Bicipital Bursa Research Articles

Septic inflammation of the bicipital bursa: clinical, imaging, and surgical findings in nine horses.

To describe the etiologies, clinicopathologic findings, diagnostic modalities employed, treatments, and outcome associated with cases of septic bicipital bursitis. 9 horses. Medical records of horses diagnosed with septic bicipital bursitis between 2000 and 2021 were reviewed. Horses were included if synoviocentesis of the bicipital bursa revealed a total nucleated cell count of ≥ 20,000 cells/µL with a neutrophil proportion of ≥ 80%, a total protein concentration of ≥ 4.0 g/dL, and/or the presence of bacteria on cytology, or positive culture of the synovial fluid. Information retrieved from medical records included signalment, history, clinicopathologic variables, diagnostic imaging findings, treatment, and outcome. Trauma was the most common inciting cause (n = 6). Synoviocentesis using ultrasonographic guidance was performed in all cases and showed alterations consistent with septic synovitis. Radiography identified pathology in 5 horses, whereas ultrasonography identified pathology in all horses. Treatment consisted of bursoscopy (n = 6) of the bicipital bursa of which 1 was performed under standing sedation, through-and-through needle lavage (3), bursotomy (2), or medical management alone (2). Five (55.6%) horses survived to discharge. Long-term follow-up was available for 3 horses and all were serviceably sound, with 2 in training as pleasure horses and 1 case continuing retirement. Ultrasonography was the most informative imaging modality and paramount in obtaining synovial fluid samples for definitive diagnosis of septic bicipital bursitis. Bursoscopy performed under standing sedation is a feasible treatment option. Horses treated for bicipital septic bursitis have a fair prognosis for survival and may return to some level of athletic performance.

A study of the shoulder and elbow joints of the donkey (Equus asinus) by gross anatomical dissection, radiography, computed tomography, and intra-articular injection

Joint diseases often represent the major part of equine clinician's caseloads. The current study aimed to document the normal anatomy of the donkey shoulder and elbow joints using computed tomography, cadaver sections, and radiography. Seven adult donkeys were used in this study. The current study proved there were no pouches of the donkey shoulder joint. Communication between the joint capsule and bicipital bursa was observed only in two limbs of four used in the present work. The joint was without pericapsular ligaments. The glenohumeral ligament was identified by the thickening of the articular capsule cranially. The shoulder joint approach for intra-articular injection is located on the lateral aspect corresponding to the humerus greater tubercle. The elbow joint capsule is attached to the margins of the articular surfaces of the humerus, radius, and ulna bones. It was thick on the cranial surface of the joint but became thinner caudally. The joint capsule of the elbow joint formed a single pouch cranially and three pouches caudally. The joint had medial and lateral collateral ligaments. The current study recorded that the lateral collateral ligament of the donkey elbow joint was not divided as in the horse, only the medial collateral ligament was divided into two parts; the long cranial and short caudal part. Elbow joint approach for intra-articular injection was in the cranial pouch on the cranial border of the lateral collateral ligament. The data collected within this study will be useful as a normal reference for donkey practitioners.

Biceps, Brachialis, and Triceps.

Tendon injuries at the elbow affect mostly the distal biceps and can progressively degenerate over time or rupture in an acute event. The degree of retraction may depend on the integrity of the lacertus fibrosus, a fibrous expansion that merges with the forearm flexor fascia. Biceps disorders are frequently associated with fluid or synovitis of the adjacent bicipital bursa; primary bursal disorders (primary inflammatory synovitis) can also be observed. Distal triceps is less frequently injured than the distal biceps, and tears usually manifest as distal ruptures with avulsion of a small flake of bone from the tip of the olecranon. Brachialis injuries are uncommon and the consequence of sudden muscle stretching during forced elbow hyperextension, as in posterior elbow luxation.

Needle Arthroscopy of the Scapulohumeral Joint and Bicipital BURSA in Horses: An Ex Vivo Study

To evaluate the feasibility of performing needle arthroscopy of the scapulohumeral joint and bicipital bursa in standing horses by using the thoracic limbs of euthanized horses. To that purpose, this experimental study was designed. Ten thoracic limbs, five left and five right from euthanized horses were retained in an upright position to simulate a standing horse. The craniolateral and lateral scapulohumeral arthroscopic portals were used to access the articular structures. A third (caudal) portal was also identified and described. The degree of difficulty in accessing the articular space and the optic maneuverability within the joint were compared between portals. The needle arthroscopy image lacks in quality, but the procedure was considered useful as a diagnostic aid for examination of the scapulohumeral joint of horses. Needle arthroscopy of the bicipital bursa was not possible. Needle arthroscopy has a great diagnostic potential for lesions in the scapulohumeral joint of horses. A new access (caudal) to the scapulohumeral joint of horses has been identified.

