- Tendon Injury in Dogs for Patient Owners
- Tendon injuries in dogs for veterinary professionals
- Clinical Examination - Tendon Injury in Dogs
- Diagnosis of tendon injuries in dogs
- Treatment & Long-Term Management
- forecast
- discussion
- Treating tendon injuries in dogs
- Common questions about tendon injuries in dogs
- diagnosis
- Treatment & Long-Term Management
- Conclusion
Tendon Injury in Dogs for Patient Owners
Your dog has strained or injured a tendon in the front leg area. Such an injury can occur when dogs e.g. B. are very active in sports (hunting, agility, ball games) and overexert themselves or twist an ankle. Typical signs include a limp (lameness), pain on palpation and sometimes slight swelling in the joint.
In most cases, no surgery is needed. Instead, methods such as targeted physiotherapy, massages, laser or shock wave therapy as well as protecting the injured area help.
A support or protective bandage (orthosis/splint) can provide additional relief to the tendon. With patience and the right treatment, your dog can usually walk normally again and resume his usual activities. However, it is important to give the animal enough time to heal and to adhere to all aftercare and training plans.
This article in the original Tendon Strain Causing Lameness in a Dog is from:
Author: Mary Sarah Bergh, DVM, MS, DACVS, DACVSMR, Midwest Veterinary Specialists, Milwaukee, Wisconsin
Last updated: October 2024
Tendon injuries in dogs for veterinary professionals
A 3-year-old intact male German Wirehaired Pointer named Jax was presented with acute left forelimb lameness that had developed approximately 2 months prior after pheasant hunting. The dog owner had not observed any specific event and the lameness did not improve with rest.
Clinical Examination - Tendon Injury in Dogs
During the general examination, Jax was alert and in good general condition. Vital signs and auscultation of the chest (heart/lungs) were within normal limits. There was moderate lameness in the left forelimb during the exercise phase; the leg was slightly relieved when standing. In addition, the muscles in the left forelimb were moderately atrophied compared to the opposite side.
The limb exhibited swelling on the posterior (caudal) surface just above the carpal joint when standing (Figure 1). Upon palpation of the caudal side of the forearm, just proximal (top) to the carpi accessory, a thickening was felt that elicited a mild pain response. Range of motion and stability in the lateral (mediolateral) and anterior/posterior (craniocaudal) directions of the left carpal joint were normal. There were no wounds or scars in this area. The remainder of the clinical examination was unremarkable.
Figure 1
Photos of the left forelimb in lateral (A) and caudocranial (B) views. The tendons on the back of the distal forearm are thickened in the area where the tendon of the flexor carpi ulnaris attaches to the os carpi accessoryium (arrows). For comparison, the mediolateral width of the normal right tendon of the flexor carpi ulnaris muscle can be seen (asterisk).
Diagnosis of tendon injuries in dogs
Differential diagnoses for soft tissue swelling, pain, and lameness included fracture, muscle or tendon strain, sprain, foreign body, or neoplasm. Although no obvious injury was known, a fracture was considered because hunting dogs often move on uneven terrain and can step into holes. This can lead to high forces on bones, ligaments and tendons. Additionally, sporting or working dogs can suffer fractures and soft tissue injuries from repetitive overuse.
The lateral and caudocranial radiographs of the left forearm showed no fracture (Figure 2). A stress scan in hyperextension (overstretched lateral scan) of the carpal joint revealed no evidence of instability of the palmar ligament structures.
Figure 2
Lateral (A) and caudocranial (B) radiographs of the left forearm. Thickening of the flexor carpi ulnaris tendon can be seen on the caudal side of the distal forearm (arrows). The hyperextended stress recording in the lateral position of the carpal joint (C) shows no evidence of instability of the palmar ligaments.
Based on the location of the swelling, a strain of the flexor carpi ulnaris tendon at its attachment to the os carpi accessory was suspected. A musculoskeletal ultrasound examination of the left and, for comparison, the right forearm showed significant damage to the tendon fibers (tendon structure) in both the humeral and ulnar parts of the flexor carpi ulnaris muscle (Figure 3). Hyperechoic areas indicated fibrosis, which is typical of chronic injury.
Figure 3
Ultrasound images of the altered (left) flexor tendon (A) and the normal (right) tendon (B) at the insertion point on the os carpi accessoryium (arrows). The irregular fiber pattern as well as hypo- and hyperechoic areas in the left limb indicate tendon fiber dysfunction and fibrosis due to chronic injury. AC = Os carpi accessory
Diagnosis: Strain injury of the left flexor carpi ulnaris tendon
Treatment & Long-Term Management
Jax underwent shock wave therapy and platelet-rich plasma (PRP) injections into or around the damaged flexor carpi ulnaris tendon twice, 2 weeks apart. He also received a support orthosis made of closed-cell foam and synthetic rubber that extended from the middle radius to the metacarpal bones. In this way, the tendon was stabilized while it could still be subjected to controlled loading.
