Biceps tendon issues - experiences?

[Rickiesmom]

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.

Edited June 12, 2019 by Rickiesmom

[cleptogrey]

fingers crossed that the steroids do the trick and rehab sounds greyt. have you gone for a second opinion, is this an ortho specialist conclusion? just curious, it may not be necessary. best of luck.

[Rickiesmom]

Thank you for the well wishes, I agree about hoping the steroid/rehab combination works.   I didn't mention it explicitly above, but Vonnie's lameness is in the left front.

We saw an orthopedic specialist / surgeon with an excellent reputation and, bonus, greyhound experience.  We were referred by the neuro specialist at the same hospital, whose MRI ruled out cervical disc causes, as well as osteo and nerve sheath tumour, but did observe the biceps tendon issue, along with a couple of related things.  The MRI was interpreted by a radiology specialist so I think the bases are pretty well covered.

[NeylasMom]

We considered PRP for Violet's Achilles tendon injury, but in the end, her ultrasound revealed multiple small tears in two of the three tendons, which didn't make her a good candidate (versus a larger tear where they could inject the PRP). We opted for PT and she recovered well. 

So while I didn't do it, I will say that my ortho felt strongly that PRP was a better choice than stem cells, at least for this injury (but I think he meant in general). 

I wonder if the "marginal" tearing is what makes the PRP the lesser option. Sounds similar to our situation. I would have tried the PRP if it was likely to help.

Keep us posted. I'll be interested to hear how things go. Hopefully well!

Going to see if this link works:

https://www.google.com/url?sa=t&source=web&rct=j&url=http://vosm.com/upload/articles/PRPfinal.pdf&ved=2ahUKEwjo-pfPqOXiAhUrT98KHXfvAGwQFjAKegQIAxAB&usg=AOvVaw0bOpJRA9c9XYRv2UuBhtya

Edited June 13, 2019 by NeylasMom