Complete biceps brachii tenotomy to facilitate internal fixation of supraglenoid tubercle fractures in three horses

OBJECTIVE: To describe a method for internal fixation of supraglenoid tubercle fractures in conjunction with complete tenotomy of the biceps brachii tendon. ANIMALS: Three horses, ranging in age from 8 months to 2 years and weighing from 300 to 400 kg. METHODS: Fractures were repaired by open reduction-internal fixation using bone screws placed in lag fashion and complete tenotomy of the biceps brachii tendon. OUTCOME: All three horses were sound for their intended use with a good cosmetic result 6 months after surgery. CONCLUSIONS: Complete transection of the biceps brachii tendon facilitates supraglenoid tubercle fracture repair by reducing tensile forces exerted on the supraglenoid tubercle. Complete tenotomy does not appear to preclude return to a successful athletic career.     

Extracorporeal shockwave therapy in a dog with chronic bicipital tenosynovitis

A 15-month-old, spayed female, Bernese mountain dog was presented to the Institute of Small Animal Surgery at the University of Zurich because of chronic left forelimb lameness. The referring veterinarian diagnosed pain in the left shoulder region and had treated the dog with systemic non-steroidal anti-inflammatory drugs and restricted exercise for a two-week period. The follow-up examination revealed only minimal improvement and therefore, the dog was referred for further diagnostic evaluation. Chronic bicipital tenosynovitis and tendinitis of the infraspinatus muscle was diagnosed based on survey radiographs, arthrography, ultrasound, computed tomography (CT), and synovial fluid cytology. The dog underwent three sessions of extracorporeal shockwave therapy and substantial clinical improvement was observed. On follow-up examinations, only mild left forelimb lameness was evident following exercise, and changes in the intertubercular groove and at the supraglenoid tuberosity appeared less active on radiographs and CT. However, six months following treatment, mild degenerative joint disease was apparent.     

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.     

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.     

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.     

Calcifying tendinopathy of the biceps brachii in a dog.

Calcifying tendinopathy of the biceps brachii was associated with lameness in a 1.5-year-old Rottweiler. Lameness was relieved by excision of the calcified mass and suture repair of the partially ruptured tendon. Calcifying tendinopathy is not well described in dogs, but it is a recognized clinical syndrome in human beings. The etiopathogenesis of the condition in human beings and dogs is poorly understood. Wider recognition of calcifying tendinopathy in dogs should lead to a better understanding of the disease and development of appropriate clinical treatments.     

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.     

Hypophysectomy as a treatment for canine and feline Cushing's disease.

The microsurgical technique of transsphenoidal hypophysectomy performed with the dogs and cats positioned in sternal recumbency enables the treatment of Cushing's disease, independent of skull type, in a safe and effective manner. In dogs, the short-term survival rate after hypophysectomy is comparable to that after treatment with o,p'-DDD, whereas the recurrence rate in this period is lower. When the surgeon has gone through a learning curve, the results of the 1- to 3-year follow-up interval may be better than those after adrenocorticolysis with o,p'-DDD. CT enables assessment of localization and size of the pituitary before surgery. In general, dogs with Cushing's disease and normal-sized pituitaries or moderately enlarged pituitaries (up to 12 mm in diameter) are suitable candidates for transsphenoidal surgery. In dogs with larger pituitary tumors and tumor extension rostrally or caudally over the dorsum sellae, transsphenoidal debulking surgery may be only a palliative treatment. The main complications are postoperative hypernatremia, keratoconjunctivitis sicca, diabetes insipidus, and secondary hypothyroidism. In cats, special attention should be paid to closure of the soft palate. The neurosurgeon must be familiar with these complications so as to recognize them as early as possible and to treat them immediately and effectively. It is concluded that microsurgical transsphenoidal hypophysectomy in dogs and cats with Cushing's disease is an effective method of treatment.     

Tenoscopic removal of a protruding osteophyte as a treatment for chronic common digital extensor tendinopathy and associated tenosynovitis

This report describes an adult Quarter Horse gelding that was presented for evaluation of chronic tenosynovitis of the right common digital extensor tendon sheath. Radiographic and tenoscopic evaluation confirmed the presence of a periarticular osteophyte from the third metacarpal bone protruding into the common digital extensor tendon sheath. Tenoscopic surgical resection of the osteophyte and debridement of the affected tendon resolved the tenosynovitis and associated right forelimb lameness. Osteophytes in this location can be a source of focal traumatic tendonitis of the common digital extensor tendon which can lead to a chronic tenosynovitis of the common digital extensor tendon sheath. Tenoscopic debridement and lavage is a viable treatment option for chronic nonseptic common digital extensor tendinopathy and associated tenosynovitis.     

