biceps tendon injury and rupture
Biceps Tendon Injury
Problems affecting the biceps tendon of dogs have been reported as a frequent cause of forelimb lameness. Recognized conditions affecting the biceps tendon of dogs include:
- tendinopathy – a chronic change to the tendon due to repetitive injury with lack of inflammation
- tendinitis – injury with associated inflammation
- tenosynovitis – injury of the tendon and associated synovium in the shoulder joint with inflammation
- partial or complete rupture of biceps tendon
What is Biceps Tenosynovitis?
Biceps tenosynovitis in dogs is the inflammation of the tendon of the biceps brachii muscle and its sheath. This tendon attaches to the scapula (shoulder blades) and crosses over the shoulder joint, and eventually widens to become the biceps muscle. The tendon of the biceps is important in stabilizing the shoulder joint, and the muscle allows for the flexion of the elbow and extension of the shoulder.
What dog breeds are most likely to get Biceps Tenosynovitis?
Biceps tenosynovitis most commonly affects mature medium to large breed dogs, especially:
- Labrador Retrievers
Because it is caused by repetitive injury to the tendon, biceps tenosynovitis is also seen in athletic dogs, such as:
- Agility dogs
- Racing greyhounds.
However, it may also occur less commonly in small breed dogs.
What are the Signs of Biceps Tenosynovitis in dogs?
The most common clinical sign in dogs with biceps tenosynovitis is lameness, which can be continuous or intermittent, and is usually made worse by exercise. The dog may experience pain with flexion of the shoulder and extension of the elbow, or just by touching the tendon near the shoulder joint. He/she will still bear weight on the affected limb, but will have a change in gait, since it is painful to not fully flex the shoulder while extending the elbow. As a result, in many cases atrophy (wasting) of the muscles of the affected limb is often present.
How is Biceps Tenosynovitis Diagnosed?
Your veterinarian can make an initial diagnosis by taking a thorough history and performing complete physical exam. Radiographs and ultrasound can also be performed but they are not helpful when the condition is in the acute phase. If the damage/injury is chronic, the radiographs can detect mineralization of the tendon and bone spurs surrounding the tendon sheath. A contrast (dye) study can be used to diagnose a tear in the ligament, and your vet may take a sample of the joint fluid to rule out an infectious cause. However, the only way to make a definitive diagnosis is through arthroscopy, which is useful in visualizing the extent of the injury and is minimally invasive.
Why did my Dog get Biceps Tenosynovitis?
Biceps tenosynovitis is caused by acute trauma, or chronic repetitive trauma to the tendon, such as extensive jumping activities, or by simple overuse. The condition can also be caused by degenerative conditions such as osteochondritis dessicans (OCD).
How is Biceps Tenosynovitis Treated?
In acute cases, biceps tenosynovitis can be managed medically. The goal is to decrease the inflammation, so the patient must be rested and confined, and is often prescribed nonsteroidal anti-inflammatories (NSAIDs). In more chronic cases, injection of corticosteroids into the joint may also be successful, but may have to be repeated. Whether the condition is chronic or acute, the patient must be strictly rested for 4-6 weeks. Physical therapy and weight loss are also beneficial.
For dogs that do not respond to medical treatment, surgery may be warranted. The surgical procdure involves completely cutting the biceps tendon. In some cases, the tendon is reattached to the humerus with a bone screw. Some surgeons do not reattach the tendon. Instead, the tendon is allowed to heal naturally, and gradually adheres to the humerus. In both procedures, normal muscle function is restored with time.
Can Biceps Tenosynovitis be Prevented?
The best method of prevention of biceps tenosynovitis is avoiding overuse of the limb and preventing trauma. Dogs that participate in intense physical activities or agility need to be properly conditioned so the tendon does not strain and become inflamed. As with any orthopedic condition, occurrence of biceps tenosynovitis can be greatly decreased with proper weight management.
What is the Prognosis for my Dog with Biceps Tenosynovitis?
