takes. The longer lameness has existed and the greater the 
atrophy of muscle, the more serious the condition. Inflammation of a 
single muscle generally takes a favourable course, but rheumatic disease 
is often obstinate. None of the articular diseases offers much hope of 
recovery, especially when of old standing. As soon as some improve¬ 
ment can be noted, a more sanguine prognosis may be delivered. Many 
cases of shoulder lameness recover in two or three weeks, whilst others 
may continue for an indefinite time. 
The treatment is as varied as the prognosis. In acute inflammation 
and mechanical injuries, rest and cold applications in the form of irri¬ 
gation or cold poultices are most useful. Failing marked improvement 
