Diagnosis and treatment of infraspinatus tendon-bursa ossification in a Eurasian Dog

Summary

A 4-year-old male Eurasian Dog presented at our veterinary clinic with a history of perpetual forelimb lameness in both thoracic limbs. In the clinical exploration, direct pressure over the infraspinatus tendon of insertion caused pain in both thoracic forelimbs and a firm band-like structure was palpable. No improvement was observed after treatment with rest, non-steroidal anti-inflammatory drugs and an intralesional injection of a long-acting glucocorticoid. Radiographic examination, ultrasonographic exploration and computed tomography were performed, identifying ossified structures lateral to the proximal humerus and an irregular roughened periosteum at the insertion and tendon of the infraspinatus muscle on both sides. There were more distinct alterations on the right thoracic limb. The imaging results led to a diagnosis of an infraspinatus tendon-bursa ossification accompanied by a chronic tendinopathy/tendovaginitis, accentuated on the right side. The dog was subjected to physiotherapy and autologous conditioned plasma (ACP) was injected into the insertion of the infraspinatus muscle of both thoracic limbs. After 5 months of physiotherapy and two injections of ACP with an interval of one week in both forelimbs, the dog showed no signs of lameness. This case report describes the diagnosis and management of infraspinatus tendon-bursa ossification in a Eurasian Dog. To the authors’ knowledge, this condition has previously not been described in this breed of dog.

Zusammenfassung

Ein 4-jähriger, männlicher Eurasier wurde in unserer Kleintierklinik mit dem Vorbericht einer Lahmheit beider Vordergliedmaßen vorgestellt. Bei der klinischen Untersuchung konnte beidseits eine Verhärtung der Ansatzsehne des M. infraspinatus palpiert werden, die bei Ausübung von Druck eine schmerzhafte Reaktion hervorrief. Eine Vorbehandlung mit Ruhighaltung, nichtsteroidalen Antiphlogistika und der lokalen Injektion eines lang wirkenden Glukokortikoids hatte keine Besserung der Symptomatik erbracht. Bei der bildgebenden Diagnostik mittels Röntgen, Ultraschall und Computertomographie stellten sich beidseits Mineralisierungen lateral des proximalen Humerus und irregulär aufgerautes Periost am Ansatz und der Sehne des M. infraspinatus dar. Die rechte Vordergliedmaße zeigte stärkere Veränderungen als die linke. Die Ergebnisse der Bildgebung führten zu der Diagnose einer beidseitigen, rechts ausgeprägteren Ossifikation der Sehne und der Bursa des M. infraspinatus, begleitet von einer chronischen Tendinopathie/Tendovaginitis. Der Hund wurde mit Physiotherapie und beidseitigen Injektionen von autologem konditioniertem Plasma (ACP) in den Ansatz des M. infraspinatus behandelt. Nach 5 Monaten Physiotherapie sowie zwei ACP-Injektionen im Abstand von einer Woche war der Hund lahmheitsfrei. Dieser Fallbericht beschreibt die Diagnose und Therapie der Ossifikation der Sehne und der Bursa des M. infraspinatus bei einem Eurasier. Nach Kenntnisstand der Autoren wurde diese Erkrankung bisher nicht bei Hunden dieser Rasse beschrieben.

Keywords

Forelimb lameness - shoulder joint - ossified structures - physiotherapy - autologous conditioned plasma

Schlüsselwörter

Lahmheit der Vordergliedmaße - Schultergelenk - Verkalkungen - Physiotherapie - autologes konditioniertes Plasma

