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.     

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.     

Unusual muscle and tendon disorders of the forelimb in the dog

Five dogs with unusual muscle and tendon disorders of the forelimb are described. In one dog, mineralisation of the tendon of insertion of the supraspinatus muscle was treated surgically but lameness returned following the resumption of exercise. Of two cases of avulsion of the origin of the extensor carpi radialis muscle, one was successfully managed conservatively while the other needed surgical intervention to resolve the lameness. A single case of chronic avulsion/rupture of the tendon of insertion of the extensor carpi radialis muscle was successfully managed conservatively while a case of medial displacement of the biceps brachii tendon was surgically corrected by repair of the transverse humeral ligament. The aetiology, diagnosis and management of the above conditions is discussed.     

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.     

Mineralization of the supraspinatus tendon in dogs

Mineralization of the supraspinatus tendon is proposed as a cause of forelimb lameness in dogs. A new radiographic position (cranioproximal-cranio-distal) is advanced to detect abnormalities of the craniomedial aspect of the proximal portion of the humerus. Four dogs had surgery to remove mineralized debris from the supraspinatus tendon insertion and have improved limb function. Two dogs were evaluated in depth, with no signs of relapse 2 to 4 years after surgery. Other dogs, without apparent forelimb lameness, have had mineralization detected by use of radiography, thus emphasizing the need for thorough forelimb evaluation before determining that the mineralization is indeed the cause of lameness.     

Bicipital tendinitis and tenosynovitis in the dog: a study of 15 cases

AIM: To describe the clinical, radiographic, and sonographic features of 15 dogs with bicipital tendinitis and tenosynovitis, classify them according to cause, and evaluate the long-term efficacy of treatment. METHODS: Dogs exhibiting forelimb lameness with pain localised to the biceps tendon were included in the study. Sonographic examination of the tendon and tendon sheath, and radiographic examination including positive contrast arthrograms of the shoulder joint were performed, and assessed for features consistent with biceps tendon disease. In some cases, synovial-fluid analysis and surgical investigation were also undertaken. The causes of the conditions were classified as either traumatic, mechanical, neoplastic or inflammatory. Dogs were treated conservatively with rest and anti-inflammatory drugs, or surgically by either transection of the transverse humeral ligament or tenodesis of the biceps tendon. Assessment of the effects of treatment was made by re-examination at six weeks and from information gained by telephone interview with the dog's owner at longer-term follow-up. RESULTS: Bicipital tendinitis and tenosynovitis were common causes of forelimb lameness in active, middle-aged or older, medium to large-breed dogs. The most sensitive physical tests for localising pain to the biceps apparatus were shoulder flexion with the elbow extended, focal digital pressure applied directly to the biceps origin, and the biceps retraction test. Sonographic assessment was found to be more sensitive than shoulder radiography or arthrography for characterising the lesion. Conservative treatment of 11 traumatic cases resulted in good or excellent function at long-term follow-up. One mechanical bicipital tendinitis secondary to mineral deposits within the supraspinatus tendon improved following transection of the transverse humeral ligament and removal of the deposits. One of two cases of inflammatory tendinitis/ tenosynovitis improved following tenodesis. One dog with neoplastic disease did not improve and was euthanased. CONCLUSIONS: The diagnosis of bicipital tendinitis and tenosynovitis requires a careful examination using a combination of physical tests. Of the ancillary tests, sonography was the most reliable, however information gained from all tests was useful in fully evaluating the biceps apparatus and shoulder joint. The classification system employed in this study was helpful in selecting a treatment protocol and determining the likely prognosis.     

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.     

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.     

Surgical Treatment of Mineralized and Nonmineralized Supraspinatus Tendinopathy in Twenty-four Dogs

Objective— To report and compare the clinical diagnosis, surgical treatment, histopathologic changes, and outcomes of dogs with mineralized and nonmineralized supraspinatus tendinopathy (ST).
Study Design— Case series.
Animals— Dogs (n=24) with ST.
Methods— Medical records (1995–2006) of dogs with ST that had surgical treatment were reviewed. Results of clinical examination, diagnostic imaging, surgery, histopathology of resected tendon tissue, and outcome were compared between dogs with mineralized and nonmineralized ST.
Results— There were 15 dogs with mineralized ST and 9 with nonmineralized ST. Chronic, unilateral, intermittent or waxing-waning lameness, and pain elicited on palpation of the cranial aspect of the shoulder were the most consistent findings. On ultrasonographic or magnetic resonance imaging (MRI) of 35 shoulders, enlargement of the supraspinatus tendon (54%), increased fluid content (63%), and medial displacement of the biceps tendon (60%) were observed. Eleven of 12 dogs with bilateral abnormalities only had unilateral lameness. Surgery was performed in 30 shoulders. Resected tendon specimens had myxomatous degeneration and/or cartilaginous metaplasia in 11 of 13 dogs in the mineralized group and all 9 dogs in the nonmineralized group. Functional outcome after surgery was poor in 3 dogs and good-to-excellent in 16.
Conclusions— Mineralized and nonmineralized ST have many similarities. Although lameness is usually unilateral, the supraspinatus tendon may be affected bilaterally.
Clinical Relevance— Ultrasonography and MRI are good imaging techniques for detection of ST especially the nonmineralized form. Surgical treatment results in good recovery of limb function. Nonmineralized ST is a recently described disorder in dogs and evaluation of more cases is necessary to determine outcome after surgical or medical treatment.     

