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Decubital shoulder ulcers are lesions on the shoulders of sows kept in production systems, reported to have a relatively high prevalence, and to some extent be comparable with human pressure ulcers. In sows, the ulcers are caused by pressure inflicted by the flooring, leading to oxygen deficiency in the skin and the underlying tissue. This paper reviews existing knowledge about decubital shoulder ulcers in sows, focusing on the pathogenesis, classification and consequences in terms of pain and animal welfare. On the basis of available human as well as animal literature, we describe the primary causal factors, underlying mechanisms, suggested direction of progression as well as temporal development. We review suggested scales for the classification of decubital shoulder ulcers, and argue that none of these are useful for the classification of decubital shoulder ulcers in live sows. The knowledge of the welfare consequences of decubital shoulder ulcers is limited. On the basis of the tissue structures that are involved, we assume that the development and presence of decubital shoulder ulcers in sows are a painful and prolonged condition. It is concluded that the extent of the welfare problem related to decubital shoulder ulcers cannot be fully determined until a valid ante-mortem classification system is available, and knowledge about the duration of the condition (including the various stages), as well as the possible consequences in terms of pain or discomfort have been established.

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