This Article is About
chronic inflammation
definitive diagnosis
diagnosis treatment
Biceps Tendon Disease
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Biceps tenosynovitis is a common cause of dog forelimb lameness, this is a short overview of the disease including clinical signs, diagnosis, treatment and prognosis.

Definitions:

Biceps tenosynovitis – inflammation of the biceps tendon and surrounding synovial shelths

Bicipital tendon tenodesis – involves surgically moving the origin of the biceps tendon

Cause and predilections-

Direct or indirect trauma to the bicipital tendon. Repetitive injury or overuse may be a factor.

Chronic inflammation may causes synovial hyperplasia and dystrophic mineralization of the tendon and the tendon may be partially or completely torn

Biceps tenosynovitis usually occurs in mid to large breed, middle aged and above, working dogs, think huntaways and shepherds

History

The presenting signs usually are an intermittent or progressive forelimb lameness that worsens after exercise. Occasionally there is an acute onset associated with a blunt trauma.

Physical exam

The affected dog are usually weight bearing but lame during gait. Pain may be evident during palpation of the bicipital tendon at its origin and insertion or of the muscle itself. Atrophy of the supraspinatus and infraspinatus may be evident

The disease can be uni or bilateral - don't forget to palpate both sides

Imaging

Lateral imaging of both shoulders as well as Craniocaudal (skyline) of the flexed shoulder to identify the bicipital groove.

Ultrasound is superior to radiographs for tendon visibility as ultrasound is more sensitive for soft tissue

Arthroscopy can provide a definitive diagnosis as provides direct visibility of the the tendon.

Differentials

• Osteoarthritis

• OCD

• Early osteosarc/ other bone tumours

• Synovial osteochondromatosis

• Cervical disk dz

• Neurofibroma of the brachial plexis

Treatment

• Medical is usually used initially. Prednisone can be infiltrated into the joint followed by six weeks confinement then gradual increase in exercise. however please note, oral steroids don’t appear to be effective.

Bicipital tenotomy or tenodesis to eliminate the movement of the tendon in the inflamed shealth. Indicated if there is complete rupture of the tendon or the dog is not responding to long term medical treatment

Surgical or arthroscopic exploration to resect minerlization and inflamed synovium may be effective

• Tenotomy or tenodesis should only be performed if there is evidence of a partial tear or chronic biceps tenosynovitis with no damage to the other supporting structures in the joint.

Post op management

• After arthroscopic treatment keep quite for 2-3 weeks post operatively

• After open surgery keep in velpeau sling for 2-3 week and the dog confined for a total of 6 weeks. Then a slow return to normal activity with the help of physotherapy

• Physical therapy helps regain muscle tone, swimming is particularly good as it builds strength while being low impact.

Prognosis

Medical treatment can range from excellent to poor, however with arthroscopic or surgical treatment the prognosis is good to excellent. Most dogs will regain optimum function in between 2-9 months


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