Physical activity was limited to 5- to 10-minute leash walks 3 to 5 times daily. At the same time, a rehabilitation program began with two underwater treadmill sessions per week, laser therapy (Class IV), acupuncture and an exercise plan based on isometric exercises and strength building.
A home exercise program included cross-friction massage of the tendon (firm pressure transverse to the longitudinal axis of the tendon), additional massage of the limb, and range of motion exercises for all joints of the affected limb three times daily. Restricted exercise and rehabilitation measures should be maintained until check-ups at 4 and 8 weeks.
Treatment of tendon injuries in dogs at a glance
- Conservative methods (e.g. laser therapy, shock wave therapy, PRP injections, acupuncture, massage) are suitable if there is no joint instability.
- Physiotherapy is crucial to optimize recovery.
- Most tendon injuries can be treated without surgery.
- A brace can protect the tendon while it heals and prevent re-injury.
forecast
At the 4-week follow-up, the lameness was significantly improved and the thickening of the flexor carpi ulnaris tendon had decreased, but Jax continued to show slight relief of the leg when standing.
After 8 weeks, Jax was fully weight-bearing on his left forelimb and the carpal and elbow joints had a normal, pain-free range of motion. Palpation of the tendon was no longer painful, and the tendon had become significantly smaller, but still about 20% thicker than the contralateral healthy tendon. Ultrasound showed a significantly improved tendon fiber structure. A gradual training program was initiated and Jax was successfully able to go pheasant hunting again with his owner approximately 20 weeks after the initial introduction.
One year after the initial illness there was only slight thickening of the tendon without pain or lameness.
discussion
Tendons are essential structures of the musculoskeletal system because they connect muscles to bones and store and release energy, especially during fast, powerful movements. Tendon injuries are therefore common and should always be considered in sporting or working dogs with lameness or poor performance. Early diagnosis and treatment is crucial to restoring tendon function and minimizing permanent damage (see “Treatment at a Glance”).
Flexor carpi ulnaris tendon
The flexor carpi ulnaris tendon is important for flexion and abduction of the carpus during locomotion and contributes to support against gravity during the stance phase. This muscle-tendon unit has two muscular heads of origin, a humeral and an ulnar head, which have different functions.
The humeral head is stronger and likely plays a greater role in locomotion because its contraction time is slower and it has a higher fatigue limit than the ulnar head. An injury to one or both muscle-tendon junctions at the os carpi accessoryium can lead to pain, lameness and reduced performance.
Chronic tendon strains can easily occur, especially in sporting or working dogs, due to repeated strain. An insertion lesion of the flexor carpi ulnaris tendon is often caused by chronic overloading with too short rest periods.
Diagnosis of tendon injuries
Diagnosis begins with a clinical examination in a standing and lateral position. Orthogonal radiographs of the affected region should be taken; Stress recordings can provide evidence of instability. Musculoskeletal ultrasound is an effective in-office procedure to assess the location and severity of the injury. A comparison with the opposite limb makes it easier to assess any abnormalities in the tendon or bone. Additional imaging procedures can include an MRI to show soft tissue more precisely, or a CT to better detect bone changes (fractures, remodeling processes).
Treating tendon injuries in dogs
Muscle and tendon injuries only need to be treated surgically if they lead to significant loss of function. The basic principles for the acute treatment of a tendon injury are cooling (ice), compression, rest, anti-inflammatory medication and strengthening exercises.⁵ Heat, rest, massage and strengthening training help with chronic injuries.
Other forms of therapy (e.g., Class IV laser therapy, shock wave therapy, acupuncture, massage, orthobiological procedures such as PRP) can improve the quality and speed of tendon healing by promoting new blood vessel formation, collagen synthesis, and ordered fiber arrangement. Growth factors can stimulate vessel formation, cell proliferation and migration and thus support the damaged tissue. Shockwave therapy uses sound waves to stimulate vascular formation and collagen synthesis in the early healing phase,²² while PRP contains cytokines and growth factors that individually or synergistically promote healing.
Support orthoses can protect a damaged tendon from excessive strain while still allowing controlled movement and strength development. This can accelerate the healing process, reduce the extent of atrophy in the limb and protect the tendon against further injury.²³⁻²⁵ Such orthoses can be standardized or custom-made. Some have hinges or adjustable straps to gradually increase joint mobility and slowly increase the load on the injured tendon.
If a tendon is completely severed (e.g. due to a laceration) or torn away from its bone attachment, an operation to directly connect or reattach the tendon may be necessary. A splint, cast, or orthosis is often applied postoperatively for several weeks to prevent a gap from forming due to muscle contraction. This phase is followed by a rehabilitation program with a gradual increase in stress.