Mineralization of the supraspinatus tendon in dogs: a long-term follow-up

Mineralization of the supraspinatus tendon was diagnosed in 24 large-breed dogs as a probable cause for a chronic unilateral forelimb lameness. Owners of 12 dogs responded to a questionnaire survey evaluating the treatment that their dog had received which consisted of either surgical removal of the mineralization after failure of conservative treatment (operated group; n=9) or rest and nonsteroidal anti-inflammatory drugs (NSAIDs) (nonoperated group; n=3). In eight out of the 12 dogs, the mineralization was also present in the asymptomatic forelimb. Based on owner evaluation, the degree of lameness had decreased distinctly in both groups. Six dogs (four operated and two nonoperated) were reevaluated at Michigan State University Veterinary Teaching Hospital (MSU-VTH) and were without lameness except for one dog in the operated group. The mineralizations had reformed in all dogs in the operated group after a mean follow-up time of 5.1 years.     

The canine shoulder: selected disorders and their management with physical therapy

The shoulder joint is the most mobile of all main limb joints. While its primary motion is in a sagittal plane, the shoulder has a significant amount of abduction and adduction, and internal and external rotation. Its stability is ensured by the joint capsule, by its specialized bands (medial and lateral glenohumeral ligaments), and by large tendons located inside (eg, tendon of origin of the biceps brachii muscle) or immediately outside the joint (eg, supraspinatus, infraspinatus, teres minor, and subscapularis). Sprains or strains of all supporting structures of the canine shoulder have now been reported and the shoulder pathology resembles the pathology of the human shoulder that includes strains and tears of the rotator cuff muscles, adhesive capsulitis, and calcific tendonitis.     

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.     

Prospective evaluation of techniques for differentiating shoulder pathology as a source of forelimb lameness in medium and large breed dogs

Objective— To assess lameness evaluation, shoulder abduction angles, radiography, and ultrasonography for determining presence, location, and severity of forelimb pathology. Study Design— Prospective cohort study. Animals— Dogs ≥20 kg (n=30). Methods— Each dog was assigned lameness scores. Shoulder abduction angles were determined. Radiographs of shoulders and elbows were subjectively graded for pathology. One investigator unaware of dog history (lameness, radiographic findings) performed ultrasonographic assessment of shoulders with subjective grading of pathology. Another investigator unaware of dog history (lameness, radiographic, ultrasonographic findings) performed arthroscopic assessment of shoulders with subjective grading of pathology. Elbows were disarticulated and evaluated for gross pathology. Histologic pathology scoring of shoulder tissues was performed. Data were compared for differences among groups, sensitivities, specificities, positive and negative predictive values, and positive and negative likelihood ratios were calculated. Results— Twenty‐seven forelimbs were considered clinically normal, 26 had shoulder pathology, 5 had elbow pathology, and 2 had pathology of both the shoulder and elbow. Dogs with shoulder pathology were twice as likely to be lame compared with dogs with elbow pathology. Limbs with medial shoulder instability had significantly higher abduction angles than normal limbs and those with elbow pathology. Radiographs were clinically useful for diagnosing elbow, but not shoulder, pathology. Ultrasonography was clinically useful for diagnosing shoulder pathology other than instability. Abduction angles, ultrasonographic evaluation, and arthroscopic assessments had strong, significant correlations with reference standards. Conclusions— Clinically relevant diagnostic techniques yielded characteristic, repeatable differences in objective and subjective assessments for distinguishing presence, location, and severity of forelimb lameness in dogs. Clinical Relevance— The diagnostic approach to forelimb lameness in dogs should include shoulder pathology as a differential with multiple assessments used to determine the clinical cause of lameness.     

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.     

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.     

ULTRASONOGRAPHY OF THE EQUINE SHOULDER: TECHNIQUE AND NORMAL APPEARANCE

This study was intended to document normal ultrasonographic appearance of the equine shoulder and anatomic landmarks useful in clinical imaging. Both forelimbs of five equine cadavers and both forelimbs of six live adult horses were used. To facilitate understanding of the images, a zoning system assigned to the biceps brachii and to the infraspinatus tendon was developed. Ultrasonography was performed with a real-time B-mode semiportable sector scanner using 7.5- and 5-MHz transducers. On one cadaver limb, magnetic resonance imaging (MRI) was performed using a system at 1.5 Tesla, T1-weighted spin-echo sequence. Ultrasonography images were compared to frozen specimens and MRI images to correlate the ultrasonographic findings to the gross anatomy of the shoulder. Ultrasonography allowed easy evaluation of the biceps brachii and the infraspinatus tendon and their bursae, the supraspinatus muscle and tendons, the superficial muscles of the shoulder, and the underlying humerus and scapula. Only the lateral and, partially, the caudal aspects of the humeral head could be visualized with ultrasound. Ultrasonographic appearance, orientation, and anatomic relationships of these structures are described. Ultrasonographic findings correlated well with MRI images and with gross anatomy in the cadavers' limbs.     

