Bilateral hypoplasia of the minor tubercle of the humerus with medial luxation of the biceps tendon in two Quarter Horses

Two Quarter Horses were examined at the Washington State University Veterinary Teaching Hospital with forelimb lameness. Case 1 was a 4‐year‐old female with a 4 month history of intermittent forelimb lameness that had partially responded to oral anti‐inflammatories. The horse was in full training and actively competing in cutting. Case 2 was a one‐year‐old filly bred for cutting that presented with a right forelimb lameness of 3 weeks’ duration, which was not responsive to oral anti‐inflammatories. The horse was not in training. On lameness examination, Case 1 was grade 1/5 (American Association of Equine Practitioners scale) lame in the left forelimb in a straight line on a hard surface, extension and flexion of the shoulder was resented and exacerbated the lameness. Case 2 was grade 3/5 lame in the right forelimb in a straight line on a hard surface, flexion and extension of the shoulder was resented and exacerbated the lameness. Both horses had a characteristic dished appearance to the dorsal aspect of the shoulder, with prominence of the proximal aspect of the humerus. Ultrasound and proximodistal oblique (skyline) radiographic views of the scapulohumeral joints demonstrated bilateral hypoplasia of the minor tubercle of the humerus with bilateral medial luxation of the proximal biceps tendon in both cases. To the authors' knowledge this is the first report of 2 cases of bilaterally affected horses, as well as the first report of the condition in the Quarter Horse breed.     

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.     

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.     

Comparison of 2 methods of centesis of the bursa of the biceps brachii tendon of horses

REASONS FOR PERFORMING STUDY: Centesis of the bicipital bursa using an 8.9 cm long spinal needle has been reported but the alternative of employing a 3.8 cm long hypodermic needle requires validation. OBJECTIVE: To compare the efficacy of 2 different methods of centesis of the bicipital bursa and to evaluate the usefulness of ultrasonographic imaging to determine the location of solution administered when centesis of the bursa is attempted. METHODS: For Trial 1, 6 clinicians, who had no previous experience of centesis of the bicipital bursa, attempted to inject a solution composed of an aqueous radiopaque contrast medium and physiological saline solution (PSS) into the bicipital bursae of 2/12 horses using the previously described distal approach to inject one bursa and a proximal approach to inject the contralateral bursa. The bicipital tendon and bursa were examined ultrasonographically before and after injection; and both shoulders were examined radiographically to identify the location of the medium. In Trial 2, another 6 clinicians, also with no previous experience of centesis, repeated Trial 1, using 6 horses, but the radiopaque contrast medium was mixed with air instead of PSS. RESULTS: Accuracy of centesis using the proximal approach was 39% and that of the distal approach 28%. Ultrasonographic examination of the shoulder allowed the location of solution and air to be accurately predicted in all 12 shoulders examined. CONCLUSIONS: Clinicians who have had no previous experience performing centesis of the bicipital bursa are unlikely to be successful in centesis using either approach. Radiographic examination after injecting a radiopaque contrast medium may be necessary to assess the success of centesis especially if bursal fluid is not obtained during centesis. Injecting air along with the radiopaque contrast medium provides more accurate ultrasonographic confirmation of centesis and better radiographic definition than does injection without air.     

Articular sagittal and medial parasagittal patellar fracture repair using lag screws in two mature horses

This report describes the clinical experience with internal fixation of a sagittal and a medial parasagittal patellar fracture using lag screws. Severely displaced sagittal and medial parasagittal fractures of the patella were diagnosed in 2 horses (a 10‐year‐old Thoroughbred gelding and a 5‐year‐old Thoroughbred mare) and were repaired using internal fixation. A direct approach through the fascia latae was used. In both cases, the leg was placed in full extension and the fracture was corrected by a combination of digital manipulation and application of bone reduction forceps. Articular congruency was assured by arthrotomy and digital assessment, and radiographic skyline projection. Then, the leg was placed in flexion and two 5.5 mm cortical screws with washers were inserted in lag fashion, under radiographic guidance (skyline projection). In one case, an additional 6.5 mm cancellous screw was used. Both fractures healed without evidence of degenerative joint disease. However, the first horse's wound dehisced, then healed by second intention uneventfully. The second horse was put in a sling in order to prevent lying down. Both horses were able to be used for their intended purpose. In these clinical cases, sagittal and medial parasagittal patellar fractures were treated successfully by open reduction and internal fixation. Post‐operative management in a sling was used successfully in the second case to prevent wound dehiscence.     

