Case Study

ORTHO – Chronic biceps tendinopathy and tenosynovitis with osteoarthrosis and emerging infraspinatus myopathy in a 12 year old FS Labrador Retriever dog

The patient is a 12 year old FS Labrador Retriever dog with right forelimb lameness. Suspect bicipital tendinopathy.

DX

The ultrasonographic findings are compatible with moderate chronic rightsided biceps tendinopathy & tenosynovitis. Moreover moderate osteoarthrosis of the right shoulder joint is present. The findings of the right infraspinatus muscle are subtle, yet suggestive for emerging fibrosing myopathy.

Image Interpretation

Ultrasound of the right and left shoulder regions – Ultrasonographic findings
Right:
The biceps tendon is continuous, even in width and smooth in outline. The cross
section of the tendon reveals multifocal heterogeneity. A mild amount of effusion is
noted within the tendon sheath. The synovial membranes of the tendon sheath reveal
mild thickening. Mild surface irregularity of the intertubercular bicipital groove is
noted.
A moderate amount of osteophytes is seen circumferential to the humeral head as
appreciated.
The infraspinatus muscle reveals mild loss of its regular fibre pattern mid level within
the infraspinatus fossa. The muscle volume is maintained.
The muscle belly and distal insertion tendon of the supraspinatus muscle do not present
ultrasonographic abnormalities.
Left:
The biceps tendon is continuous, even in width and smooth in outline. The cross
section of the tendon is homogenous. There is no effusion and no synovial thickening. The bone surface of the intertubercular bicipital groove is even.
A moderate amount of osteophytes is seen circumferential to the humeral head as
appreciated.
The infraspinatus muscle reveals no ultrasonographic abnormalities.
Within the distal insertion tendon of the supraspinatus muscle a small irregular
calcification is noted. The tendon pattern and volume are as anticipated.

Outcome

The emerging calcifying tendinopathy of the left supraspinatus muscle is unlikely to be
of significance at this point. But a moderate osteoarthrosis is noted for the left shoulder
too.
Overall a multifactorial cause of the lameness emerging from the right shoulder is
likely.
The findings of the right shoulder should be correlated with the clinical examination
(carpal flip?). If the clinical examination is inconclusive regarding the relevance of the
individual findings injection of the biceps tendon sheath may be considered as
diagnostic therapy. Also note that MRI has a higher sensitivity to identify early stages
of infraspinatus myopathy and would therefore be ideal to rule out infraspinatus
pathology in case the clinical examination is inconclusive.
The findings are overall moderate and a conservative treatment attempt appears to be
justified for the biceps tendinopathy.
Other underlying causes of the shoulder lameness – such as osteochondrosis – should
be ruled out radiographically if not performed yet.