Biceps Tendon Tenodesis in Dogs

The bicep is made up of two tendon attachments that meet at the shoulder joint. These tendons control both bending movements (flexion) and turning movements (supination). In larger breeds of dog that are used for hunting and other sports, damage to the bicep tendon is not uncommon. It can be caused by repetitive injury from jumping up onto things, and especially by hanging off of things. 

If a dog is suffering from bicep tendon damage, it will have increasing bouts of lameness. This lameness will often correspond with periods of heightened activity. The issue can be confirmed by an x-ray of the affected shoulder joint. Tenodesis is a surgical procedure to repair the damaged tendon and salvage as much natural joint movement as possible. It can be an isolated surgery or it can be combined with a shoulder repair caused by severe trauma. This operation should only be performed by an ACVS board-certified veterinary surgeon, as the technique is newer and not widely performed.

To determine if the dog is a good surgical candidate, full blood work will be run. This will show the dog's overall health condition and highlight any clotting issues that may be present. If the dog is healthy enough for the procedure, x-rays will be taken to show whether the tendon is partially or fully removed from the shoulder joint. With this information, the surgery can be planned out. 

The dog will have to fast for several hours before the surgery is performed. The joint area will be shaved and cleaned in preparation for the operation. Either one large incision or multiple portal incisions will be made, depending on whether arthroscopic surgery is being used or not. If the bicep is still partially attached to the joint, it will need to be detached. The tendon is then secured to the humerus. It is positioned further down from the shoulder joint to prevent issues later in life. It is affixed using metal inserts. The incision(s) can then be closed using sutures or staples.

The majority of dogs that receive a tenodesis make a full recovery. Complications at a year's time post-surgery are rarely reported. If the dog received this procedure combined with a larger shoulder repair operation, the recovery time may be longer and more complicated. There is a surgical alternative to a tenodesis operation called a tenotomy. This procedure is more commonly performed and heals faster, although the movement in the joint upon recovery may be limited. Non-surgical alternatives do exist, however these are rarely permanent solutions.

The dog should be closely monitored as it wakes up from the general anesthesia. Pain management can begin at this time, often starting intravenously and continuing via oral prescription. Once the dog has been discharged, you will need to keep the incision site clean and watch it closely for any signs of infection. The dog should not be allowed any off-leash activity for a minimum of two weeks after this procedure. 

A follow-up appointment will be needed 10 to 14 days after the operation to assess healing and remove the sutures from the incision. An ultrasound will be needed at four to six weeks to evaluate the success of the procedure. To promote healing with proper movement, the dog should be encouraged to walk up and down the stairs multiple times a day. Therapeutic treatments including physiotherapy and hydrotherapy can begin during the healing process to increase the range of motion in the joint. The dog should be fully recovered by 12 weeks’ time.

The overall cost of tenodesis will depend on whether it is performed arthroscopically or not. Arthroscopic surgery requires advanced equipment and extra training on the veterinarian’s part. The cost of tenodesis ranges from $1,500 to over $6,000, especially if the issue is paired with other injuries. There are non-surgical alternatives such as cross-friction massage, ultrasound therapy and steroid injections. These treatments must be ongoing to be effective, and often are not a permanent solution in saving the tendons.

The overall cost of tenodesis will depend on whether it is performed arthroscopically or not. Arthroscopic surgery requires advanced equipment and extra training on the veterinarian’s part. The cost of tenodesis ranges from $1,500 to over $6,000, especially if the issue is paired with other injuries. There are non-surgical alternatives such as cross-friction massage, ultrasound therapy, and steroid injections. These treatments must be ongoing to be effective, and often are not a permanent solution in saving the tendons.

As with all surgeries, complications can arise from the use of anesthesia, although this is rare. If arthroscopic tenodesis is used, less post-surgical complications develop. Cases of infection are also lower using the arthroscopic technique. Full incision tenodesis carries higher risk of complications, but is still widely successful. In some cases, the repair of the tendon will fail and the tendon will detach. This can happen if the dog is allowed to resume activity too quickly.  This would require further surgery. 

Dogs who are mid to old in age are more susceptible to developing tendon problems. Medium to large breeds are more prone to these issues, especially Labrador Retrievers and Rottweilers. Do not allow your dog to jump up onto fences or other objects that they may hang off of. Keep play and exercise controlled. If your dog is injured, keep its activity level low until it is fully healed. Choosing frequent, short walks may be less hard if joints than one long walk. At the first sign of tendon issues, begin therapy treatments and specific exercises​ and stretches to promote movement before the condition worsens.