Fixation of skin grafts in the horse using stainless steel staples.

Three horses with a chronic wound on the distal part of a leg were treated successfully by grafting. Small split skin grafts were fixed onto pieces of adhesive tape. The tape pieces were spread over and fixed to the granulation surface with stainless steel staples. A tight pressure bandage including strongly compressed cellular rubber was then applied over the wound. The combination of staple fixation and strong pressure proved effective in immobilising the skin graft. It was stressed that a firm covering of granulation tissue was a prerequisite for success and therefore the technique should not be used for fresh wounds.     

Transposition of the biceps tendon to reduce lateral scapulohumeral luxation in three species of nondomestic ruminant.

Open reduction of lateral luxation of the scapulohumeral joint was performed in a Mhorr gazelle (Gazella dama mhorr), a southern pudu (Pudu puda), and an Alpine ibex (Capra ibex ibex) by transposition of the biceps brachii tendon lateral to the greater tubercle of the humerus. The ibex had a very large greater tubercle that required a second osteotomy to allow successful lateral transfer of the tendon. Although all three animals were non-weight bearing in the first 2-3 wk after surgery, ambulation improved at 3 wk and was almost normal by 6 wk after surgery. Postoperative follow-up of 8 yr, 7 mo, and 3 mo in the gazelle, pudu, and ibex, respectively, revealed normal ambulation with no gait deficits. The gazelle was euthanized 8 yr after surgery for unrelated disease and necropsy demonstrated mild to moderate degenerative joint disease. Similar lateral shoulder luxations in comparably sized, nondomestic ruminants, without concurrent fractures or significant joint abnormality, have a good prognosis for return to function after surgical reduction using a biceps tendon transposition.     

Carbon fibres and plasma-preserved tendon allografts for gap repair of flexor tendon in bovines: clinical,radiological and angiographical observations

Twenty-four tenorrhaphies were performed at the mid-metatarsal region in 12 crossbred calves under xylazine-ketamine spinal analgesia. A 2.5-cm long gap was created in the superficial digital flexor (SDF) tendon and immediately repaired with carbon fibres in the animals of group I and with plasma-preserved tendon allografts in group II. Clinical examination revealed a slight increase (P > 0.05) in rectal temperature, heart and respiratory rate for 2-4 days postoperation in both groups. Milder pain and exudation as well as earlier restoration of tendon gliding movements and weight bearing were observed in group I as compared to group II. Air-tendogram in the carbon fibre group on day 30 revealed restoration of continuity across the defect of the tendon. whereas, in the allograft group, a dense homogeneous swelling was seen along the flexors. Regression of peritendinous adhesions and swelling at the reconstructed site at later stages was seen in both groups. Angiography showed hypervascularization at the reconstructed site on day 14 in the carbon fibre group, however, in the allograft group the site appeared to be relatively avascular. On days 30 and 90, blood vessels were normally organized in both groups.     

Surgical repair of peripheral detachment of the medial meniscus in 34 cattle

A detachment of the periphery of the medial meniscus from the joint capsule and medial collateral ligament in 34 cattle was repaired by securing the meniscus to the joint capsule with vertical mattress sutures during arthrotomy. Of 28 cattle with follow-up reports, 20 had recovered satisfactorily by their owners' evaluations; 17 were either not lame or slightly lame after the operation and three were moderately lame. Three of four cattle without follow-up reports were either not lame or slightly lame when discharged from the hospital.     

Extension of the scapulohumeral joint increases the likelihood of success of centesis of the bursa of the biceps brachii tendon of horses

The accuracy of a technique for centesis of the bicipital bursa using a 9 cm, spinal needle inserted through the tendon of the biceps brachii muscle was evaluated. A veterinary radiologist who had no previous experience of performing centesis of the bicipital bursa and an equine clinician who had little experience in performing the procedure, attempted to inject a solution of aqueous radiopaque contrast medium into the bicipital bursae of 8 horses using an approach in which the bursa was accessed by directing a needle through the tendon of origin of the biceps brachii muscle until cartilage in the lateral portion of the intertubercular groove was contacted. Centesis of the bicipital bursa using this approach in horses having no signs of disease of the bursa was consistently successful if the cubital joint was flexed and the scapulohumoral joint extended.     

