ULTRASONOGRAPHIC EVALUATION OF THE CANINE SHOULDER

The aim of this study was to determine the normal ultrasonographic anatomy of the canine shoulder. Fourteen shoulders from 7 clinically normal mid-sized dogs were radiographed and imaged using high frequency ultrasound. Each shoulder was isolated postmortem, and the ultrasonographic and gross anatomy was studied during dissection. The ultrasonographic appearance of the shoulder specimens was similar to that found in the live dogs. Twenty-four shoulders isolated postmortem from 12 variably sized dogs were also used to characterize the normal ultrasound anatomy over a range of sizes. Important anatomic structures that could be consistently evaluated were the biceps tendon and bursa, the bicipital groove surface, the supraspinatous tendon, the infraspinatous tendon, the teres minor tendon, and the caudal aspect of the humeral head. Results of ultrasonographic examination of 4 dogs with shoulder lameness are described to illustrate some applications of canine shoulder ultrasonography in the evaluation of the canine shoulder. In these dogs, ultrasound was a valuable tool to evaluate effusion and synovial proliferation within the bicipital bursa, supraspinatous and biceps tendinitis, biceps tendon strain, and dystrophic calcification.     

Glenoid dysplasia and bicipital tenosynovitis in a Maine coon cat

This report describes a rare case of bicipital tenosynovitis in a Maine coon cat. The cat, a three-and-half-year-old neutered female, presented with chronic weightbearing lameness of the left forelimb. Flexion of the left glenohumeral joint and extension of the left cubital joint were resented, and palpation of the biceps brachii tendon in the bicipital groove elicited pain. A mild incongruity of the joint with mild degenerative changes was seen radiographically. Glenohumeral joint dysplasia was suspected. Ultrasound examination revealed marked thickening of the bicipital tendon and moderate effusion of the left bicipital tendon sheath. Positive contrast radiography of the joint confirmed dilation of the tendon sheath. A tentative diagnosis of bicipital tenosynovitis was made and confirmed on arthrotomy. Surgical removal of osteophytes resulted in the cat being free from pain but a mild lameness recurred six months after surgery.     

Bilateral medial displacement of the biceps tendon of origin: repair using polypropylene mesh and staples

A three‐year‐old male greyhound was presented with acute onset right forelimb lameness because of medial displacement of the biceps tendon of origin. Ultrasonographic examination confirmed the diagnosis, and a concomitant partial tear of the medial glenohumeral ligament was detected during arthroscopy. To stabilise the biceps tendon, polypropylene mesh was fixed across the intertubercular groove to replace the torn transverse humeral retinaculum. Recovery was uneventful and lameness resolved. Fifteen months later, the dog was presented with medial displacement of the biceps tendon of origin of the left shoulder, and was treated successfully using the same technique.     

Rupture of the biceps brachii tendon sheath in two dogs

Rupture of the biceps brachii tendon sheath was diagnosed in two dogs which were presented with chronic thoracic limb lameness. In each case, diagnosis was achieved by positive contrast arthrography, which revealed obvious leakage of contrast agent from the distal portion of the tendon sheath. Arthroscopy was performed in each affected shoulder joint and no other significant lesions were found. In one dog, concomitant bicipital tendinopathy was confirmed by histopathology. Both dogs were treated by bicipital tendon transposition, and tenodesis and both showed improvement in the degree of lameness following surgery. Tearing of the biceps brachii tendon sheath has not been reported previously but should be included in the differential diagnosis for shoulder lameness in the adult dog.     

Standing biceps brachii tenectomy to treat chronic bicipital tendinopathy associated with bursal fibrosis and humeral adhesions in a Quarter Horse gelding

Chronic biceps brachii (BB) tendinopathy is a rare cause of lameness in horses that can be challenging to diagnose and treat successfully. This pathology is typically insidious in onset and unresponsive to conservative treatment. A 12-year-old Quarter Horse gelding presented for chronic severe lameness of the left forelimb that was localised to the left shoulder area. The horse was unresponsive to conservative management and surgical exploration revealed a grossly enlarged proximal BB tendon, a thickened fibrotic bicipital bursa and adhesions between the tendon, humerus and bursa. With standing sedation and local anaesthesia, the adhesions were debrided and 10 cm of the affected tendon was excised. Immediately post-operatively, the left forelimb lameness dramatically decreased. The horse recovered well and after rehabilitation returned to the previous level of athletic performance without evidence of lameness or gait abnormality. In this case, tenectomy of the chronic unresponsive BB tendinopathy, with associated bursal fibrosis and humeral adhesions, was successful and resulted in a return to previous athletic performance without complications. Standing excision of the BB tendon may be a viable treatment option for chronic BB tendinopathy and associated conditions when there is significant compromise to the integrity of the BB tendon.     

