Surgical management and follow-up of triceps tendon avulsion after repeated local infiltration of steroids: two cases

Abstract

Disruption of the triceps tendon insertion is an uncommon injury, with only a few reports of traumatic triceps tendon avulsion in dogs or cats present in the veterinary literature. Although this injury has been previously described in two dogs that had received a local injection of corticosteroids for the treatment of soft tissue injuries, reports with long term clinical follow-up and outcome in working dogs are lacking. This report describes two surgically treated cases of complete triceps tendon avulsion rupture in Malinois police dogs. These two dogs had a history of repeated local infiltration of a corticosteroid preparation used to treat adventitial bursitis. The clinical features, surgical treatment, long-term management and outcome are reported. A modified triple locking loop pattern was used to suture the tendons. The long-term outcome was considered excellent with both dogs resuming work. Although it is an uncommon condition in small animals, avulsion of the triceps tendon should remain on the differential diagnosis list for acute onset forelimb lameness, particularly if there is a history of local infiltration with corticosteroids. The diagnosis should be based on clinical, radiographic and ultrasonographic examination.

Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003–2014)

“…Imaging features of a chronic tendinopathy has been identiied in previous reports. [3][4][5][6][7][8][9] Two of our six cases had radiographic evidence of mineralisation but no reported previous problem or chronic lameness. Mineralised opacities are likely to occur through dystrophic calciication stimulated by previous or repetitive trauma with disturbance of the tendon blood supply.…”

“…The available data are also not appropriate to demonstrate a clear advantage of one method of immobilisation over the other, but there seems to be a tendency to use spica splints in cats and a TAESF in dogs for three to eight weeks. Custom-made orthotic braces, as used in one recent case report may ofer a viable alternative, 9 but more data would be needed to conirm this.…”

“…To date, 11 cases (2 cats, 9 dogs) of triceps tendon rupture and/or avulsion have been reported in the veterinary literature. [3][4][5][6][7][8][9][10] A further case report was in fact a cat with an olecranon avulsion fracture. 4 Previous historical indings have been acute trauma, corticosteroid treatment or chronic lameness.…”

“…Mineralisation in the region of the triceps tendon attachment has been seen on radiographs and ultrasound in eight cases. [3][4][5][6][7][8][9] MRI indings have been reported in two cases. 8 10 Surgical repair is performed mostly with modiied tendon suture patterns passed through bone tunnels.…”

Triceps tendon avulsion in a cat

“…1 Case reports in dogs and humans have also documented non-traumatic causes for tendon avulsion after an intra-articular or local infiltration of corticosteroids. 6,7 The diagnosis of a triceps tendon avulsion has historically been based on a combination of orthopaedic examination and subsequent radiography. 3 The use of computed tomography (CT) for the evaluation of a triceps tendon avulsion has not been described in either cats or dogs, although two case reports have described magnetic resonance imaging (MRI) findings in dogs.…”