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.     

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.     

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.     

Ultrasonographic examination of injuries to the achilles tendon in dogs and cats.

The value of ultrasonography in the diagnosis of lesions of the Achilles tendon was Investigated in 42 dogs and seven cats. A standardised four-part ultrasonographic examination was established. Linear transducers with a frequency of more than 7.5 MHz were used. Ultrasonography allowed identification and differentiation of total ruptures and the differentiation of partial ruptures into deep or superficial ruptures, or those comprising muscular tears. The healing process could be monitored and imaged using this technique. Suture material was readily visible in surgically treated cases. Displacement of the superficial digital flexor tendon could be identified. In such cases, the tendon tissue was seen either medially or laterally to the calcaneus. The healing process of the Achilles tendon could also be documented using ultrasonography. However, it was not possible to determine the age of the injury and the exact end of the healing process. Ultrasonography therefore proved to be an excellent diagnostic method for imaging lesions of the Achilles tendon and associated injuries in dogs and cats. After physical examination, the technique should be the next logical step in the evaluation of a suspected injury to the Achilles tendon.     

Correlation of ultrasonographic observations with anatomic features and radiography of the elbow joint in dogs

OBJECTIVE: To define the ultrasonographic appearance of the elbow joint of dogs and to develop an ultrasonographic imaging protocol to reliably accomplish complete evaluation of that joint. ANIMALS: 11 clinically normal mixed-breed dogs. PROCEDURE: Ultrasonographic observations (by use of a 5 to 10 MHz linear array probe) were made of 22 elbow joints in cadaveric forelimbs from clinically normal dogs. Images in standard anatomic planes were recorded with a multi-image camera, on videotape, or onto a computer. The anatomic plane of the ultrasonographic beam and position of the ultrasonographic probe were also recorded. Dissection of each elbow joint was performed, and anatomic features were correlated with ultrasonographic images. RESULTS: Structures clearly identified ultrasonographically included the lateral and medial humeral epicondyles, the humeroradial and humeroulnar joints, anconeal process, medial coronoid process, hyaline cartilage covering the proximal articular surface of the radius, collateral ligaments, tendons of triceps brachii and supinator muscles, and the supinator tendon and sesamoid in the supinator cartilage. An ultrasonographic imaging protocol for examination of the elbow joint was developed. CONCLUSIONS AND CLINICAL RELEVANCE: Precise correlations were established between the gross anatomic appearance of the elbow joint and the ultrasonographic images of its component structures. The ultrasonographic imaging protocol will enable complete examination of all regions of the joint for detection of pathologic lesions.     

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.     

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.     

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.     

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.     

Tenosynovitis of the digital flexor tendon sheath and annular ligament constriction syndrome caused by longitudinal tears in the deep digital flexor tendon: a clinical and surgical report of 17 cases in warmblood horses

REASONS FOR PERFORMING STUDY: Inflammation of the digital flexor tendon sheaths is a chronic and nebulous condition often unresponsive to medical and surgical treatment. OBJECTIVES: To evaluate the incidence of longitudinal tears (LT) as the underlying cause of chronic tenosynovitis and annular ligament constriction syndrome (ALCS) in warmblood horses. METHODS: The records of 25 horses with chronic tenosynovitis and ALCS in which tenoscopical inspection of the digital flexor tendon sheath (DFTS) was performed between 1999-2000 were reviewed. Of 25 horses, 17 were diagnosed with an LT in the deep digital flexor tendon (DDFT). All horses had a history of distension of the DFTS and/or signs of an ALCS. All cases presented typical signs of a chronic inflamed DFTS on ultrasonography and 11 horses showed ultrasonographic changes (echogenic material or an irregular outlining) at the lateral or medial border of the DDFT. The diagnosis of LTs of the DDFT was established in all cases by tenoscopy. Surgical treatment consisted of removal of the torn collagen fibrils using a mechanical resector and decompressing the fetlock canal by a transection of the palmar annular ligament (PAL) using a hook knife under tenoscopic control. RESULTS: Ten horses became sound and resumed their previous level of work, 3 horses remained lame, 4 horses returned to previous level of work but needed intrasynovial treatment of the DFTS and reduced competition frequency to remain sound. CONCLUSIONS: Horses presented with chronic inflamed DFTS and/or ALCS might suffer from LTs in the DDFT; however, the diagnosis cannot be established with absolute certainty using only ultrasonography. Longitudinal tears should be suspected if ultrasonographic changes are present lateral or medial to the border of the DDFT but tenoscopical examination of the tendon sheath is essential to establish an accurate diagnosis and an effective treatment. POTENTIAL RELEVANCE: The presence of these LTs might explain why some cases of chronic tenosynovitis of the digital flexor tendon sheath and/or ALCS do not respond on surgical transection of the PAL alone without tenoscopy.     