Standing biceps brachii tenectomy to treat chronic bicipital tendinopathy associated with bursal fibrosis and humeral adhesions in a Quarter Horse gelding

SummaryChronic biceps brachii (BB) tendinopathy is a rare cause of lameness in horses that can be challenging to diagnose and treat successfully. This pathology is typically insidious in onset and unresponsive to conservative treatment. A 12‐year‐old Quarter Horse gelding presented for chronic severe lameness of the left forelimb that was localised to the left shoulder area. The horse was unresponsive to conservative management and surgical exploration revealed a grossly enlarged proximal BB tendon, a thickened fibrotic bicipital bursa and adhesions between the tendon, humerus and bursa. With standing sedation and local anaesthesia, the adhesions were debrided and 10 cm of the affected tendon was excised. Immediately post‐operatively, the left forelimb lameness dramatically decreased. The horse recovered well and after rehabilitation returned to the previous level of athletic performance without evidence of lameness or gait abnormality. In this case, tenectomy of the chronic unresponsive BB tendinopathy, with associated bursal fibrosis and humeral adhesions, was successful and resulted in a return to previous athletic performance without complications. Standing excision of the BB tendon may be a viable treatment option for chronic BB tendinopathy and associated conditions when there is significant compromise to the integrity of the BB tendon.

7-T clinical MRI of the shoulder in patients with suspected lesions of the rotator cuff

BackgroundTo evaluate feasibility and diagnostic performance of clinical 7-T magnetic resonance imaging (MRI) of the shoulder.MethodsEight patients with suspected lesions of the rotator cuff underwent 7-T MRI before arthroscopy. Image quality was scored for artifacts, B1+ inhomogeneities, and assessability of anatomical structures. A structured radiological report was compared to arthroscopy. In four patients, a visual comparison with pre-existing 1.5-T examinations was performed.ResultsRegarding image quality, the majority of the sequences reached values above the middle of each scoring scale. Fat-saturated proton density sequences showed least artifacts and best structure assessability. The most homogenous B1+ field was reached with gradient-echo sequences. Arthroscopy did not confirm tendinopathy/partial tear of supraspinatus in 5/8 patients, of subscapularis in 5/6, and of infraspinatus in one patient; only a partial lesion of the subscapularis tendon was missed. Pathologic findings of long bicipital tendon, acromioclavicular joint, glenohumeral cartilage, labrum, and subacromial subdeltoideal bursa were mainly confirmed; exceptions were one lesion of the long bicipital tendon, one subacromial bursitis, and one superior glenoid labrum anterior-to-posterior lesion, missed on 7-T MRI. Evaluating all structures together, sensitivity was 86%, and specificity 74%. A better contrast and higher image resolution was noted in comparison to previous 1.5-T examinations.Conclusions7-T MRI of the shoulder with diagnostic image quality is feasible. Overrating of tendon signal alterations was the main limitation. Although the diagnostic performance did not reach the current results of 3-T MRI, our study marks the way to implement clinical 7-T MRI of the shoulder.

Development of a Novel Medial Synoviocentesis Approach to the Bicipital Bursa in an Equine Cadaver Model.

To describe the volume and dimensions of the bicipital bursa and its position in relation to bony and soft tissue structures, in order to develop a novel medial synoviocentesis approach to the bicipital bursa. Cadaveric study. Adult equine cadaver limbs (n=19). Bicipital bursa dimensions, volume, and relationship to bony structures were obtained from positive contrast computed tomography images after distension of the bursa (n=7). Following an intra-bursal injection of polyurethane resin, the bicipital bursa (n=4) was dissected and its relationship to soft tissue structures described. After computed tomography and dissection, a novel medial bicipital bursocentesis approach was investigated on intact cadavers (n=8). Median (range) of measurements were: length 9.02 cm (8.48-9.45 cm); width 7.06 cm (6.71-8.01 cm); and volume 51 mL (45-58 mL). The medial aspect of the bicipital bursa was located at the junction of the subclavius and biceps muscles, which corresponds with the externally visible lateral pectoral sulcus. Needle insertion 5-10 mm craniolateral to the center of the lateral pectoral sulcus midway between the palpable distal aspect of the deltoid tuberosity and the cranial part of the greater tubercle was found to be a reliable landmark for the novel medial bursocentesis approach. This approach was successful in all cadavers. The novel approach to the bicipital bursa provided access to the medial aspect of the bursa and is an alternative to the lateral approaches. Further validation in live horses is warranted to establish the safety and efficacy of this technique.