Prognosis for tendon injuries
Since tendons have only a limited ability to regenerate compared to other tissues, they heal more slowly and never fully regain their original strength. Instead, scarred tissue forms, which can affect structure and function. After an operation, only around 56% of the original tendon strength is regained after 6 weeks, and around 79% after a year. If a tendon is subjected to controlled loading early in the healing process, the fibers can align better, resulting in better strength.
When a normal muscle contracts, it exerts a force that is approximately 25-33% of the maximum tendon strength. For dogs without physical activity, relatively good healing is sufficient for everyday use. Sports and working dogs, on the other hand, exceed these normal loads more often and therefore have a higher risk of new injuries.
Common questions about tendon injuries in dogs
How do I know if my dog may have a tendon injury?
A tendon injury (e.g. tendon strain, partial rupture) usually manifests itself as a sudden or gradual onset of lameness. Dogs often avoid putting full weight on the affected leg and show pain when touched or moved - especially if certain directions of movement put strain on the injured tendon. Some dogs try to protect the leg by keeping it slightly bent and unloaded.
Other indications : swelling or thickening along the affected muscle and tendon area, warmth and sensitivity to touch. Chronic injuries can cause a noticeable hardening or thickening (“knot”) in the tissue.
When should you go to the vet ? If the lameness lasts longer than two days, worsens, or the dog shows significant pain, a veterinary visit is advisable. An early diagnosis increases the chances of an uncomplicated healing.
Why do tendon injuries occur and how can I prevent them?
Tendons connect muscles and bones. They transmit large forces during movement and rapid changes of direction. Sporting, hunting or working dogs are particularly at risk because they often have to start explosively, stop abruptly or jump.
Possible causes : Overuse due to long training or competition phases without sufficient regeneration
Missteps or twisting an ankle on uneven terrain
Excess weight: Extra kilos increase the pressure on joints and tendons
Starting training too early in young dogs (lack of bone and tendon maturity)
Preventive measures : Warm-up exercises before intensive stress , e.g. B. loose walking on a leash, small exercises for mobility
Regular check-ups at the vet, especially if the gait is abnormal
Controlled training : take breaks, build up the training plan gradually, increase the load as muscle strength increases
Weight control : avoid being overweight, as it puts additional strain on the tendons
Suitable Equipment : Leash length, harness instead of collar for dogs with known shoulder or neck problems
What treatment options are there and how do they differ?
Therapy depends on the severity of the tendon injury. For most tendon strains or partial tears (without joint instability), conservative treatment is sufficient. In the case of complete ruptures or severe damage, surgical treatment may be necessary.
Conservative measures (non-surgical): Rest and controlled movement : Short walks on a leash several times a day in order not to overload the tendon.
Physiotherapy/rehabilitation : Underwater treadmill, targeted stretching and strengthening exercises, isometric training, massages (e.g. transverse friction)
and shock wave therapy and laser therapy : promote blood circulation and metabolism in the tendon, accelerate healing
PRP injections (platelet-rich plasma) : platelet-rich Plasma is introduced into the injured tendon, can accelerate tissue repair
Orthoses/splints : Stabilize the affected area, relieve the tendon and ensure healing
Surgical options : tendon suture or reinsertion on the bone if the tendon is completely torn or a piece of bone has been torn off ( Avulsion)
Post-operative immobilization using a splint or plaster cast for several weeks.
Subsequent physiotherapy to get muscle and tendon structures used to stress again.
Benefits and Limitations : Conservative treatments are less invasive, have a lower risk of infection, but require discipline and time until the tendon is resilient again.
In severe cases, operations can enable faster and more stable healing, but the risk of wound healing problems or scarring increases.
As a pet owner, what can I do at home to support healing?
Healing from a tendon injury often takes several weeks to months. A structured plan can help speed up the process and avoid incorrect charges.
Limited, targeted exercise : Short walks on a leash (5-10 minutes, depending on veterinary recommendation), spread throughout the day
Slowly increasing walking time, always in consultation with the veterinarian or physiotherapist
Regular therapy sessions : If prescribed: underwater treadmill and professional Physiotherapy
Daily home exercises such as moderate stretching, controlled weight shifting, balance training on wobbly surfaces (e.g. balance cushion, if from Professional recommended)
Massage and heat/cold therapy : For relaxation and better blood circulation of the muscles and tendons
Cold (cryotherapy) in the acute phase to relieve pain
Heat rather in the later phase or for chronic complaints
Rest areas and equipment : A non-slip surface (e.g. Carpet runners on smooth surfaces to prevent slipping
Soft, easily accessible lying surfaces so that the dog does not have to jump or climb
Regular weight control : especially during rest periods the dog does not gain weight; If necessary, adjust the feed ration
How long does recovery take and what are the chances of success?
The healing process of tendons is generally slower than that of muscles or superficial wounds because the blood supply to the tendons is lower.