Deep digital flexor tenotomy for treatment of severe laminitis in a cow

A first-calf Guernsey cow was referred for evaluation of severe udder edema, mastitis, metritis, and ketosis. During the course of treatment, the cow became recumbent and was unable to rise. Intensive treatment resulted in the cow being able to stand for short periods with the aid of a sling. However, severe pressure necrosis of the udder and ongoing mastitis made performance of a complete mastectomy necessary. After surgery, the cow's condition improved, although assistance in standing was still required. Radiography of the distal phalanges revealed severe rotation in the right lateral and left medial digits of the hind limbs. The laminitis was nonresponsive to medical management; therefore, a deep digital flexor tenotomy was performed in the affected claws. The procedure provided almost immediate relief of signs of foot pain and resulted in ability to stand without assistance. Deep digital flexor tenotomy should be considered when treating cows with severe laminitis.     

Fibrin sealant as a treatment for canine aural haematoma: a case history

Aural haematomas occur commonly in dogs in which predisposing factors include trauma to the pinna, a history of violent head shaking, and acute or chronic otitis externa. Treatment usually involves invasive surgery performed under general anaesthesia but these techniques can create wounds requiring intensive aftercare. Furthermore, certain breeds of dog and/or older animals are often at greater risk due to complications arising from the use of anaesthetics. Therefore, a need exists for a less invasive procedure which can be performed easily in general practice and with minimal reliance on anaesthetics. Fibrin sealants fulfil these criteria and have been used successfully to treat aural haematomas in humans. This is the first known report on the use of fibrin sealant to treat a canine aural haematoma. In the present case, the haematoma recurred shortly after removal of the protective collar, and was subsequently treated by conventional surgery. Possible reasons for initial success of the fibrin sealant and then later recurrence of the haematoma (e.g. premature removal of the collar) are discussed.     

Effects of enalapril versus placebo as a treatment for canine idiopathic glomerulonephritis

A blinded, multicenter, prospective clinical trial assessed the effects of enalapril (EN) versus standard care in dogs with naturally occurring, idiopathic glomerulonephritis (GN). Twenty-nine adult dogs with membranous (n = 16) and membranoproliferative (n = 13) GN were studied. Dogs were randomly assigned to receive either EN (0.5 mg/kg PO q12-24h; n = 16) or placebo (n = 14) for 6 months (1 dog was treated first with the placebo and then with EN). All dogs were treated with low-dose aspirin (0.5-5 mg/kg PO q12-24h) and fed a commercial diet. At baseline, serum creatinine (SrCr), systolic blood pressure (SBP), and glomerular histologic grade were not different between groups, but the urine protein/creatinine ratio (UP/C) was greater in the EN group compared with the placebo group (8.7 +/- 4.4 versus 4.7 +/- 2.3). After 6 months of treatment, the change in UP/C from baseline was significantly different between groups (EN = -4.2 +/- 1.4 versus 1.9 +/- 0.9 in the placebo group). When data were adjusted for changes in SrCr (SrCr X UP/C) a similar significant reduction was noted ( 2.2 +/- 15.2 versus 8.4 +/- 10.1). The change in SBP after 6 months of treatment also was significantly different between groups (EN = -12.8 +/- 27.3 versus 5.9 +/- 21.5 mm Hg in the placebo group). Response to treatment was categorized as improvement (assigned a value of 2), no progression (assigned a value of 1), and progression (assigned a value of 0). Response was significantly better in the EN group (1.4 +/- 0.8) compared with the placebo group (0.3 +/- 0.5). These results suggest that EN treatment is beneficial in dogs with naturally occurring idiopathic GN.     

