Equis ISSN 2398-2977

Humerus: bicipital bursa - disease

Synonym(s): Bursa intertubercularis, bicipital bursitis

Contributor(s): Helen Herinckx, Graham Munroe

Introduction

  • Most common conditions are:
    • Septic and aseptic bursitis.
    • Tendinitis of the biceps brachii tendon.
    • Fractures of humeral tubercles.
  • Cause: often history of trauma, ie kicks/falls and/or penetration of skin.
  • Signs: acute or chronic upper forelimb lameness with decreased foot flight and anterior (cranial) phase of stride.
  • Diagnosis: intrasynovial anesthesia and centesis, ultrasonography, radiography and endoscopy can all be helpful.
  • Treatment: surgical or medical depending on specific problem.
  • Prognosis: poor to guarded depending on the chronicity and specificity of the condition.

Pathogenesis

Etiology

  • Fractures of the supraglenoid tubercle   Scapula: fracture - supraglenoid tubercle    →   an absence of tension in the biceps brachii tendon.
  • Septic bursitis:
    • Wound to cranial aspect of shoulder.
    • Brucella abortusinfection.
    • Humeral tubercle fragmentation.
  • Tendinitis of biceps brachii tendon.
  • Aseptic intertubercular bursitis.
  • Medial displacement of bicipital apparatus.
  • Enthesiopathy at the insertion of the biceps brachii tendon on the radial tuberosity.
  • Fractures/osteitis of the humeral tubercles following a kick or fall.
  • Osseous cyst-like lesion of the proximal humerus.
  • Hematoma of the intertubercular bursa.
  • Adhesions between biceps brachii tendon and surrounding structures post-trauma and/or wounds.

Pathophysiology

  • Biceps brachii (bicipital apparatus) is a complicated structure that acts as part of the forelimb passive stay apparatus and assists in forelimb protraction.
  • Originates from the supraglenoid tubercle of the scapula and distally divides into a:
    • Short tendon that inserts onto the radial tuberosity and the medial collateral ligament of the elbow.
    • Long tendon that blends with the forearm fascia and tendon of the extensor carpi radialis.
  • The upper part consists entirely of a bilobed tendonous structure which conforms to the 'M' shape of the cranial humerus.
  • Between the tendon and fibrocartilage-covered humerus is the intertubercular (bicipital) bursa which has the function of a tendon sheath.
  • The tendon is bound down to the proximal humerus by a tendonous band of the pectoralis ascendens muscle and continues distally through the biceps brachii muscle.
  • In septic bursitis due to wounds to the cranial aspect of the shoulder region signs may not occur for several weeks after the original injury.
  • Medial displacement is a rare condition that may be congenital or acquired.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Adams M N & Turner T A (1999)Endoscopy of the intertubercular bursa in horses.JAVMA214, 221-225 PubMed.
  • McDiarmid A M (1999)The equine bicipital apparatus - review of anatomy, function, diagnostic investigative techniques and clinical conditions.Equine Vet Educ11(2), 63-68 VetMedResource.
  • Oikawa M & Narama I (1998)Enthesopathy of the radial tuberosity in 2 Thoroughbred racehorses.J Comp Path118, 133-134 PubMed.
  • Vatistas N Jet al(1996)Infection of the intertubercular bursa in horses - four cases (1978-1991).JAVMA208, 1434-1437 PubMed.

Other sources of information

  • Gillis C L (1996)Biceps Brachii Tendinitis and Bicipital Bursitis.Proc AAEP42, 276-277.


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