• References

• 1 Bardet JF. Diagnosis of shoulder instability in dogs and cats: a retrospective study. J Am Anim Hosp Assoc. 1998; 34: 42-54.
• 2 Codman EA. On stiff and painful shoulders – The anatomy of the subdeltoid or subacromial bursa and its clinical importance. Subdeltoid bursitis. Boston Med Surg J. 1906; 154: 613-620.
• 3 Danova NA, Muir P. Extracorporal shock wave therapy for supraspinatus calcifying tendinopathy in two dogs. Vet Rec. 2003; 152: 208-209.
• 4 Franch J, Bertán J, Remolins G, Fontecha P, Diaz-Bertrana MC, Durall I. Simultaneous bilateral contracture of the infraspinatus muscle. Vet Comp OrthopTraumatol. 2009; 22: 249-252.
• 5 Franklin SP, Cook JL. Prospective trial of autologous conditioned plasma versus hyaluronan plus corticosteroid for elbow osteoarthritis in dogs. Can Vet J. 2013; 54: 881-884.
• 6 Hofstee D-J, Gosens T, Bonnet M, Malefijt J. Calcifications in the cuff: take it or leave it? Br J Sports Med. 2007; 41: 832-835.
• 7 Kunkel KA, Rochat MC. A review of lameness attributable to the shoulder in the dog: part one. J Am Anim Hosp Assoc. 2008; 44: 156-162.
• 8 Kunkel KA, Rochat MC. A review of lameness attributable to the shoulder in the dog: part two. J Am Anim Hosp Assoc. 2008; 44: 163-170.
• 9 Laitinen OM, Flo GL. Mineralization of the supraspinatus tendon in dogs: a long-term follow-up. J Am Anim Hosp Assoc. 2000; 36: 262-267.
• 10 Maddox TW, May C, Keeley BJ, McConnell JF. Comparison between shoulder computed tomography and clinical findings in 89 dogs presented for thoracic limb lameness. Vet Radiol Ultrasound 2013; 54 (04) 358-364.
• 11 Marcellin-Little DJ, Levine D, Canapp SO. The canine shoulder: Selected disorders and their management with physical therapy. Clin Tech Small Anim Pract. 2007; 22: 171-182.
• 12 McKee M, Macias C. Orthopaedic conditions of the shoulder in the dog. In Pract. 2004; 26: 118-129.
• 13 McKee WM, Macias C, May C, Scurrell EJ. Ossification of the infraspinatus tendon-bursa in 13 dogs. Vet Rec. 2007; 161: 846-852.
• 14 Merolla G, Bhat MG, Paladini P, Porcellini G. Complications of calcific tendinitis of the shoulder: a concise review. J Orthop Traumatol. 2015; 16: 175-183.
• 15 Merolla G, Singh S, Paladini P, Porcellini G. Calcific tendinitis of the rotator cuff: state of the art in diagnosis and treatment. J Orthop Traumatol. 2015; 17: 7-14.
• 16 Salomon FV. Bewegungsapparat. In: Anatomie für die Tiermedizin. Salomon FV, Geyer H, Gille U. Hrsg. Stuttgart: Enke; 2005: 199.
• 17 Sánchez M, Anitua E, Orive G, Mujika I, Andia I. Platelet-rich therapies in the treatment of orthopaedic sport injuries. Sports Med 2009; 39 (05) 345-354.
• 18 Sidaway BK, McLaughlin RM, Elder SH, Boyle CR, Silverman EB. Role of the tendons of the biceps brachii and infraspinatus muscles and the medial glenohumeral ligament in the maintenance of passive shoulder joint stability in dogs. Am J Vet Res. 2004; 65: 1216-1222.
• 19 Stief M, Gottschalk JC, Einspanier A, Oechtering G, Böttcher P. Concentration of platelets and growth factors in canine autologous conditioned plasma. Vet Comp Orthop Traumatol. 2011; 24: 122-125.
• 20 Uhthoff HK, Loehr JW. Calcific tendinopathy of the rotator cuff: pathogenesis, diagnosis, and management. J Am Acad Orthop Sur 1997; 05 (04) 183-191.
• 21 Waselau M, Sutter WW, Genovese RL, Bertone AL. Intralesional injection of platelet-rich plasma followed by controlled exercise for treatment of midbody suspensory ligament desmitis in Standard-bred racehorses. J Am Vet Med Assoc. 2008; 232: 1515-1520.