Treatment of bicipital tenosynovitis with double tenodesis

This report describes two dogs with bilateral bicipital tenosynovitis which were managed using double tenodesis. Surgical repair involved the attachment of the tendon to the humerus with a bone screw and plastic spiked washer, and a double Bunnell-Meyer suture. Six months postoperatively, neither of the treated dogs displayed any lameness on clinical examination.     

Ultrasonographic examination of the proximal tendon of the biceps brachii: Technique and reference images

Ultrasonography of the shoulder is of interest in the diagnosis of proximal forelimb lameness. The proximal tendon of the biceps brachii (PTBB) and its associated structures are frequently injured and should be included in the routine ultrasonographic examination of the shoulder. This paper describes a complete ultrasonographic procedure for examining the bicipital apparatus, on transverse and longitudinal scans, from the insertion of the PTBB on the supraglenoid tubercle to the muscle body below the intertubercular sulcus.     

BICIPITAL TENOSYNOVITIS IN THE DOG—EVALUATION WITH POSITIVE CONTRAST ARTHROGRAPHY

This paper describes seven dogs with traumatic bicipital tenosynovitis in which complete clinical, radiographic, and surgical evaluations were performed. All were adult dogs of medium to large breed and were presented with a chronic front limb lameness of several months' duration and shoulder muscle atrophy. Survey radiographs of the scapulohumeral joint showed new bone production almost exclusively in the region of the biceps tendon, i.e., the intertubercular groove and the supraglenoid tuberosity. Arthrograms in six of seven dogs revealed difficulty in filling or irregular filling of the bicipital tendon sheath, best seen on the mediolateral view of the shoulder. On surgical exploration, macroscopic lesions of the tendon and/or the sheath were observed in all dogs and included adhesions, fibrosis, scar tissue, edema, and thickening. Partial tear of the tendon was observed in three dogs.     

Arthroscopic biceps brachii tenotomy as a treatment for canine bicipital tenosynovitis

Five dogs of varying breeds, ranging from 4 to 8 years in age, were presented with clinical signs consistent with bicipital tenosynovitis. After failure of conservative treatment, each dog underwent shoulder arthroscopy. Following examination of the scapular humeral joint, the bicipital tendon was severed with a bipolar radiofrequency electrosurgical system. The arthroscopic procedure resulted in a good to excellent outcome for all five dogs.     

Lameness associated with the bicipital bursa in an Arab stallion.

Severe, chronic lameness in the left forelimb of a five-year-old Arab stallion was localised to the bicipital bursa by local anaesthesia and gamma scintigraphy. Radiographic and ultrasonographic examinations of the proximal humeral tubercles and bicipital bursa revealed new bone production in the region of the intertubercular grooves and irregularities in the density of the soft tissues of the bicipital tendon and bursa. An endoscopic examination of the bicipital bursa with a standard arthroscope under general anaesthesia was a useful diagnostic procedure. The stallion was euthanased, and marked fibrocartilage fibrillation and formation of adhesions were found postmortem, confirming a diagnosis of chronic fibrinous bursitis.     

Supraspinatus tendinosis associated with biceps brachii tendon displacement in a dog

A 4-year-old spayed female Australian Cattle Dog (Blue Heeler) was evaluated because of right forelimb lameness of 5 months' duration. Orthopedic evaluation revealed signs of pain localized to the cranial aspects of both shoulder joints. Via magnetic resonance imaging, the mass of the supraspinatus tendon insertion in both shoulder joints was increased, compared with findings in cadavers of clinically normal dogs; additional imaging procedures revealed that, compared with clinically normal tendons, the tendon had increased signal intensity that was consistent with increased fluid content. The increased supraspinatus tendon mass in each shoulder joint was associated with medial displacement of the biceps brachii tendon, which was more severe in the right limb. Arthroscopic evaluations of both shoulder joints revealed no abnormalities. The dog underwent surgery, and the abnormal parts of the tendons were resected. The most prominent finding on histologic examination of excised tissues was severe myxomatous degeneration. The lameness resolved, and at 22 months after surgery, the dog was reported to have had no recurrence of lameness. The clinical signs and histologic appearance of the tendons in this dog strongly resemble findings associated with tendinosis in humans. Decompression of the biceps brachii tendon may have contributed to the successful outcome after surgery in this dog. Supraspinatus tendinosis should be considered among the differential diagnoses in dogs with uni- or bilateral forelimb lameness.     