Extension of the scapulohumeral joint increases the likelihood of success of centesis of the bursa of the biceps brachii tendon of horses

SummaryThe accuracy of a technique for centesis of the bicipital bursa using a 9 cm, spinal needle inserted through the tendon of the biceps brachii muscle was evaluated. A veterinary radiologist who had no previous experience of performing centesis of the bicipital bursa and an equine clinician who had little experience in performing the procedure, attempted to inject a solution of aqueous radiopaque contrast medium into the bicipital bursae of 8 horses using an approach in which the bursa was accessed by directing a needle through the tendon of origin of the biceps brachii muscle until cartilage in the lateral portion of the intertubercular groove was contacted. Centesis of the bicipital bursa using this approach in horses having no signs of disease of the bursa was consistently successful if the cubital joint was flexed and the scapulohumoral joint extended.

Comparison of ultrasound‐guided vs. ‘blind’ techniques for intra‐synovial injections of the shoulder area in horses: Scapulohumeral joint, bicipital and infraspinatus bursae

Diagnosis and treatment of pathologies involving synovial structures in the shoulder region are technically difficult. Ultrasound-guided (UG) injection techniques have been shown to be highly accurate, safe and reliable for various structures in human and equine patients. To develop easy-to-use and reliable UG injection techniques for the infraspinatus bursa (IB), bicipital bursa (BB) and scapulohumeral joint (SHJ) and to compare them with conventional 'blind' methods. Eight pairs of equine shoulders were positioned on a computed-tomography (CT) table with left and right shoulders randomly assigned to Operator A (UG) and Operator B ('blind'). Contrast medium mixed with methylene blue was injected into the target structures. Time and number of attempts for correct needle placement and ease of injection were recorded. A CT scan of each shoulder was performed after every injection to evaluate the location of contrast material. Once injections and CT scans were completed, anatomic dissections were conducted. Statistical analysis was used to compare UG and 'blind' techniques with significance set at P<0.05. Intra-synovial injections using UG techniques were successful in all 24 synovial structures compared with 14/24 with conventional methods. The median number and range of needle repositioning to obtain accurate needle placement was 1 (1-2) for UG and 2 (1-4) for the 'blind' techniques. The median time and range required for accurate needle placement was 75.5 s (32-210 s) for UG and 43.5 s (11-140) for 'blind' technique. In 31% of all attempts, ease of injection was not indicative of successful intra-synovial administration. Ultrasound-guided injections of IB, BB and SHJ proved to be highly reliable and more accurate than conventional 'blind' techniques. Ultrasound-guided injection techniques may be of great help for equine practitioners in the diagnosis and treatment of pathologies involving synovial structures in the shoulder region. Further work is needed to confirm these results in clinical cases.

Osseous cyst‐like lesions of the lateral intertubercular groove of the proximal humerus: A report of 5 cases

SummaryThis report documents the case presentation, evaluation, treatment and outcome of 5 horses with an osseous cystlike lesion (OCLL) of the intertubercular groove of the proximal aspect of the humerus. In 3 of the 5 cases, delayed phase gamma scintigraphic findings demonstrated increased radiopharmaceutical uptake in the region of the intermediate tubercle of the proximal humerus of the affected limb, demonstrating increased bone remodelling in this region. In 4 of the 5 horses, an OCLL was identified in the intermediate tubercle of the proximal humerus, and in one horse the OCLL was identified in the greater tubercle. Medial‐lateral and craniomedial‐caudolateral oblique radiographic views were helpful to see the lesions in all cases. Ultrasonography confirmed the location of the subchondral and fibrocartilage defect associated with the OCLL and confirmed communication of the cyst with the lateral intertubercular groove of the humerus in 3 of the 5 cases. Ultrasonography also confirmed a variable degree of bicipital tendonitis in 3 of the horses. OCLL of the lateral intertubercular groove of the proximal humerus should be considered in the evaluation of any mature horse with lameness isolated to the bicipital bursa. Development of these OCLL may be a result of trauma or altered limb biomechanics as a result of shoulder osteoarthritis or concurrent chronic lameness, which leads to disruption or thinning of the fibrocartilage, remodelling of the subchondral bone and subsequent cyst development.

Comparison of 2 methods of centesis of the bursa of thebiceps brachiitendon of horses

