Bicepital Tenosynovitis

[XTRAWLD]

Experience?

 

Ryder had x-rays today while going under for a dental. I wanted to rule out anything major (specifically bone wise) before beginning a course of treatment for his intermittent lameness.

 

Left side shoulder - she has not noticed any bone issues, however, what the x-rays shows is something called Bicepetal Tenosynovitis = inflammed muscles.

 

This corroborates the feeling that chiro really helps him, and that it's more of a muscular issue and not bone. To that end, she recommends an inflammatory to help him, however she suggested to start with an injection of Cartrophen and see how he responds. From what I read it's a spaced out treatment of 4 subcutaneous injections generally performed annually. I shall ask for further confirmation and pricing.

 

I also suggested perhaps using a muscle relaxant as I explored the potential use of Robaxin a couple years ago, which she has admitted she has used, but isn't sure how well he would respond to it.

 

The only other options would be NSAIDs, Metacamm, Deramaxx, etc. I suggested to let it sit with me to mull over for a few days, which is my cue to ask the wise on GT!

 

I think he would benefit from some relief, but I feel Cartrophen (after reading about it) and Metacamm are too "strong" to use? I'm not sure how to proceed. Anyone have experience treating this? Is it common/normal in greys? He's limped all his life!

 

Edited to add - she did say she could send them to a radiologist to confirm. At this point I refused, since I think based on what I know and I agree and am satisfied with her diagnosis, there isn't really much reason to send them along for a second opinion. What do you guys think? I have the greyhound savvy vet up the street that would review them for a second opinion (not a radiologist). I'm not sure there is a reason to send them to Couto.

Edited February 19, 2016 by XTRAWLD

[dante2zoe]

Goose was just diagnosed with a muscle strain of the muscle that is between the shoulder blades. You can physically feel it spasming. Anyway, he received an accupuncture treatment and will be on Previcox and Robaxin for a week. Accupuncture will continue weekly for several weeks. Hope your sweetie feels better soon!

[krissy]

Generally Cartrophen is given as an initial series of 4 injections at 7 day intervals, followed by injections every 1-3 months depending on the dog. It has some anti-inflammatory effects and is most commonly used for joint issues (i.e. arthritis), however it is sometimes utilized for anti-inflammatory action in other situations (I've used it for cats with urinary issues for example). It's worth giving a try as there are few contraindications for it.

[XTRAWLD]

Upon discharge, there is a note here that they ordered something called Onsior (Robenacoxib). I was told to come back and pick it up on Monday. Whatsat?

[ramonaghan]

You've been so helpful and supportive through my trials with Sweep, I wish I could repay the favor and offer some advice, but I'm no help here. (I will say if you go the NSAID route, my vets have said Previcox is thought to be gentler on the kidneys/liver than some of the other options, and it's been the best fit for Sweep in terms of effectiveness without side effects...but every dog is different, of course.) I'm wishing you and Ryder well and glad you have an answer!

[krissy]

Upon discharge, there is a note here that they ordered something called Onsior (Robenacoxib). I was told to come back and pick it up on Monday. Whatsat?

 

It's an NSAID, like Metacam or Rimadyl or Deramaxx. It helps with pain through its anti-inflammatory properties.

[XTRAWLD]

Thanks Krissy. Is it a reasonable med? What I mean by that is it a mild pain reliever? Is it heavy on kidneys, etc. moreso than above mentioned Previcox? Should i expect him to remain on this for a while? Is it usually reasonably priced? (I didn't get the full details when I picked him up, but I trust the vet after our intense discussion when she called in the afternoon giving me the update.)

Edited February 20, 2016 by XTRAWLD

[krissy]

Thanks Krissy. Is it a reasonable med? What I mean by that is it a mild pain reliever? Is it heavy on kidneys, etc. moreso than above mentioned Previcox? Should i expect him to remain on this for a while? Is it usually reasonably priced? (I didn't get the full details when I picked him up, but I trust the vet after our intense discussion when she called in the afternoon giving me the update.)

 

The reality is that opinions are mixed on the research that is out there on NSAIDs. Some say that COX-1 vs COX-2 selectivity is very important, but there is research out there that suggests it's not that simple. The reality is that ALL of them have the potential for side effects, and none have really been demonstrated to have better efficacy than any other. My general finding is that each individual reacts differently to different drugs. I have "favourites", but it's not really because I've had better effects with them than others. NSAIDs demand respect and responsible use - give the right dose, at the right time, for the prescribed duration of time, and stop if there is any sign of an adverse reaction.

 

Onsior is a good drug - I've used it, I haven't had any significant problems with it, and clients have liked it (i.e. it seems to work well and is easy to give). How long he needs it depends on how well he heals, and how much activity he will be doing later.