Ultrasonographic examination of the musculoskeletal system in cattle

Ultrasound machines with 7.5 to 5.0MHz linear transducers are well suited for rapid and straightforward differentiation of soft tissue swelling in the musculoskeletal system of cattle; in proximal limb regions 3.5MHz convex scanners allow better imaging. The main indications for ultrasonography of the musculoskeletal system in cattle are suspected arthritis, tenosynovitis, bursitis, abscesses, haematomas, diagnosis of muscle and tendon lesions, and generally the evaluation of soft tissue swellings everywhere that cannot be diagnosed based on clinical examination. The examiner starts by obtaining a general overview of the affected region for orientation purposes. This is achieved by locating and identifying anatomical landmarks, thereafter one can search for pathological changes by examination of the region of interest in longitudinal and transverse planes from all sides. The ultrasonographic investigation should follow a standardised systematic protocol. Normal synovial cavities in cattle are difficult or impossible to visualize via ultrasonography because of the very small physiological amount of synovial fluid. Thus, effusion that is easily visualized usually indicates a pathological process like arthritis, tenosynovitis or bursitis. Ultrasonography provides accurate information about the location and size of lesions or fluid-filled cavities, the nature of the content and an exact measurement of the distance from pathologically altered structures to the skin surface. Targeted centesis of synovial or other cavities can be carried out after a preliminary ultrasonographic inspection. Characterization of the lesions and a thorough preoperative inspection of affected regions are of enormous benefit for planning surgery and treatment.     

Ultrasonographic examination of the equine sacroiliac region

REASONS FOR PERFORMING STUDY: Little information exists about the normal ultrasonographic appearance of the equine sacroiliac region, but knowledge of the ultrasonographic anatomy is necessary to understand the possible pathological changes in sacroiliac diseases. OBJECTIVES: The normal ultrasonographic appearance of soft tissues and bony structures of the sacroiliac region in horses was studied in order to establish clinically relevant reference parameters. METHODS: Thirteen cadaver specimens were examined using a transcutaneous approach above the tubera sacrale to image the dorsal sacroiliac ligament and the tendon of the longissimus dorsi muscle. A rectal approach was used to outline the sacroiliac joint and its adjacent structures. Thirteen sound horses with no history of back pain were examined following the same protocol as for the post mortem examinations. RESULTS: The tendon of the longissimus dorsi muscle can clearly be distinguished from the dorsal sacroiliac ligament, especially in longitudinal images. Transrectal examination of the sacroiliac joint consists of evaluation of the bony surfaces of the sacrum and ilium in comparison with the contralateral side. CONCLUSIONS: Ultrasonographic examination of the sacroiliac region provided clear images of the caudomedial border of the sacroiliac joint and its adjacent structures and is a useful aid in the diagnosis of sacroiliac joint diseases and adjacent lesions. The study has shown ultrasonography to be a useful method for examining and differentiating the longissimus dorsi muscle and the dorsal sacroiliac ligament at the level of the tubera sacrale. POTENTIAL RELEVANCE: Diagnostic ultrasound is available to most practitioners. These reference ultrasound parameters may help to improve the diagnosis of sacroiliac diseases.     