Healing, diagnosis, repair, and rehabilitation of tendon conditions.

Management of tendon conditions can be frustrating due to difficulty with diagnosis, choice of treatment or repair technique, prolonged tissue healing, and potential for permanent compromise of limb function after surgery. This article reviews tendon healing and reported tendon conditions, focusing on bicipital tenosynovitis and common calcaneal tendon injuries. Surgical management options, research in enhancement of tendon healing, and postoperative rehabilitation are also reviewed.     

Role of the tendons of the biceps brachii and infraspinatus muscles and the medial glenohumeral ligament in the maintenance of passive shoulder joint stability in dogs

OBJECTIVE: To objectively evaluate the effect of transecting the tendon of the biceps brachii muscle (BBT), tendon of the infraspinatus muscle (IFS), or medial glenohumeral ligament (MGHL) on shoulder joint stability in canine cadavers. SAMPLE POPULATION: 81 forelimbs from mature dogs. PROCEDURE: Cadaver forelimbs were placed in a testing frame and axially preloaded with 4 kg of weight. Shoulder joint stability was tested in neutral joint position, flexion, and extension before and after transection of the BBT (n = 37), IFS (37), or MGHL (7). Humeral translation relative to the glenoid was induced by applying a 3-kg load in each of 3 directions (cranial, lateral, and medial) and quantitatively measured by use of an electromagnetic motion tracking system. Peak translational data were compared in each joint position before and after transection of the BBT, IFS, or MGHL. RESULTS: When tested in neutral position, the cranial, lateral, and medial translation of the humerus was significantly increased after BBT transection. In the flexed position, translation of the humerus in the cranial and lateral directions was significantly increased after BBT transection. In the extended position, the medial translation of the humerus was significantly increased after BBT transection. Complete medial luxation of all humeral heads occurred following transection of the MGHL. CONCLUSIONS AND CLINICAL RELEVANCE: The BBT contributes to passive shoulder joint stability in dogs, particularly in the neutral and flexed positions. It also provides medial stability during shoulder joint extension. Complete luxation of the joint occurs when the MGHL is transected.     

Experimental and clinical investigations of the use of carbon fiber sutures in equine tendon repair

Braided carbon fiber sutures were used to repair surgically transected or lacerated digital flexor tendons of 20 mature horses (10 experimental and 10 clinical cases). In addition, 4 experimental horses had tenectomies that were not surgically repaired; these served as controls for the horses with carbon-implanted tendons. Six of the 10 clinically affected horses were returned to their intended use; 2 were euthanatized because of complications and 2 were still recuperating. The experimental horses were euthanatized at 12 days and 1, 2, 4, 8, and 12 months. Tendon scars were structurally and functionally similar in all of these horses. The main histologic difference between the controls and principals was the more extensive remodeling in the latter group at 8 months.     

The relationship between in vivo limb and in vitro tendon mechanics after injury: a potential novel clinical tool for monitoring tendon repair

Reasons for performing the study: Highly prevalent superficial digital flexor tendon (SDFT) injury results in compromised tendon function through fibrosis and high frequency of re‐injury due to altered biomechanical function. This study investigated the consequences of SDF tendinopathy on limb mechanics in relation to the mechanical properties of injured tendon. Objectives: To develop and validate a noninvasive in vivo assessment of tendon mechanics to investigate the effect of recent SDFT injury on limb stiffness index, providing an objective method to assess quality of healing. Hypotheses: Limb stiffness index would reduce as a consequence of SDFT injury and progressively increase during tendon healing and correlate with in vitro mechanical properties of the respective SDFTs. Methods: Kinematic analysis was performed at walk in 10 horses that had sustained career‐ending SDFT injury. Stiffness index was derived from limb force recorded via a series of force plates and measurement of change in metacarpophalangeal joint angle using 3D motion analysis software. Horses were subjected to euthanasia 7 months after injury, the SDFTs removed and subjected to nondestructive in vitro mechanical testing. Results: Limb stiffness index was reduced following SDFT injury in comparison with the contralateral limb and increased during the convalescent period, approximating that of the contralateral limb by 7 months post injury. There was a significant positive correlation between in vivo limb stiffness index and in vitro SDFT stiffness. Clinical relevance: The ability to assess and monitor SDFT mechanical competence through limb stiffness measurement techniques in horses recovering from SDFT injury and the possibility of corroborating this with functional tendon healing may permit a more objective and accurate assessment of optimal tendon repair in the horse. This technique may be a useful method for assessing the efficacy of treatment regimens for tendinopathy and could be utilised to predict time to safe return to performance or re‐injury.     

