Ultrasound-guided, minimally invasive, biceps brachii tenotomy in a standing horse.

Overview

• This research article reports the successful long-term outcome of performing a minimally invasive, ultrasound-guided tenotomy of the biceps brachii tendon in a standing horse with chronic shoulder lameness.
• The procedure led to rapid improvement in lameness and sustained pasture soundness without complications.

Background and Problem Description

• The subject was a 17-year-old Tennessee Walking Horse gelding presenting with chronic, severe lameness localized to the left shoulder region.
• Diagnostic imaging revealed multiple shoulder issues:
  • Fractures of the intermediate and lesser tubercles of the left humerus
  • Tendinopathy of the biceps brachii muscle (BB tendon)
  • Bicipital bursitis (inflammation of the biceps tendon sheath/bursa)
• The lameness was refractory to conservative management, prompting consideration of surgical intervention.

Methods and Surgical Procedure

• The chosen surgical approach was a minimally invasive tenotomy (cutting of the tendon) of the biceps brachii tendon.
• This procedure was performed while the horse was standing, utilizing:
  • Ultrasound guidance to precisely locate the target structures and aid in minimizing tissue trauma
  • Sedation for standing restraint
  • Local anesthesia to manage procedural pain
• The use of ultrasound guidance represents a modern, less invasive method compared to traditional open surgery.

Post-operative Care

• Following surgery, the horse received:
  • Systemic pain management: likely medications to manage inflammation and discomfort
  • Local pain management: possibly injections or topical therapies to control localized pain
  • Physiotherapy exercises: structured movements to support muscle recovery and function
  • Periodic local corticosteroid injections: to control inflammation in the region and support healing

Results and Outcomes

• The procedure resulted in a substantial and immediate improvement in the horse’s lameness.
• There were no incisional complications, likely due to the minimally invasive approach.
• Long-term follow-up (21 months post-surgery) showed that the horse remained pasture sound, indicating sustained functional improvement.
• These results suggest that ultrasound-guided, minimally invasive tenotomy can be an effective treatment for chronic biceps brachii tendon injury in horses.

Significance and Conclusions

• The study describes a cutting-edge technique allowing surgical intervention in standing horses, avoiding general anesthesia and open surgery risks.
• The ultrasound-guided method enables precise targeting, reducing tissue trauma and recovery time.
• Successful handling and absence of complications demonstrate the technique’s practicality and safety.
• This case supports the use of minimally invasive biceps brachii tenotomy as a viable and effective treatment for chronic shoulder lameness related to biceps tendinopathy and associated injuries in horses.