Clinical and pathologic analyses of bicipital tenosynovitis in dogs

OBJECTIVE: To determine the clinical and pathologic findings in dogs with primary bicipital tenosynovitis. ANIMALS: 19 dogs with 20 shoulder joints treated surgically for bicipital tenosynovitis and 8 shoulder joints from 4 clinically normal dogs. PROCEDURE: Histologic abnormalities of tendon sheaths of the biceps brachii in affected dogs were determined by use of comparison with findings in clinically normal dogs. Specimens were graded for inflammation, fibrosis, villous hypertrophy, vascular prominence, and synovial cell proliferation. Histopathologic results were statistically evaluated for relationship with clinical findings and treatment before surgery. RESULTS: Synovial villous hypertrophy and vascular prominence were the most consistent histologic findings in 16 and 14 of 20 affected joints, respectively. Evidence of inflammation was lacking in 6 joints. Ten joints had inflammatory cell infiltration of the tendon sheath. Plasma cells and lymphocytes were the most common infiltrates; however, the type and amount of inflammatory cell infiltrate were variable. Fibrosis of the tendon sheath was seen in 8 joints, and synovial cell proliferation was seen in 11 joints. Other changes included accumulation of hemosiderin, focal calcification, osseous metaplasia, lysis of collagen, and fibrocartilaginous metaplasia. No significant relationship was detected between histopathologic findings and clinical findings or treatment before surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Inflammation was more variable than hypothesized and may not be a consistent pathophysiologic feature of bicipital tenosynovitis. In some dogs, this disease may be the result of a degenerative process rather than an inflammatory process.     

ULTRASONOGRAPHY OF THE EQUINE BICIPITAL TENDON REGION: A CASE HISTORY REPORT AND REVIEW OF ANATOMY

The equine shoulder region is difficult to investigate by conventional imaging modalities. Diagnostic ultrasound has proven valuable for investigation of soft tissue injuries of the human shoulder. In a horse with shoulder lameness, the authors employed diagnostic ultrasound to augment the use of conventional radiography. A defect in the subchondral bone layer of the medial humeral tuberosity, with adjacent bony fragments were clearly identified with ultrasound. Ultrasound was used for initial evaluation of the bicipital tendon and bursa. The technique was subsequently used to follow and evaluate the post-operative condition of the proximal cranial humerus, bicipital tendon and bursa in this patient. The bicipital regions of 2 immature and 3 adult normal horses were also examined with to illustrate the normal ultrasonographic anatomy of the cranial shoulder region.     

Radiographic and ultrasonographic diagnosis of stenosing tenosynovitis of the abductor pollicis longus muscle in dogs

Stenosing tenosynovitis of the abductor pollicis longus muscle causes chronic front limb lameness in dogs. The lesion, similar to de Quervain's tenosynovitis in people, is caused by repetitive movements of the carpus. Thirty dogs with front limb lameness, painful carpal flexion, and a firm soft tissue swelling medial to the carpus were examined prospectively. Seven dogs had bilateral abductor pollicis longus tenosynovitis. Radiographs of the carpus were characterized by a deeper radiolucent medial radial sulcus and bony proliferations medial and slightly cranial to the distal radius, resulting in stenosis of the tendon sheath and subsequent tendinitis. Ultrasonographic examination of the firm soft tissue swelling medial to the carpus was characterized by an irregular hypoechoic abductor pollicis longus tendon or tendinitis in 22 of 37 dogs. Nineteen of 37 abductor pollicis longus tendon sheaths were fluid-filled and all tendon sheaths were thickened, more hyperechoic, with small hyperechoic mineralizations embedded in the connective tissue of the abductor pollicis longus tendon sheath in 25 dogs. Enthesopathy of the abductor pollicis longus tendon was identified in seven dogs. While radiographs of stenosing tenosynovitis of the abductor pollicis longus are helpful in visualizing the deep radial sulcus and osteophytes medial to the distal radius, ultrasonography is useful to distinguish between lesions of the tendon or tendon sheath and to determine thickness and fluid content of the abductor pollicis longus tendon sheath.     

Arthroscopic biceps tenodesis: technique and results in six dogs

Biceps tenodesis was performed using an arthroscopic-assisted technique on six dogs diagnosed with chronic bicipital tendon pathology. The technique was performed using two different fixation methods (i.e., cannulated interference screw, cannulated screw and tissue washer). All six dogs had successful outcomes in terms of return to full function at a mean follow-up time of 11.7 months after surgery. Arthroscopic biceps tenodesis is a feasible option for surgical management of biceps tendon pathology, and it may have advantages over open tenodesis and open or arthroscopic tenotomy. Further study is needed before definitive recommendations regarding indications, complications, and prognosis associated with arthroscopic biceps tenodesis can be made.     