Medical management is successful about 50% of the time. Many dogs will need to be treated again, with either another course of NSAIDS or a cortisone injection. Physical therapy may be beneficial in long-term management, and weight control is critical. Many of these dogs will suffer chronic lameness due to the development of arthritis as a result of prolonged inflammation.
With surgical treatment, prognosis is very good, providing the patient with pain relief and resolution of lameness. Full recovery takes about 4-6 months.
What are Biceps Tendon Tenodesis?
The bicep is made up of two tendon attachments that meet at the shoulder joint. These tendons control both bending movements (flexion) and turning movements (supination). In larger breeds of dog that are used for hunting and other sports, damage to the bicep tendon is not uncommon. It can be caused by repetitive injury from jumping up onto things, and especially by hanging off of things.
If a dog is suffering from bicep tendon damage, it will have increasing bouts of lameness. This lameness will often correspond with periods of heightened activity. The issue can be confirmed by an x-ray of the affected shoulder joint. Tenodesis is a surgical procedure to repair the damaged tendon and salvage as much natural joint movement as possible. It can be an isolated surgery or it can be combined with a shoulder repair caused by severe trauma.
Biceps Tendon Tenodesis Procedure in Dogs
To determine if the dog is a good surgical candidate, full blood work will be run. This will show the dog’s overall health condition and highlight any clotting issues that may be present. If the dog is healthy enough for the procedure, x-rays will be taken to show whether the tendon is partially or fully removed from the shoulder joint. With this information, the surgery can be planned out.
The dog will have to fast for several hours before the surgery is performed. The joint area will be shaved and cleaned in preparation for the operation. Either one large incision or multiple portal incisions will be made, depending on whether arthroscopic surgery is being used or not. If the bicep is still partially attached to the joint, it will need to be detached. The tendon is then secured to the humerus. It is positioned further down from the shoulder joint to prevent issues later in life. It is affixed using metal inserts. The incision(s) can then be closed using sutures or staples.
What to expect if your dog needs a Biceps Tendon surgery
The majority of dogs that receive a tenodesis make a full recovery. Complications at a year’s time post-surgery are rarely reported. If the dog received this procedure combined with a larger shoulder repair operation, the recovery time may be longer and more complicated. There is a surgical alternative to a tenodesis operation called a tenotomy. This procedure is more commonly performed and heals faster, although the movement in the joint upon recovery may be limited. Non-surgical alternatives do exist, however these are rarely permanent solutions.
Biceps Tendon Tenodesis Recovery in Dogs
The dog should be closely monitored as it wakes up from the general anesthesia. Pain management can begin at this time, often starting intravenously and continuing via oral prescription. Once the dog has been discharged, you will need to keep the incision site clean and watch it closely for any signs of infection. The dog should not be allowed any off-leash activity for a minimum of two weeks after this procedure.
A follow-up appointment will be needed 10 to 14 days after the operation to assess healing and remove the sutures from the incision. To promote healing with proper movement, the dog should be encouraged to walk up and down the stairs multiple times a day. Therapeutic treatments including physiotherapy and hydrotherapy can begin during the healing process to increase the range of motion in the joint. The dog should be fully recovered by 12 weeks’ time.
Dog Biceps Tendon Injury Considerations
As with all surgeries, complications can arise from the use of anesthesia, although this is rare. If arthroscopic tenodesis is used, less post-surgical complications develop. Cases of infection are also lower using the arthroscopic technique. Full incision tenodesis carries higher risk of complications, but is still widely successful.
Biceps Tendon Injury Prevention in Dogs
Dogs who are mid to old in age are more susceptible to developing tendon problems. Medium to large breeds are more prone to these issues, especially Labrador Retrievers and Rottweilers. Do not allow your dog to jump up onto fences or other objects that they may hang off of. Keep play and exercise controlled. If your dog is injured, keep its activity level low until your dog is fully healed. Choosing frequent, short walks may be less hard on joints than one long walk.