Vonnie has been diagnosed via MRI with "proximal left bicipital tendonopathy with marginal fraying and lateral proliferative tissue". The tendon is irritated and unlikely to get better on its own, even with rest and rehab.
The non-invasive options are stem cell therapy / PRP (platelet rich plasma) or a steroid shot (this surgeon prefers depomedrol for this type of injury).
We will try the non-invasive route first, probably the depo shot as surgeon's experience is that stem cell / PRP is not very effective for this injury. We will also do rehab.
Depending on how that goes, next step could be arthroscopic surgery to sever the biceps tendon. According to the surgeon, this relieves pain and does not materially affect gait. Recovery is 4 - 6 weeks of rest, and rehab following that is recommended.
While cartilage degeneration is a known side effect of steroid shots, Vonnie is almost 10.5 and the degradation is slow enough that she wouldn't be affected in the short to mid-term.
My thinking is to give that a try, so that she is comfortable and mobile during the warmer weather, and defer surgery, if we do that at all, until winter when keeping her quiet during recovery won't be a big deal since she won't want to be out in the cold much anyway.
If anyone has experience with any of the therapies, including the surgery, I would be very grateful if you would share. Thank you!
ETA: I did do a search in H&M, most recent post on the subject is from 5 years ago. The treatment information in those threads is consistent with what I was told and one hound had a consult at Angell. Vet we saw is familiar with their work and in fact copied an article published by their staff on this subject. However, none of the posts included any experience with the surgical option.