Biceps Tendonitis, or Bicipital Tenosynovitis, is a common cause of forelimb lameness in medium or large-sized dogs, as well as middle-aged or older dogs. Biceps tendonitis in dogs is defined as inflammation of the biceps brachii tendon and its enveloping synovial sheath. The biceps brachii muscle in dogs acts to flex the elbow and extend the shoulder joint. In most cases a cause is not found. It is suspected that repeated stress or trauma to the biceps tendon results in damage to the tendon and the surrounding tendon sheath. Calcification of the bicep tendon dog is common and can be seen on radiographs.
Symptoms of dogs affected by Biceps Tendonitis typically have a history of chronic, progressive or intermittent, and moderate to severe weight-bearing lameness that worsens with exercise.
Biceps Tendonitis in dogs is not specific to any one breed or sex. Furthermore, it has yet to be determined if it is more prevalent in the athletic dog, as opposed to the less active dog. Otherwise, as stated above, Biceps Tendonitis is a common cause of forelimb lameness in medium or large-sized dogs, as well as middle-aged or older dogs.
In addition to a complete examination of the shoulder joint, a detailed neurologic examination may also be indicated, as conditions affecting the brachial plexus and cervical spinal cord often mimic shoulder pain.
Dogs generally bear weight on the affected limb because pain occurs only when the diseased tendon is gliding within the intertubercular groove. Muscle atrophy of the supraspinatus muscles over the spine of the scapula can be noticed. The degree of muscle atrophy is associated with the severity of the disease.
In addition to the physical examination, radiographic evaluation of the shoulder joint is also indicated. The special “skyline” positioning will require sedation of your pet. At this time, a joint tap may be recommended to rule out other causes of shoulder pain, such as septic arthritis or immune-mediated arthritis. Ultrasound can also be used to visualize the biceps tendon. In some cases, MRI is also recommended. Arthroscopy is also valuable in determining biceps tendonitis from medial shoulder instability.
The primary objective of medical therapy is to reduce inflammation of the biceps tendon and sheath. Intraarticular injection of steroids into the shoulder joint has been advocated in the past. Direct injection of corticosteroids into the tendon, however, has been associated with collagen necrosis and tendon rupture and is, therefore, not recommended.
The use of systemic NSAID or corticosteroid therapy in the medical management of bicipital tenosynovitis has not been scientifically evaluated. Some reports show only about half of the pets treated with medical therapy respond. The use of anti-inflammatory medications, combined with physical rehabilitation that includes therapeutic ultrasound, has had some positive effects.
Surgical treatment for bicipital tenosynovitis in dogs is often recommended for dogs that do not respond to medical therapy. Most surgeries reposition the biceps tendon to a new location by anchoring it with a screw and spiked washer on the front of the humerus, which changes its action and reduces the irritation to the tendon sheath. Cutting the biceps tendon is another surgery that is used. While this surgery reduces pain it also increases the instability of the shoulder joint, adding to arthritis in the future. At the time of this writing, these surgeries cost between $2,500 and $5,000 and require physical rehabilitation for 8 to 10 weeks post-surgery.
Stem Cell Therapy, along with PRP therapy, can prevent the need for surgery by helping to reduce the inflammatory cycle that occurs in tendonitis in dogs and restore normal function to the shoulder joint.
