Case Study

CT – Chonic bilateral biceps tendovaginitis with osteoarthritis of the shoulder joints in a 11 year old MN Border Collie dog

This 11 year old MN Border Collie dog presented with lameness of the right front and “wobbliness” of 24 hour duration. CBC/Chem wnl.

Physical exam – cervical myelopathy (C3-4 disc surgery today) and pain on right shoulder flexion. Post-op CT to determine cause of right shoulder pain.

This 11 year old MN Border Collie dog presented with lameness of the right front and “wobbliness” of 24 hour duration. CBC/Chem wnl.

Physical exam – cervical myelopathy (C3-4 disc surgery today) and pain on right shoulder flexion. Post-op CT to determine cause of right shoulder pain.

Image Interpretation

CT of the shoulders, right lateral recumbency, plain – Shoulders:
The CT of the right shoulder reveals moderate joint and biceps tendon sheath effusion. An irregular semicircular bony exostosis is seen within the intertubercular groove of the biceps tendon which is entrapping the tendon & tendon sheath. The biceps and supraspinatus tendon are continuous and smooth in outline.
A moderate amount of osteophytes is noted along the periarticular margins.
The subchondral bone of the humeral head is even and smooth, there is no subchondral bone defect.
Similar, but slightly less pronounced findings including joint & tendon sheath effusion, intertubercular bony exostosis and osteophytes are noted for the left shoulder region.
Cervical spine:
The ventral slot site is recognized at C3/4. The surgical approach is demarcated by a tract of gas accumulations within swollen hypaxial muscles. A mild protrusion of the intervertebral disc C6/7 into the ventral epidural space is noted. A compressive myelopathy is not seen. However, assessment of the discs and myelon is limited in general owing to the lack of contrast between these structures and beam hardening streaks emerging from the vertebral endplates.

DX

The computed tomographic findings are suggestive for chronic bilateral biceps tendovaginitis with osteoarthritis of the shoulder joints.

Outcome

The changes are marked bilaterally but slightly more pronounced on the right side.
Ultrasonography or MRI of both shoulders would be ideal to further define the soft tissue changes. The ultrasonographic examination can usually be done without sedation depending on the compliance of the patient.

Further assessment of the soft tissues is recommended here as it is necessary to adjust the treatment accordingly and rule out partial tendon rupture. Possible therapeutic options comprise conservative treatment with restriction of activity, systemic NSAIDs, injection of the shoulder joint/tendon sheath and targeted physical therapy (mobilization, laser, shock waves) up to arthroscopic revision with tenotomy.

The assessment of the intervertebral discs is limited on plain CT, yet there appears to be a mild, non-compressive protrusion in the deep cervical spine.