Chronic biceps tendinosis

[lmp37dvm]

Hello forum,
I would love to know how often everyone is successfully rehabbing chronic biceps tendinosis/tendinopathies. How often are you injecting these shoulder joints? If you are, at what point are you doing that? How often are you ending up recommending a biceps release? Does anyone else feel like even when these dogs are doing well, you’re just waiting for them to come up lame again? My most recent one that is giving me heartache is a 2 yr old MN Duck Tolling Retriever who of course, is owned by a referring vet. She had previously been doing agility and lots of ball play, really working him hard with no issues. He came up lame on his LF in October of 2015. She stopped agility, stopped ball play and implemented pretty strict exercise restriction and the lameness resolved. The owner had a baby in December, so the dog was not as restricted in December and January. The lameness again became more consistent by February as he became more active. He was evaluated by a chiropractor who thought the lameness was coming from his neck, but he did not improve with treatment. The dog was then evaluated by the surgeon I work with, who diagnosed biceps tendinitis/tendinosis left worse than right with changes noted bilaterally on ultrasound. I got involved in April. We implemented a stretching and strengthening plan but continued to not allow rough housing with the other dog in the family and no ball play. He did great through the beginning of summer, even making multiple trips to the family’s lake house where he was swimming and leaping off the dock and doing a little play with the other dogs. A follow up ultrasound in the end of June showed evidence of healing…obviously not normal, but improved. I made his exercises more challenging and since it his absolute favorite thing, I introduced some easy ball play (rolling the ball into the corner of a carpeted room) in June…literally just a few throws, maybe 2-3 times a week. He tolerated this fine. I last saw him in the beginning of August and he was still doing well. He was playing ball more regularly and doing a little play with the other dog and handling it fine. I just got an email from the owner at the end of last week that he has been lame on two occasions since I last saw him. They feel it is almost always after he plays ball or plays with the other dog. Each time he was lame it was in the evening after laying down for a bit, and after a few minutes of walking around he would warm out of it, and would be normal by the morning with no meds or treatment. Maybe at most the next day he just seemed a little short strided in front, but not a true limp. The owner would still “keep him quiet” for a few days after that. Watching the Four Leg video on biceps/supraspinatus tendinopathies, I know Laurie that you say it is OK for them to be a little lame when increasing/re-introducing more strenuous activities. Is this the sort of lameness you are describing? Should we always expect him to show this sort of lameness after ball play? If not, how long do we expect him to show this little bit of lameness…meaning is there a “normal” time frame for this transitional lameness that we shouldn’t get worried about? Do we just never let this dog play ball again!!?!? I’m joking, sort of, but is it realistic to think that this dog will ever be able to play ball again without getting a bit sore?? We’ve talked about injecting the shoulder as well as adding in acupuncture, etc., but am I just delaying the inevitable? We are now almost a year into the initial onset of lameness. Just curious what others experience has been with long term soundness and expectations for a dog like this. Thanks for taking the time to read…

Laura

[lehughes]

Hi Laura,

So my other questions to you:
Did you check for Medial shoulder instability? See if the dog has some apprehension. When the condition has been chronic, they are often apprehensive and therefore don't show you the hypermobility unless they are very very very comfortable with you and your assessment.
Did you check rib 1? It may have been missed in the chiro eval. I've taught many vet chiros, and not all of them check those first 3 ribs.
What exercises have you had them doing? Eccentrics? Walking down hills / down stairs? Rear legs up and reaching out forward and down to the floor for a cookie? Stabilization exercises - 3-leg standing and using theraband to pull in multiple directions as the dog balances?

Now, if the issue is a truly stubborn biceps (with nothing additional to address), and you have done all things possible to heal it (and the owners aren't committing unknowing sabotage - i.e. free play rough-housing when owners are at work)... then you could very well break down and advise a cortisone injection. But remember that even after the injection, they will need to be diligent with continuing on with some of the eccentric exercises and stabilizing exercises... since the injury isn't 100% healed or strong.

I've never had one of mine go on to NEEDING a biceps release!

Laurie