Intermuscular Heterotopic Ossification in the Shoulder Region Associated with a Hopping-type Forelimb Lameness

Heterotopic ossification has not previously been described in the horse. An event horse was investigated due to poor performance and development of a hopping-type forelimb lameness when ridden. Comprehensive local analgesic techniques did not alter the hopping-type lameness. Radiological assessment revealed an osseous plate between the biceps brachii and brachiocephalicus muscles of the lame limb. Ultrasonographic examination verified that there was no involvement of the intertubercular bursa or tendon of biceps brachii or the muscles themselves. The horse was humanely destroyed because of multilimb lameness, with multiple sources of pain. Postmortem examination revealed a large plate of bone with very sharp, pointed margins, which was easily dissected from the adjacent muscles. The radiological and gross appearances of the bone plate were typical of heterotopic ossification in human beings.     

Biceps Brachii and Brachialis Tendon of Insertion Injuries in Eleven Racing Greyhounds

Objective— To report injuries of the biceps brachii (BTI) or brachialis (BrTI) tendons of insertion in 11 racing Greyhounds.
Study Design— Case series.
Animals— Greyhounds (n=11).
Methods— Medical records (1990–2006) of racing Greyhound dogs with BTI injuries were reviewed. Preinjury, injury, and posttreatment information was obtained via trainer telephone questionnaire and individual greyhound race data. Outcomes between surgical and conservative management were compared.
Results— Dogs had elbow hyperextension, positive biceps test, and forelimb circumduction and 82% were male, whereas Queensland's male to female ratio of racing Greyhounds was almost equal. Eight dogs had right BTI injuries. Nine dogs had surgically confirmed tendon injuries: 5 combined BTI and BrTI, 2 mid-body BTI, 1 musculotendinous BTI, and 1 ulnar tuberosity avulsion fracture. Seven dogs were treated surgically (3 loop pulley sutures, single radial screw and washer, suture screws or fracture fixation in lag fashion), 2 dogs were euthanatized at surgery, 2 were rehomed and hence managed conservatively. All surgically treated dogs returned to near preinjury performance; 6 returned to racing and at least 4 won races in the same or higher grade. One conservatively managed dog returned to "pet" function. No dog reinjured its BTI or BrTI.
Conclusion— BTI and BrTI avulsions are rare acute traumatic performance injuries of racing Greyhounds.
Clinical Relevance— Preinjury racing performance can be achieved with early surgical repair of BTI and BrTI and optimal postoperative management.     

COMPARISON BETWEEN SHOULDER COMPUTED TOMOGRAPHY AND CLINICAL FINDINGS IN 89 DOGS PRESENTED FOR THORACIC LIMB LAMENESS

Computed tomography (CT) is an established technique for detecting shoulder lesions in dogs, however the clinical significance of shoulder CT lesions often remains uncertain. The purposes of this retrospective study were to describe the prevalence of CT lesions in both shoulder joints for 89 dogs presenting with thoracic limb lameness and to compare CT lesions with clinical characteristics. For all included dogs, results of a full orthopedic examination, other diagnostic tests, and signalment data were available in medical records. Multilevel, multivariable logistic regression was used to test clinical significance of the most prevalent CT lesions and determine factors associated with their presence. Computed tomographic lesions were detected in one or both shoulder joints for 51/89 dogs (57.3%). Mineralization of one or more surrounding peri‐articular soft‐tissue structures was identified in 31.5% of dogs, with supraspinatus muscle/tendon mineralization being the most frequently identified (24.7%). The prevalence of humeral head osteochondrosis was 9 and 21.3% of dogs had shoulder osteoarthritis. Border collies (odds ratio [OR] 9.3; 95% CI 1.39–62.1, P = 0.02) and dogs with shoulder pain (OR 4.3; 95% CI 1.08–17.1, P = 0.04) had increased risk of osteochondrosis lesions. Border collies (OR 8.4; 95% CI 1.27–55.6; P = 0.03) and older animals (OR 1.04; 95% CI 1.02–1.1, P < 0.001) had increased risk of osteoarthritis lesions. Female entire dogs had an increased risk of supraspinatus mineralization lesions (OR 6.8; 95% CI 1.55–29.5, P = 0.01). Findings indicated that shoulder CT lesions are common in dogs with thoracic limb lameness, and that some CT lesions are not associated with shoulder pain.