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A vigorous session of training or competition may have initiated the lameness and a few months history of lameness is common. Traditional methods of nonsteroidal anti-inflammatory and strict or modified crate rest temporarily solve the problem, but as soon as the dog returns to activities, the lameness returns. The specific diagnosis of bicipital tenosynovitis is challenging, especially since it is inclusive of a possible primary tendon disruption or degeneration of the tendon. Both scenarios provide concurrent synovitis of the surrounding synovial membrane. Radiographs should be performed to rule out an obvious lesion but may prove of little assistance in acute cases. In chronic cases, ostephytes may be viewed along the intertubercular grove. A thorough evaluation of the shoulder should be performed inclusive of range of motion, palpation and manipulation of the shoulder complex. Pain over the bicipital tendon is common, especially at the intertubercular grove with bicipital tenosynovitis. Shoulder flexion combined with elbow extension may illicit pain and a spasm of the biceps muscle. A gait analysis should be performed to determine the severity of the lameness and if any compensations are present. If the dog is intermittently lame, ask the owner to replicate the activity that produces the lameness before the dog comes in for the evaluation. Acute cases are often treated conservatively with a multimodal approach of nonsteroidal anti-inflammatories (NSAIDS), pain management, and physical rehabilitation. Controlled activity must be instituted to decrease the cause of the inflammation. This often means a cessation of any jumping activity including dog sports, jumping in and out of the car, and jumping on and off furniture. Physical rehabilitation is a strong component in the approach and is utilized to reduce pain and inflammation, restore muscle function, retrain the shoulder complex to perform the desired activities, and return the dog to normal activity. Cyrotherapy or ice is a common method of reducing the inflammation of the bicipital region. Ice packs may be applied or an ice massage may be applied to the area. LASER therapy is utilized to reduce the inflammation and pain, promote healing and reduce adhesions. This is applied directly to the bicipital tendon as well as the circumference of the glenohumeral joint. Transverse friction massage is also applied directly to the bicipital tendon. The transverse friction massage is applied in sweeping motions perpendicular to the tendon to realign the fibers of the bicipital tendon and prevent adhesions. In acute cases, avoiding vigorous stretching should prevent micro tears in the biceps tendon. Pain free and passive range of motion should be performed at the shoulder and elbow. Attention should also be made to the scapulothoracic joint and mobilizations may be applied to this area. There should also be a focus on the restoration of weight bearing on the effected limb with weight shifting exercises.
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