Biceps tenosynovitis is inflammation of the biceps brachii tendon and its surrounding sheath

The diagnosis is best made with arthroscopic examination of the shoulder joint

Both medical and surgical treatments can be used, however, surgery provides the best outcome

What is it?

• Biceps tenosynovitis is inflammation of the biceps brachii tendon and its sheath
• Causes
  • repeated injury to the biceps tendon
  • acute severe trauma
  • chronic osteochondritis dissecans of the shoulder joint

Anatomy

• The biceps tendon inserts on the bottom of the shoulder blade bone (scapula), passes through the shoulder joint and along the front part of the humerus bone (bicipital groove)
• The tendon attaches to the belly of the biceps muscle; the biceps then inserts onto the radius and ulna bones of the forelimb
• Function of the biceps - shoulder extension and elbow flexion

Signs

• Most dogs that develop biceps tenosynovitis are mature
• Medium to large breeds are most common
• Small breed dogs also can develop this condition
• Lameness
  • intermittent or continuous lameness
  • exacerbated by exercise

Diagnosis

• Physical examination
  • pain upon hyperflexion of the shoulder and extension of the elbow
  • direct palpation of the tendon near the shoulder joint also may elicit a painful response
  • atrophy of the muscles of the affected forelimb is a nonspecific, but common finding.
• X-rays of the shoulder
  • could reveal calcium deposits of the biceps tendon and bone spurs surrounding the sheath of the biceps tendon
• Ultrasound of the biceps tendon may also reveal calcium deposits within the tendon and swelling of the sheath around the tendon
• A sample of joint fluid from the shoulder typically will be compatible with degenerative arthritis
• A definitive diagnosis of biceps tenosynovitis is made with arthroscopic examination of the tendon
  

Treatment

• Medical therapy
  • exercise restriction
  • rehabilitation therapy
  • weight loss
  • anti-inflammatory medications
  • injection of cortisone into the shoulder joint; this can be repeated three weeks after the initial injection
  • failure of medical therapy to resolve the clinical signs warrants surgical treatment
• Surgery
  • arthroscopic examination of the shoulder to confirm the diagnosis
  • the tendon is cut from its insertion onto the shoulder blade bone
  • the tendon will heal onto the top of the humerus bone with time, allowing the muscle to regain its function

Homecare

• Continue to give your pet a prescribed pain relievers
• Limit your dog’s activity and exercise for 3 months
• Rehabilitation exercises can be done at your home or if you choose, by professionally trained therapists at an animal rehabilitation center
• Rehabilitation therapy should be continued until your dog is bearing weight well on the operated limb (typically 4 to 8 weeks after surgery)
• Weight management
• Intermittent use of nonsteroidal anti-inflammatory medication may be needed long-term
• Re-evaluations by the surgeon
  • 2 weeks
  • 2 months

Prognosis

• By 2 weeks after surgery, most dogs are moderately weight-bearing on the operated limb, although exercise should be limited during the first two to three months after the procedure
• Medical management is successful in about 50% of the cases
• Surgical treatment usually provides the patient relief of function and resolution of lameness
• Full recovery may take 4 to 6 months after the surgery

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