Typical periods of time : Mild strain : First improvement often after 2-4 weeks of consistent protection and therapy.
Partial rupture : 2-3 months until the tendon is moderately resilient again.
Complete rupture (with or without surgery) : 3-6 months or longer before the dog can return to normal activities
Important factors : Age and general health of the dog: Younger and healthy animals often regenerate more quickly.
Extent of the injury : If the damage is extensive or multiple, the tissue needs more time
Adherence to therapy : Consistent adherence to rest periods, orthopedic aids (e.g. orthoses) and rehabilitation measures is crucial.
Long-term prospects : After successful therapy, many dogs can take part in everyday life or even in sporting activities with almost no restrictions.
However, a slight thickening of the tendon often remains, although this does not necessarily lead to functional restrictions.
For very active working dogs (sports, rescue, hunting) there is a certain risk of renewed overload. An adapted training and recovery concept is therefore important.
Tendon strain in dogs
diagnosis
An accurate diagnosis is the key to successful treatment of a tendon injury. As a rule, it consists of:
- Clinical examination: Check for lameness, swelling, pain reaction to palpation
- X-ray: rule out broken bones (fractures)
- Ultrasound: Depiction of tendon lesions and comparison with the opposite side
- Possibly MRI or CT: For more detailed soft tissue or bone images
These methods can be used to determine whether and to what extent the tendon (e.g. flexor carpi ulnaris tendon) is injured.
Treatment & Long-Term Management
The treatment aims to relieve and support the tendon so that it can heal in a controlled and as complete manner as possible.
- Protection and controlled movement
- Shock wave therapy and laser therapy
- PRP (platelet-rich plasma) injections
- Physiotherapy (e.g. underwater treadmill, massage)
- Orthoses or splints for stabilization
If a tendon is not completely ruptured (ie without instability in the joint), this form of therapy is usually sufficient.
- Regular checks at the vet
- Step-by-step structure of the training
- Slow increase in load to avoid relapses
- Longer healing time than muscle injuries
With consistent treatment and patience, an almost complete recovery can be achieved. However, a slight thickening of the tendon often remains.
Conclusion
Early detection and treatment of tendon injuries is critical to maximize healing outcomes and avoid the development of excessive scar tissue. Depending on the severity of the injury, both surgical and conservative therapies can be used, although the prognosis is often good with timely treatment - even if the tendon cannot fully regain its original biomechanics. Physiotherapy measures can improve mobility, relieve pain and reduce the risk of re-injury.
(1) Tendon injury in dogs can manifest as sudden lameness.
(2) Tendon injury in dogs occurs especially in very active animals.
(3) Tendon injury in dogs is often caused by excessive use or unfortunate movements.
(4) Tendon injuries in dogs can also be caused by being overweight.
(5) Tendon injury in dogs often shows significant swelling and pain at the affected area.
(6) Tendon injuries in dogs usually require careful diagnosis using x-rays or ultrasound.
(7) Tendon injuries in dogs should always be clarified by a vet if lameness persists.
(8) Tendon injuries in dogs are usually treated conservatively unless the tendon is completely torn.
(9) Tendon injuries in dogs can heal more quickly with physical therapy, such as underwater treadmills or massages. (
10) Tendon injuries in dogs often benefit from anti-inflammatory medications and controlled exercise.
(11) Tendon injury in dogs can be additionally supported by shock wave therapy or laser therapy.
(12) Tendon injuries in dogs require close observation of the healing process.
(13) Tendon injuries in dogs sometimes require the use of a splint or orthosis.
(14) Tendon injury in dogs can worsen or recur if weight is placed on the affected leg too early.
(15) Tendon injuries in dogs usually heal more slowly than a pure muscle strain.
(16) Tendon injuries in dogs therefore require patience and consistent follow-up care.
(17) tendon injuries in dogs often lead to a good prognosis if treated promptly.
(18) Tendon injuries in dogs can be easily prevented through warm-up exercises and a balanced training concept.
(19) Tendon injuries in dogs occur primarily in sporting dogs or hunting dogs.
(20) Tendon injuries in dogs can also occur in older animals who slip on slippery floors.
(21) Tendon injury in dogs sometimes requires surgery in severe cases.
(22) tendon injuries in dogs do not mean the end of sporting activities, provided they are treated correctly and consistently.
Teach
- Tendon injuries should always be considered in sporting and working dogs with lameness or loss of performance.
- A detailed anamnesis and orthopedic examination are essential. In addition to fractures, cuts and foreign bodies, tendon and ligament injuries are particularly important differential diagnoses.
- X-rays (including special stress projections) and musculoskeletal ultrasound are part of the basic diagnostic procedure to assess bones and soft tissues. If necessary, CT or MRI can be used for additional detailed information.
- Tendons take a long time to heal and there is a risk of reinjury.