Ultrasonography for the diagnosis of diseases of the tendon and tendon sheath of the biceps brachii muscle

OBJECTIVE: To describe the ultrasonographic appearance of the normal and diseased biceps brachii tendon and its tendon sheath in dogs. STUDY DESIGN: A prospective clinical study. ANIMALS: One hundred twenty client-owned dogs. METHODS: In the first part of the study, the ultrasonographic appearance of the normal biceps brachii muscle and the surrounding soft tissue was determined in 27 healthy dogs. Standard views were described and established. In the second part, 120 dogs with suspected pathology of the biceps brachii muscle were examined ultrasonographically. Fifty-five of these dogs had no sonographic changes, and 65 dogs had sonographically detectable pathologic changes of the tendon or the tendon sheath or both. The mean age of the affected dogs was 3.7 years. The ratio of males to females was 1.95:1. Sedation or anesthesia of the dogs was required because of the extreme movements of the leg necessary for the examination. To achieve a perpendicular view of the tendon and the tendon sheath, the area of the shoulder joint was rotated outward and abducted as far as possible. Examination of the muscle-tendon apparatus of the biceps brachii muscle was divided into 4 main sections. RESULTS: Linear transducers (7.5-10 MHz) allowed the soft tissue structures to be easily visualized with ultrasonography. Pathologic changes of the tendon and tendon sheath were visualized sonographically by using high-frequency linear probes. Partial or complete tendon rupture, medial luxation of the tendon, corpora libera in the tendon sheath, and tenosynovitis were clearly shown. CONCLUSIONS: High-frequency ultrasonography using linear transducers allows the examiner to accurately define the pathologic changes in the region of the biceps brachii tendon in dogs. CLINICAL RELEVANCE: The use of sonography for diagnosis of disease processes of the tendon and tendon sheath of the biceps brachii muscle complements clinical and radiographic examination findings.     

Semitendinosus tenotomy for treatment of fibrotic myopathy in the horse

The medical records and follow-up data for 4 horses with fibrotic myopathy of the semitendinosus muscle treated by semitendinosus tenotomy were reviewed. The gait deficit for each of the 4 horses was typical of fibrotic myopathy. Two of the horses had the gait deficit since birth. The efficacy of semitendinosus tenotomy was compared with the traditional treatment of partial myotenectomy of the affected muscle. The functional results in the 4 horses appeared to be equal to partial myotenectomy in returning the horses to athletic function and, compared with what has been reported, was cosmetically superior.     

Deep digital flexor tenotomy as a treatment for chronic laminitis in horses: 35 cases (1988-1997)

OBJECTIVE: To determine long-term prognosis for horses with laminitis treated by deep digital flexor (DDF) tenotomy and to identify factors affecting success of the surgical procedure. DESIGN: Retrospective study. ANIMALS: 35 horses with laminitis treated by DDF tenotomy between 1988 and 1997. PROCEDURE: Information was obtained from individual medical records and follow-up telephone interviews with owners and referring veterinarians. Cumulative proportions of horses that survived 6 months and 2 years after tenotomy were determined. Effect of Obel grade of lameness on 6-month and 2-year survival and effect of distal phalangeal rotation on survival and future performance were evaluated by chi 2 analysis. Body weights of horses that survived > or = 2 years were compared with those of horses that survived < 2 years by ANOVA. RESULTS: 27 of the 35 (77%) horses survived > or = 6 months, and 19 of 32 (59%) survived > 2 years. Obel grade of lameness and body weight at time of surgery had no effect on 6-month or 2-year survival. Degree of distal phalangeal rotation had no effect on 2-year survival or the ability of horses to be used for light riding. Twenty-two of the 30 (73%) owners interviewed indicated they would have the procedure repeated on their horses given similar circumstances. CLINICAL IMPLICATIONS: DDF tenotomy is a viable alternative for horses with laminitis refractory to conventional medical treatment. In some instances, the procedure may be effective in returning horses to light athletic use.     

Surgical uterine drainage and lavage as treatment for canine pyometra

Pyometra is a common post-oestral syndrome in bitches. Classical treatment consists of either ovariohystorectomy or medical intervention. Surgical uterine drainage and lavage via direct trans-cervical catheterisation using a 5% povidone-iodine in saline solution was performed successfully in 8 bitches with pyometra. All bitches conceived and whelped without complications subsequent to this treatment. It is concluded that this method offers an effective alternative treatment for canine pyometra with shorter recovery times as well as good clinical recovery and pregnancy rates in bitches destined for further breeding.