Refractory bicipital tenosynovitis in the dog: treatment
6-year-old Rottweiler with a 3-month right forelimb lameness. Pain on shoulder flexion with the elbow extended and on palpation of the intertubercular groove. Ultrasound shows a thickened biceps tendon with effusion in the sheath, and at arthroscopy the tendon is frayed. It has not improved with 6 weeks of rest and NSAIDs.
What is the most appropriate treatment?
chevron_right Show answer and explanation
A. Continue NSAIDs and rest indefinitely, because biceps surgery leaves the shoulder unstable
Biceps tenotomy rarely causes clinically relevant instability in dogs, and prolonging a treatment that is not working maintains pain and muscle atrophy.
B. Antibiotics for 6 weeks for infectious tenosynovitis
Bicipital tenosynovitis is almost always degenerative or due to overuse, not infectious. Without evidence of infection in the synovial fluid, antibiotics are not indicated.
C. Shoulder arthrodesis
It is a salvage procedure for destroyed joints; the lesion here affects the tendon, which can be treated far less aggressively.
D. Arthroscopic biceps tenotomy (or tenodesis)
Correct. Releasing the damaged tendon eliminates the source of pain and, arthroscopically, morbidity is low. Tenodesis is an alternative. Functional outcomes are usually good to excellent.
lightbulb Key takeaway
In mild cases that do not respond to rest, a corticosteroid injection into the sheath or joint may suffice, once infection has been ruled out. Look for associated lesions that change the plan: OCD fragments in the sheath, medial instability or a thickened supraspinatus tendon compressing the biceps.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.