- Tendon injury in dogs - for pet owners
- Tendon injury in dogs for veterinarians
- Clinical examination – tendon injury in dogs
- Diagnosis of tendon injuries in dogs
- Treatment & Long-Term Management
- Forecast
- Discussion
- Treatment of tendon injuries in dogs
- Frequently asked questions about tendon injuries in dogs
- Diagnosis
- Treatment & Long-Term Management
- Conclusion
Tendon injury in dogs - for pet owners
Your dog has strained or injured a tendon in its front leg. Such an injury can occur when dogs are very active, for example during sports (hunting, agility, playing fetch), and overexert themselves or twist their ankle. Typical signs include limping (lameness), pain when touched, and sometimes slight swelling at the joint.
In most cases, surgery is not necessary. Instead, methods such as targeted physiotherapy, massage, laser or shockwave therapy, and resting the injured area are helpful.
A supportive 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 its 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 its original form 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 injury in dogs for veterinarians
A 3-year-old intact male German Wirehaired Pointer named Jax was presented with acute lameness of the left forelimb, which had developed approximately two months prior after pheasant hunting. The owner had not observed any specific incident, 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 chest auscultation (heart/lungs) were within normal limits. A moderate lameness was observed in the left forelimb during weight-bearing; the leg was slightly favored when standing. Furthermore, the muscles in the left forelimb showed moderate atrophy compared to the opposite side.
The limb showed swelling on the posterior (caudal) side immediately above the carpal joint while standing (Figure 1). Palpation of the caudal side of the forearm, directly proximal (superior) to the accessory carpal bone, revealed a thickening 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
Photographs of the left forelimb in lateral (A) and caudocranial (B) views. The tendons on the posterior aspect of the distal forearm are thickened in the region of the insertion point of the flexor carpi ulnaris tendon on the accessory carpal bone (arrows). For comparison, the mediolateral width of the normal right flexor carpi ulnaris tendon is shown (asterisks).
Diagnosis of tendon injuries in dogs
Differential diagnoses for the 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 frequently move across uneven terrain and may step into holes. This can result in high forces on bones, ligaments, and tendons. Additionally, sporting or working dogs can suffer fractures and soft tissue injuries from repetitive strain.
Lateral and caudocranial radiographs of the left forearm showed no fracture (Figure 2). A stress radiograph in hyperextension (overextended lateral view) of the carpal joint revealed no evidence of instability of the palmar ligamentous structures.
Figure 2
Lateral (A) and caudocranial (B) radiographs of the left forearm show thickening of the flexor carpi ulnaris tendon on the caudal side of the distal forearm (arrows). The hyperextended stress radiograph in lateral carpal position (C) shows no evidence of palmar ligament instability.
Based on the location of the swelling, a strain of the flexor carpi ulnaris tendon at its insertion on the accessory carpal bone 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 portions of the flexor carpi ulnaris muscle (Figure 3). Hyperechoic areas indicated fibrosis, which is typical of a chronic injury.
Figure 3
Ultrasound images of the altered (left) flexor tendon (A) and the normal (right) tendon (B) at its insertion point on the accessory carpal bone (arrows). The irregular fiber pattern and hypo- and hyperechoic areas in the left limb indicate tendon fiber dysfunction and fibrosis due to chronic injury. AC = accessory carpal bone
Diagnosis: Sprain injury of the left flexor carpi ulnaris tendon
Treatment & Long-Term Management
Jax underwent two rounds of shockwave therapy and injections of platelet-rich plasma (PRP) into and around the damaged flexor carpi ulnaris tendon, spaced two weeks apart. He also received a supportive brace made of closed-cell foam and synthetic rubber, extending from the mid-radius to the metacarpal bones. This stabilized the tendon while still allowing controlled weight-bearing.
Physical activity was limited to 5- to 10-minute walks on a leash, 3 to 5 times daily. Simultaneously, a rehabilitation program was initiated, including two underwater treadmill sessions per week, Class IV laser therapy, acupuncture, and an exercise plan based on isometric exercises and strength training.
A home exercise program included three daily cross-friction massages of the tendon (firm pressure applied perpendicular to the tendon's longitudinal axis), additional massages of the limb, and range-of-motion exercises for all joints of the affected extremity. The restricted movement and rehabilitation measures were to be maintained until the follow-up examinations after 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 instability of the joint.
- Physiotherapy is crucial to optimizing recovery.
- Most tendon injuries can be treated without surgery.
- An orthosis It can protect the tendon during healing and prevent re-injury.
Forecast
At the follow-up examination after 4 weeks, the lameness had improved significantly, and the thickening of the flexor carpi ulnaris tendon had decreased, however, Jax still showed a slight relief of the leg when standing.
After eight weeks, Jax was fully bearing weight on his left foreleg, and both 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, although still approximately 20 mm thicker than the contralateral, healthy tendon. Ultrasound showed a markedly improved tendon fiber structure. A gradual training program was initiated, and about 20 weeks after his initial examination, Jax was able to successfully return to pheasant hunting with his owner.
One year after the initial illness, there was only a slight thickening of the tendon without pain or lameness.