Ultrasonography of the equine elbow technique and normal appearance

This study was intended to document normal ultrasonographic appearance of the equine elbow and anatomic landmarks useful in clinical imaging. Both forelimbs of five equine cadavers and both forelimbs of six live adult horses were used (4 Arabian-Barbes, 3 Arabs, 2 Anglo-Arabs, 1 Selle Français, 1 Anglo-Hispano-Arab, three to 18 years old). To facilitate the reading of the scans, a zoning system was developed for some anatomic structures. Ultrasonography was performed with a real-time B-mode semi-portable sector scanner using 7.5 & 5 MHz transducers. On one cadaver limb, MRI was performed on a system at 1.5 Tesla, T1 weighted spin echo, TR of 475 msec, RE of 15 msec, image matrix size 179 × 256 pixels. Ultrasonography images were compared with gross anatomy and with MRI scans to provide the normal ultrasonographic representation of the equine elbow. The lateral collateral ligament, the triceps brachii tendon with its subtendinous bursa, the proximal tendon of the ulnaris lateralis and the articular cartilage of the humeral trochlea were easy to examine ultrasonographically. The medial collateral ligament and the distal biceps brachii tendon required more expertise to assess. Ultrasonographic appearance and course of these structures are described. The 7.5 MHz transducer was best to be used. Ultrasonographic findings correlated well with MRI scans and with gross anatomy in the cadavers' limbs.     

ULTRASONOGRAPHIC ANATOMY OF THE CANINE ELBOW

To produce detailed ultrasonographic images of the soft tissue structures around the canine elbow joint, a series of greyhound cadaver limbs were scanned both intact and dissected in a water bath. Suitable transducer positions and bone landmarks are described and the ultrasonographic appearance of the lateral collateral ligament, anconeal process, triceps tendon, origin of olecranon ligament, biceps tendon insertion, medial collateral ligament, and medial coronoid process are illustrated. Improved understanding of the anatomy of the canine elbow will support clinical ultrasonography of this region.     

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.     

Synovial sarcoma of the tendon and tendon sheath in a dog

A 19.5-year-old male mongrel dog developed a progressive lameness and swelling around the right carpus. A tumor (6 x 3 x 3 cm) was found in the caudal of distal antebrachium of the right forelimb, including tendons of the superficial digital flexor muscle and deep digital flexor muscle. No joint destruction was observed. The tumor consisted of round and spindle cells arranged in a compact sheet. There were occasional slit-like spaces or lumina, and areas rich in collagen fibers giving an appearance of tendon tissues. Neoplastic cells gave a positive immunoreaction to vimentin, but negative reactions to antibodies against S-100 protein, cytokeratin and myoglobin. Based on these findings, this tumor was diagnosed as a synovial sarcoma generating from the tendon and tendon sheath, which is very uncommon in dogs.     

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.     

Dynamic flexion/extension and non‐weight bearing ultrasonography is helpful for identifying manica flexoria tears in horses

Lesions of the manica flexoria are a tenoscopic finding in horses with digital flexor tendon sheath tenosynovitis. This retrospective case series study describes the ultrasonographic findings in seven horses admitted for digital flexor tendon sheath swelling associated with lameness and tenoscopic confirmation of a manica flexoria tear. Six horses had a partial manica flexoria tear, one a complete rupture. The ultrasonographic examination included a static examination on the weight and non‐weight bearing limb and a dynamic limb assessment during flexion and extension. The main ultrasonographic finding at the static weight bearing examination in horses with a partial tear was an asymmetrical appearance of the manica flexoria at the level of the junction with the lateral border of the superficial digital flexor tendon, or an incomplete visualization of the manica flexoria in case of complete rupture. The split edges of the completed ruptured manica flexoria were seen floating in the synovial fluid at the examination in flexion. In six of seven cases, the superficial digital flexor tendon slid abnormally relative to the deep digital flexor tendon, during flexion/extension movements, with medial displacement of the superficial digital flexor tendon, appearance of an anechoic gap between the flexor tendons or reduced superficial digital flexor tendon sliding. Because ultrasonographic diagnosis of the manica flexoria tear is considered challenging, detection of these ultrasonographic features is helpful to increase the likelihood of identifying manica flexoria tears prior to tenoscopy. Authors recommend static ultrasonographic examination of the manica flexoria using a flexed limb position and dynamic ultrasonographic examination using flexion and extension positioning for horses with suspected digital sheath injury.