Supraspinatus and biceps brachii tendinopathy in dogs

Calcifying tendinopathy was seen on radiographic views of the scapulohumeral joint in 12 of 183 (7 per cent) dogs reviewed retrospectively. Calcifying tendinopathy was identified only in large breed dogs, five being labradors. All the affected dogs, except one, were presented for unilateral thoracic limb lameness, which was typically of a chronic and intermittent pattern. Pain on manipulation of the scapulohumeral joint in the lame leg was present in eight of 12 dogs (67 per cent). Calcification of the supraspinatus tendon was seen in eight dogs and calcification of the biceps brachii tendon was seen in the other four dogs. Radiographic changes indicative of biceps brachii tendon avulsion were found in conjunction with calcification of the contralateral biceps brachii tendon in two dogs. Filling defects, indicative of bicipital tenosynovitis, were also seen in positive contrast arthrograms of two dogs with biceps brachii calcification. Of the eight dogs for which radiographic views of both scapulohumeral joints were available, six dogs had bilateral radiographic signs of calcifying tendinopathy. Overall, radiographic signs of calcifying tendinopathy were seen in 18 scapulohumeral joints, but lameness was apparent in only nine limbs, suggesting the lesion may at times be asymptomatic. Further prospective investigation of calcifying tendinopathy is needed to determine why lameness does not always appear to be associated with the presence of the lesion.     

Disorders of the infraspinatus tendon and bursa in three horses

CASE DESCRIPTION: 3 horses with penetrating wounds to the shoulder area were examined because of forelimb lameness. CLINICAL FINDINGS: All horses had physical examination findings (decreased cranial phase of the stride, swelling in the shoulder region, and signs of pain on manipulation of the shoulder) that were suggestive of problems in the upper portion of the forelimb. Injury to the biceps tendon or bursa was the primary differential diagnosis in each instance, but no abnormalities involving those structures were found. Radiographic and ultrasonographic imaging revealed injuries to the caudal eminence of the greater tubercle of the humerus, the infraspinatus tendon, and the infraspinatus bursa. Examination with ultrasound was more sensitive than radiography at detecting both osseous and soft tissue changes. TREATMENT AND OUTCOME: All 3 horses responded favorably to treatment with antimicrobials and non-steroidal anti-inflammatory drugs. Although initial response to standing lavage was favorable in 1 horse, endoscopic lavage was later required. Standing removal of fracture fragments was performed in 2 horses. Ultrasonographic imaging was helpful in monitoring the response to treatment and changes in the affected structures. All 3 horses eventually became sound after treatment. CLINICAL RELEVANCE: Infraspinatus bursitis and tendonitis should be included in the differential diagnoses of horses with shoulder lameness. Diagnosis and monitoring should include ultrasonographic monitoring. The prognosis for return to soundness after appropriate treatment appears to be good.     

Ultrasonographic evaluation and surgical treatment of humeral osteitis and bicipital tenosynovitis in a horse.

Ultrasonography and radiography were used to diagnose bicipital tenosynovitis and humeral osteitis in a horse with a history of lameness of 7 weeks' duration. Surgical exploration confirmed the diagnosis.     

Unusual soft tissue orthopaedic problems in the dog

Single cases of supraspinatus and infraspinatus muscle contracture in working sheep-dogs are reported. Both cases showed characteristic abnormal forelimb posture and were successfully treated by complete section of the affected muscle. Three cases of anteromedial shoulder luxation with damage to the biceps brachii tendon are also described. In two of these the tendon was completely severed. The integrity of the biceps tendon is important in maintaining shoulder joint stability and should be inspected when surgical reduction of shoulder dislocations is carried out. Repair of the tendon, if severed, is important. Three cases of lameness associated with tendon displacement are considered i.e. slipping of the biceps brachii, long digital extensor and superficial digital flexor tendons. In two cases the displacement was prevented by the insertion of mattress wire sutures to form a 'lid' over the tendon.     

Mastocytoma in the common carpal sheath of the digital flexor tendons of a horse

A 13-year-old Morgan gelding was examined for right forelimb lameness and tenosynovitis of the right common carpal sheath of the digital flexor tendons. The horse had moderate right forelimb lameness at the trot and marked effusion of the right common carpal sheath of the digital flexor tendons. Ultrasonographic examination revealed a soft tissue mass within the proximal pouch of the affected tendon sheath, located adjacent to the distal physis of the radius. Cytology and culture of the fluid revealed a sterile, eosinophilic tenosynovitis. Tenoscopic exploration confirmed the presence of a capsulated soft tissue mass. Thecotomy was required to fully debride the mass, which histology revealed to be a mast cell tumour. At 22 months postoperatively, the horse developed mild right forelimb lameness and eosinophilic tenosynovitis because of recurrence of the mastocytoma. Mastocytosis is a possible differential diagnosis in any horse exhibiting lameness associated with tenosynovitis. Surgical excision combined with rest and postoperative intrasynovial and systemic corticosteroids may be palliative.