Guilherme F. Marques, Valerie J. Moorman, Katie L. Ellis, Michael Perlini, Veronica L. Edwards
Background
Shoulder-localized thoracic limb lameness in horses is uncommon and challenging to diagnose due to the complex anatomy of the glenohumeral region. In this case, the biceps brachii tendon and associated bicipital bursa were implicated in a chronic severe lameness associated with fractures of the intermediate and lesser tubercles of the humerus. Traditional treatments range from conservative management to open tenotomy, but minimally invasive ultrasound-guided tenotomy had not previously been described with long-term follow-up. The aim of this case report was to document such an approach and its outcome in a horse with chronic biceps pathology and tubercular fractures.
Methods
A 17-year-old Tennessee Walking Horse presented with 8 weeks of severe left forelimb lameness. Radiographs revealed bone loss at the greater tubercle, cortical lysis in the bicipital groove, and fractures of the intermediate and lesser tubercles. Ultrasound showed biceps brachii tendinopathy and bicipital bursitis. After unsuccessful conservative management, a standing, ultrasound-guided minimally invasive biceps brachii tenotomy was performed under sedation and local anesthesia. A small vertical incision was created, and a bistoury knife was advanced under continuous ultrasound guidance to transect the tendon. Postoperative care included analgesics, topical therapy, stall rest, physiotherapy, and periodic corticosteroid injections. Follow-up imaging was performed at 8 and 21 months.
Results
The horse demonstrated immediate improvement in lameness following tenotomy, with an increased cranial phase of stride and ability to extend the limb. No incisional complications occurred, and the horse was discharged on day 4. Initial postoperative lameness improved progressively, though intermittent exacerbations at 4 and 8 months required local corticosteroid injections and continued analgesia. At 8 months, ultrasound revealed a persistent core lesion and heterogeneous tendon structure, but by 21 months the tendon appeared smaller with improved fiber organization. At final evaluation, the horse was pasture sound, comfortable, and off medications.
Limitations
As a single case report, generalizability is limited. Additional diagnostics such as repeated ultrasound, regional anesthesia, bicipital bursoscopy, or radiographic follow-up could have strengthened assessment but were restricted by financial constraints. The long-term contribution of surgical technique versus ongoing rehabilitation and medical management cannot be fully separated.
Conclusions
This case demonstrates that a standing, ultrasound-guided, minimally invasive biceps brachii tenotomy can be successfully performed with rapid clinical improvement and no immediate complications. The approach allowed effective treatment of chronic tendinopathy and associated bony injuries while avoiding the morbidity of open procedures. With appropriate postoperative management, long-term pasture soundness was achieved.
Illustration of the local anatomy related to the ultrasound-guided surgical approach. (A) Musculature over the shoulderregion in the region of the surgical approach include combined brachiocephalicus and omotransversarius (1), which have been madetransparent to show the underlying supraspinatus muscle (2), and biceps brachii tendon (3). (B) Location of the spinal needle through thecombined brachiocephalicus/omotransversarius and supraspinatus muscles transversing under the biceps brachii tendon, as well as thelocation of the surgical incision (dashed blue line) cranial to the supraspinatus muscle
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