Shoulder Joint Part 2 Flashcards
Where does the biceps brachii m originate and run?
The biceps brachii muscle originates from the supraglenoid tubercle of the scapula and runs distally within the intertubercular groove of the humerus
The A) part of the biceps tendon invaginates the joint capsule so that it forms a B) around the tendon.
A) intra-articular
B) sheath
Biceps muscle during standing/weight bearing in locomotion has what effects on:
A) Elbow?
S) Shoulder?
A) Flexes
B) Extends/stabilise
What is Bicipital tenosynovitis?
An inflammation of the tendon and its surrounding sheath.
What is the aetiology of Bicipital tenosynovitis?
The underlying aetiology is unknown, however, chronic trauma to the shoulder joint causing minor injuries of the muscle and/or tendon which fail to heal appropriately.
Biceps tendinopathy:
A) Breed?
B) Age?
A) Medium-large
B) Middle- older
What can be seen on xrays with biceps tendinopathy? (3)
Sclerosis and/or osteophytosis of the intertubercular groove
Mineralisation of the biceps tendon
What may synovial fluid analysis of biceps tendinopathy show?
increased numbers of monocytes, macrophages, and vacuolated phagocytes which suggests degenerative joint disease
What would a biopsy of biceps tendinopathy show?
proliferative tenosynovitis and lymphocytic-plasmacytic infiltration.
What may atrophy as biceps tendinopathy becomes chronic? (2)
infraspinatus and supraspinatus muscles
Clinical signs of biceps tendinopathy?
Lameness - aggravated by exercise.
What is found on clinical exam with biceps tendinopathy?
Palpation of the tendon within the intertubercular groove typically results in pain, particularly with hyperextension of the shoulder or flexion of the shoulder and extension of the elbow (positive “biceps tendon test”) or while pushing the humerus cranially while holding the scapula steady with the other hand (positive “shoulder drawer test”).
What is the biceps tendon test?
hyperextension of the shoulder or flexion of the shoulder and extension of the elbow
What is the shoulder drawer test?
pushing the humerus cranially while holding the scapula steady with the other hand
How is biceps tendinopathy diagnosed?
Radiographic changes usually only become evident in chronic cases and perhaps in as few as one-third of patients with chronic biceps tendinopathy. However, nearly all dogs with biceps tenosynovitis will have non-specific degenerative changes on shoulder radiographs
D/Dx for biceps tendinopathy? (5)
Supraspinatus tendinopathy;
Shoulder instability;
OCD;
Cervical disc disease;
Neoplasia (brachial plexus neurofibroma, osteosarcoma).
How successful is medical management if there is no chronic change with biceps tendinopathy?
50-75%
How is biceps tendinopathy medically managed? (7)
- Confinement for 4-6 weeks
- weight reduction
- NSAID
- Physio
- Hydry treadmill
- Regen medicine
- Shockwave
IF there is advanced stages of biceps tendinopathy - what can be used? Can it be repeated?
What if this fails?
Injection of long-acting corticosteroids (e.g. methylprednisolone acetate (10 to 40 mg) into the scapulohumeral joint is recommended in advanced stages. If there is no improvement in two weeks, the injection may be repeated. If no improvement is seen after one or two injections, surgery should be considered.
Why should steroid NOT be injected into a tendon?
Predispose to rupture
Is the following sentence true or false for biceps tendinopathy?
Surgical management is recommended if changes are chronic or if patients have not responded to conservative treatment.
True
Is the following sentence true or false? For biceps tendinopathy
Recovery to full function may take up to 2 to 3 months and mild, residual lameness may persist in some cases.
True
Surgical treatment for biceps tendinopathy? (2)
Tenotomy
Tenodesis
What is done during a tenopathy?
The tendon is simply cut free of its origin. Recovery time is much shorter and affected dogs seem to have more rapid relief of their discomfort. Open or arthroscopic biceps tendon tenotomy is considered a safe and reliable technique, which yields favorable short and long-term clinical results and it therefore has replaced the technique of tenodesis in most cases.