[XTRAWLD]

Thanks for your input Krissy. I picked up the meds and had a quick breakdown of his exact problem and how the drug will help. We will try for a week (1 40mg tablet every 24hrs) to assess the efficacy. If it makes a difference we can go onto a lower dose or alternating schedule. Because I will be out of town for a few days and I'd prefer to monitor and assess myself, I will not start him on this until next Saturday (the next time I'll be home with him for a weekend). She did warn me about potential effects on liver/kidneys but we wont have much concern about that for this initial week period. I'm just concerned about any ongoing need but she did reassure me that it is one of the safer meds to use.

 

I was also able to view his x-rays, where she pointed out a little dot on his shoulder where the muscle meets the bone. Its so minor she can't even say for certain if thats where his issue really is, but given that he's limping on that leg, its as sure of a diagnosis as any. What gets me is he's been limping off and on like this his whole life. Could he really have developed inflammation 5 years ago that never went away and just progressed like this?

[XTRAWLD]

Ryder has been on Onsior for his one week trial. I thought it may have been helping but yesterday he was limping just the same as before. Now which road do I go down on? As I suspected, I don't think it's a bone thing, it's a muscle thing. What meds would work better on inflamed muscles? Is it worth asking the x-rays be passed along to an Oncologist? If it's a muscle thing though, I'm not sure there is much to see.

Edited March 10, 2016 by XTRAWLD

[krissy]

NSAIDs are your best bet for inflammation, so if the Onsior isn't working but you still think it's a muscle issue then you could try washing out for 7 days and then starting a different NSAID. Every dog is an individual and they all have slightly different responses to different drugs; sometimes one works better than another. Strict rest is also vitally important. If you pull a muscle, cover it up with pain killers and keep using it, it'll never heal. If he's still been going for walks, running, or jumping on and off furniture I would immediately restrict him for 7-10 days and see if any improvement.

 

If not and you still think muscle then laser and massage would be next on my list.

 

If there's any consideration for a bone or joint issue then I'd get the x-rays done.

 

Edit: Sorry, I forgot he had x-rays done already. You can either retake them on the off chance that something as progressed in the past few weeks, or ask them to be passed on to a radiologist for an expert eye.

Edited March 11, 2016 by krissy

[krissn333]

Krissy beat me to it...if he were my dog I'd be doing massage and cold laser therapy. Physical therapy maybe once the inflammation is calmed down so that you minimize the risk of re-injury.

[PatricksMom]

Leo has this, recently diagnosed. We're working with a rehab vet, so we're doing physical therapy at home, massage and stretching at home, and massage, stretching, & cold laser therapy at the vet's office. We also have Meloxicam as needed, but we've basically stopped since staring physical therapy (we were using it every day). So far (1 week) we're seeing a lot of improvement.

[XTRAWLD]

Thanks. The issue here is that I cannot take him to regular therapy appointments which is why I must resort to meds. Chiro works but I can't take him regularly.

[PatricksMom]

Thanks. The issue here is that I cannot take him to regular therapy appointments which is why I must resort to meds. Chiro works but I can't take him regularly.

I was thinking if you could get him there once, you could learn the exercises and stretching to do at home. I think that's what's really causing Leo's progress, I'm not convinced the cold laser is helping that much.

[XTRAWLD]

Brought Ry home from pupcare (where he stood and walked around for 4 hours). I went to school (he slept the whole time). Came home. He did not greet me at the door. I walked in and he was standing but hunched in a curl. He walked a few paces to me and decided instead to lay down. It took me about 10 mins to convince him to get up again so I could loosen up those muscles. His muscles quivered at my touch and I'm certain he was having a muscle spasm, sort of like when you just move the wrong way and you've tweaked your back. I got him up and moving and then called the vet. She has RobaxIN in stock as I pretty much told her that's what I want to try at this point.

I don't know what else to do. My schedule at school is winding down for the term so I can take him to chiro again starting next month, but both the meds and limited visits are short fixes.

[cleptogrey]

This sounds ver similar to what we went through with Annie last april.the bundle of muscles /tendons that wraps from the shoulder (front) to spine were joined to the shoulder, 2 calcification points (the size of molars)developed. A sudden jump and she was in remarkable pain. The pain resulted in screaming if she moved. The course of treatment was metacam, tramadol and gabapentin. We did liver workup before and a couple of months down the road. Months if crate rest and slow rehab worked we avoid d the 3.5k surgery to remove the calcification. A year later,some pain,but she's running and walking 20 miles a week and I can't find the points. This was the result of an injury many years ago.it may take a couple of days for your dogs meds to kick in,but crate rest,no activity was essential.

Edited March 25, 2016 by cleptogrey

[cleptogrey]

This sounds ver similar to what we went through with Annie last april. At the supraspintuis muscle that wraps from the shoulder to spine were joined to the shoulder, 2 calcification points (the size of molars)developed. A sudden jump and she was in remarkable pain. The pain resulted in screaming if she moved. The course of treatment was metacam, tramadol and gabapentin. We did liver workup before and a couple of months down the road. Months if crate rest and slow rehab worked we avoid d the 3.5k surgery to remove the calcification. A year later,some pain,but she's running and walking 20 miles a week and I can't find the points. This was the result of an injury many years ago.