Centesis of the bicipital bursa using an 8.9 cm long spinal needle has been reported but the alternative of employing a 3.8 cm long hypodermic needle requires validation. To compare the efficacy of 2 different methods of centesis of the bicipital bursa and to evaluate the usefulness of ultrasonographic imaging to determine the location of solution administered when centesis of the bursa is attempted. For Trial 1, 6 clinicians, who had no previous experience of centesis of the bicipital bursa, attempted to inject a solution composed of an aqueous radiopaque contrast medium and physiological saline solution (PSS) into the bicipital bursae of 2/12 horses using the previously described distal approach to inject one bursa and a proximal approach to inject the contralateral bursa. The bicipital tendon and bursa were examined ultrasonographically before and after injection; and both shoulders were examined radiographically to identify the location of the medium. In Trial 2, another 6 clinicians, also with no previous experience of centesis, repeated Trial 1, using 6 horses, but the radiopaque contrast medium was mixed with air instead of PSS. Accuracy of centesis using the proximal approach was 39% and that of the distal approach 28%. Ultrasonographic examination of the shoulder allowed the location of solution and air to be accurately predicted in all 12 shoulders examined. Clinicians who have had no previous experience performing centesis of the bicipital bursa are unlikely to be successful in centesis using either approach. Radiographic examination after injecting a radiopaque contrast medium may be necessary to assess the success of centesis especially if bursal fluid is not obtained during centesis. Injecting air along with the radiopaque contrast medium provides more accurate ultrasonographic confirmation of centesis and better radiographic definition than does injection without air.

Intra-articular analgesia of the equine shoulder joint

ANATOMY The shoulder joint is a relatively capacious cavity between the glenoid cavity of the scapula and the head of the humerus. The shoulder joint can be located by palpating down the spine of the scapula towards the ‘point of the shoulder’ that comprises the cranial division of the greater tubercle of the humerus1. Both cranial and caudal parts of the greater tubercle can be palpated and with firm digital pressure a notch between the two can be detected forming the site for arthrocentesis. Arthrocentesis necessitates insertion of a needle through the cutaneous omobrachialis and cleidobrachialis muscles. Communication between the shoulder joint and the bicipital bursa has been reported1.

Ultrasonographic examination of important aspects of the bovine shoulder – physiological findings

The left and right shoulder region of 19 healthy cattle and the left and right shoulders of six bovine cadavers were examined ultrasonographically using a 7.5 MHz linear and a 3.5 MHz convex transducer. The lateral shoulder muscles were successfully imaged in all cases; the joint space appeared as a funnel shaped interruption of the hyperechoic bone surfaces of the distal part of the scapula and the proximal and lateral part of the humeral head. In healthy cattle, the synovial cavities of the scapulohumeral joint, the bicipital bursa and the infraspinous bursa could not be clearly defined. After experimental filling with water, the synovial cavities could be differentiated as discrete anechoic zones. In this study, the normal ultrasonographic appearance of the soft tissue structures and bone surfaces of the scapula and proximal humerus is presented, providing basic reference data for the ultrasonographic evaluation of the bovine shoulder region.

Lameness associated with the bicipital bursa in an Arab stallion

Severe, chronic lameness in the left forelimb of a five-year-old Arab stallion was localised to the bicipital bursa by local anaesthesia and gamma scintigraphy. Radiographic and ultrasonographic examinations of the...

Infection of the intertubercular bursa in horses: four cases (1978-1991)

Objective To determine the clinical outcome of horses treated for infection of the intertubercular bursa (infectious bicipital bursitis). Design Retrospective analysis of case records. Animals Four horses referred for treatment of infectious bicipital bursitis. Procedure Medical records of horses that were severely lame on admission were reviewed. Results In 3 horses, palpation over the bicipital bursa as well as flexion and extension of the scapulohumeral joint were resented. Ultrasonography performed in 1 horse revealed that the bicipital bursa was large and that excessive amounts of fluid containing hyperechoic material were evident within the bicipital bursa. Two horses were treated by the administration of antimicrobial and nonsteroidal antiinflammatory drugs. Both remained lame and failed to resume their former activity. Two horses additionally were treated surgically by means of a partial synovectomy. Both resumed their former activity although a subtle lameness remained in 1 horse. Clinical Implications Partial synovectomy may be useful in the treatment of horses with infectious bicipital bursitis. (J Am Vet Med Assoc 1996;208:1434-1437)

Posterior interosseous nerve compression due to an enlarged bicipital bursa confirmed by MRI

Posterior interosseous nerve compression is a well-described clinical entity with many aetiologies. Fewer than 12 documented cases of the condition due to an enlarged bicipital bursa exist in the literature. We describe a case in which magnetic resonance imaging (MRI) was used in the preoperative assessment of a mass in the proximal forearm with a clinical diagnosis of partial posterior interosseous nerve compression.

Posterior Interosseous Nerve Syndrome Caused by a Bursa in the Vicinity of the Elbow

A case of posterior interosseous nerve syndrome presented with difficulty in extending the metacarpophalangeal joint of the little finger. Compression was caused by a bicipital bursa. Surgical decompression led to a complete recovery.

Posterior interosseous nerve syndrome caused by a bursa in the vicinity of the elbow

A case of posterior interosseous nerve syndrome presented with difficulty in extending the metacarpophalangeal joint of the little finger. Compression was caused by a bicipital bursa. Surgical decompression led to a complete recovery.