Supraspinatus and biceps tendinopathies are very common. We see this injury in athletes who are injured during sport. We also see shoulder tendinopathies in dogs that have an injury elsewhere are are compensating in their shoulders.
If you pet has a biceps or supraspinatus tendinopathy to the shoulder we have many services that can help.
The supraspinatus is a muscle that sits on the top of the scapula and travels down to attach on the top of the humerus. The biceps is a muscle that runs from the front of the scapula down to the radius and ulna. These muscles are responsible for swinging the limb forward during gait and for slowly lowering the dog’s body to the ground when transitioning from standing to lying down.
A tendinopathy is an injury that occurs in the tendon that leads to pain, muscle atrophy (muscle wasting), mineralization of tendon, reduced range of motion of shoulder, and decreased weight bearing. Within the tendon itself, collagen fibers are disrupted, scar tissue fills in, and the tendon loses its elasticity and extensibility.
Frequently, an injury to the supraspinatus and/or biceps tendon occurs as a result of chronic, repetitive motion. An injury to one of these tendons can also occur acutely when the joint moves rapidly from one extreme range of motion to another.
Signs of a supraspinatus/biceps tendinopathy can present on a physical examination. These often include decreased shoulder range of motion, muscle atrophy, pain with stretching of the tendon, and tenderness to palpation of the tendon. The extent and severity of a supraspinatus/biceps tendinopathy can be diagnosed using musculoskeletal ultrasound. Performing a diagnostic ultrasound allows us to track the progression of the tendinopathy and ensure when the tendon is completely healed. This can be performed at Walking Paws Rehab.
Treatment of a supraspinatus/biceps tendinopathy focuses first on pain management through medications, laser therapy, massage, shockwave, electrotherapy, and heat. Ultrasound therapy is used to decrease swelling, break up mineralization, and increase blood flow to the tendon. We then focus on range of motion of the shoulder joint through passive movement with our hands and active movement with exercises.
Gradual, consistent loading of the tendon is crucial for tendon healing to occur. We load a tendon by slowly increasing weight bearing through the tendon during targeted strengthening exercises. Another crucial component of rehab for a tendinopathy is activity modification. Limiting jumping down, sprinting, or “weekend warrior” type activities.
Stem Cells and PRP can also be used to help speed up the healing of a tendinopathy. Adult regenerative stem cells are multipotent cells located in the bone marrow and fat that are capable of modulating the immune system and promote regeneration of cartilage and tendons.
If a medial shoulder instability component is suspected in conjunction with the tendinopathy, a Hobbles vest is recommended to keep the shoulder movement within the sagittal (forward and backwards) plane.