Bilateral fixation of Y-T humeral condyle fractures via medial and lateral approaches in 29 dogs

OBJECTIVES: To describe bilateral fixation of Y-T fractures of the humeral condyle via combined medial and lateral approaches, and to determine the technique's clinical and radiographic short-term outcomes. METHODS: Details of 30 consecutive fractures in 29 dogs were reviewed. These included signalment, method of fixation, complications, and follow-up limb function and range of elbow joint motion. RESULTS: The age of the dogs ranged from three months to nine years, and bodyweight ranged from 1.9 to 48 kg. The humeral condyle was reattached to the shaft using medial and lateral bone plates in 18 fractures, a medial plate and lateral Kirschner wire(s) in six fractures, and medial and lateral Kirschner wire(s) in six fractures. Major complications were recorded in four fractures and minor complications in two fractures. Limb function at follow-up was graded as excellent in 12, good in 15 and fair in three fractures. The range of elbow flexion was normal in seven, mildly reduced in 18, moderately reduced in four and severely reduced in one fracture. CLINICAL SIGNIFICANCE: In contrast to the caudal approach, combined medial and lateral approaches decrease the extent of periarticular soft tissue dissection, avoid complications associated with olecranon osteotomy and enable exposure of the entire humeral diaphysis for fixation. Bilateral fixation is likely to be better at counteracting bending and torsional forces compared with unilateral fixation.     

The use of a polypropylene mesh for treatment of ruptured collateral ligaments of the equine metatarsophalangeal joint: a report of two cases

The prognosis of ruptured collateral ligaments of the metacarpophalangeal or metatarsophalangeal joint in horses is usually considered to be poor, especially for future athletic performance. The main problem is the development, due to joint instability, of osteoarthritis, which may result in persistent lameness. In this paper a surgical technique is described in which joint stabilisation is realised by using a polypropylene mesh as a substitute for the ruptured ligaments, with the subsequent application of a cast for 7 weeks. The technique was successfully performed in 2 horses with ruptured lateral collateral ligaments of a metatarsophalangeal joint. Fifteen months after surgery both horses resumed exercise. Performance could be classified as fair in one case and good in the other. It is concluded that the preliminary results obtained with this surgical technique to stabilise ruptured collateral ligaments of the fetlock joint are promising.     

Anatomic and radiographic appearance of a sesamoid bone in the tendon of origin of the supinator muscle of dogs

Radiologic and anatomic studies of the elbow of 100 dogs of 17 different breeds showed that a sesamoid bone may be located in a constantly present sesamoid cartilage associated with the tendon of origin of the supinator muscle. The sesamoid was observed in 31% of the radiographs of 100 supinator tendons dissected from 50 of the dogs. The bone was usually bilateral and was best demonstrated in craniocaudal medial-to-lateral oblique radiographs of the elbow where it articulated with the craniolateral aspect of the head of the radius.     

Use of polypropylene mesh in addition to internal obturator transposition: a review of 59 cases (2000-2004)

Fifty-nine dogs with a total of 69 perineal hernias that were repaired by internal obturator transposition and polypropylene mesh reinforcement were reviewed. Thirty-six dogs were available for follow-up at a mean of 29.4 months postoperatively. Six dogs had complications within the first 60 days of surgery, such as perineal swelling, persistent tenesmus, and incisional infections. Twenty-two dogs had excellent outcomes; seven dogs needed continued medical treatment after surgery; and seven dogs had poor outcomes. Hernias recurred in five dogs. The incisional infection rate was 5.6%; the recurrence rate was 12.5%; and the overall success rate was 80.5% for the 36 dogs with long-term follow-up.     

The use of carbon fibre implants for the repair of Achilles tendon rupture in dogs

Implants of plaited carbon fibre have been used in the repair of ruptured Achilles tendons in ten dogs. Additionally the hock was held in extension by inserting a screw through the fibular tarsal bone and the tibia. When the screw was removed in the sixth week the repaired tendon was thick and taut, and leg use was thereafter virtually normal.