Discussion
Tendons are essential structures of the musculoskeletal system, as they connect muscles to bones and, especially during fast, powerful movements, store and release energy. Tendon injuries are therefore common and should always be considered in sporting or working dogs exhibiting lameness or reduced performance. Early diagnosis and treatment are 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, as its contraction time is slower and it has a higher fatigue threshold than the ulnar head. Injury to one or both muscle-tendon junctions of the accessory carpal bone can lead to pain, lameness, and reduced performance.
Chronic tendon strains are particularly common in sporting and working dogs due to repetitive strain. An insertional lesion of the flexor carpi ulnaris tendon is frequently caused by chronic overuse combined with insufficient rest periods.
Diagnosis of tendon injuries
Diagnosis begins with a clinical examination in the standing and lateral decubitus positions. Orthogonal radiographs of the affected region should be obtained; stress radiographs can indicate instability. Musculoskeletal ultrasound is an effective in-office procedure for assessing the location and severity of the injury. Comparison with the contralateral limb facilitates the evaluation of tendon or bone abnormalities. Additional imaging may include MRI to visualize soft tissues in greater detail or CT to better identify bone changes (fractures, remodeling processes).
Treatment of tendon injuries in dogs
Muscle-tendon injuries only require surgery if they result in significant functional impairment. The basic principles for the acute treatment of a tendon injury are cooling (ice), compression, rest, anti-inflammatory medication, and strengthening exercises.⁵ For chronic injuries, heat, rest, massage, and rehabilitation exercises are helpful.
Other therapies (e.g., Class IV laser therapy, shockwave therapy, acupuncture, massage, orthobiological procedures such as PRP) can improve the quality and speed of tendon healing by promoting angiogenesis, collagen synthesis, and ordered fiber arrangement. Growth factors can stimulate angiogenesis, cell proliferation, and migration, thereby supporting the damaged tissue. Shockwave therapy uses sound waves to stimulate angiogenesis and collagen synthesis in the early healing phase,²² while PRP contains cytokines and growth factors that individually or synergistically support healing.
Supportive orthoses can protect a damaged tendon from excessive stress while still allowing controlled movement and strength building. This can accelerate the healing process, reduce the degree of atrophy in the limb, and protect the tendon against further injury.²³⁻²⁵ Such orthoses can be standardized or custom-made. Some feature hinges or adjustable straps to gradually increase joint mobility and slowly raise the load on the injured tendon.
If a tendon is completely severed (e.g., by laceration) or torn from its bony attachment, surgery may be necessary to directly reattach or reconnect the tendon. Postoperatively, a splint, cast, or orthosis is often applied 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 activity.
Prognosis for tendon injuries
Because tendons have a limited capacity for regeneration compared to other tissues, they heal more slowly and never fully regain their original strength. Instead, scar tissue forms, which can impair structure and function. After surgery, only about 56 Tbps of the original tendon strength are regained after six weeks, and approximately 79 Tbps after one year. If a tendon is subjected to controlled stress early in the healing process, the fibers can align better, leading to improved strength.
A normal muscle exerts a force during contraction that is approximately 25–33 times the maximum tendon tensile strength. Therefore, in dogs without athletic activity, relatively good healing is sufficient for everyday use. Sporting and working dogs, however, more frequently exceed these normal stresses and thus have a higher risk of re-injury.
Frequently asked questions about tendon injuries in dogs
How can I tell if my dog might be suffering from a tendon injury?
A tendon injury (e.g., tendon strain, partial rupture) usually manifests 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 when certain movements put stress on the injured tendon. Some dogs try to protect the leg by keeping it slightly bent and weight-relieved.
Further evidenceSymptoms include swelling or thickening along the affected muscle-tendon area, warmth, and tenderness. In chronic injuries, a palpable hardening or thickening ("nodule") may develop in the tissue.
When should you go to the Veterinarian? If the lameness persists for more than two days, worsens, or the dog shows clear signs of pain, a veterinary visit is advisable. Early diagnosis increases the chances of a smooth recovery.
Why do tendon injuries occur and how can I prevent them?
Tendons connect muscles and bones. They transmit great forces during movement and rapid changes of direction. Sporting, hunting, or working dogs are particularly at risk because they frequently have to start explosively, stop abruptly, or jump.
Possible causesOverexertion 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 maturation)
Preventive measures:Warm-up exercises before intense exertion, e.g. light walking on a leash, small mobility exercises
Regular check-ups at the vet, especially if the gait is abnormal
Controlled trainingTake breaks, build up your training plan gradually, and increase the load as your muscle strength increases.
Weight controlAvoid being overweight, as this puts additional strain on the tendons.
Suitable equipmentLeash length, harness instead of collar for dogs with known shoulder or neck problems
What treatment options are available and how do they differ?
Treatment depends on the severity of the tendon injury. For most tendon strains or partial tears (without joint instability), one [treatment/surgery] is sufficient. conservative Treatment is available. In cases of complete ruptures or severe damage, a operative Supplies may be necessary.
Conservative measures (non-operative):Rest and controlled movementShort walks on a leash several times a day to avoid overstraining the tendon.
Physiotherapy/RehabilitationUnderwater treadmill, targeted stretching and strengthening exercises, isometric training, massages (e.g. cross-friction)
Shockwave therapy and laser therapyPromotes blood circulation and metabolism in the tendon, accelerates healing
PRP injections (Platelet-Rich Plasma)Platelet-rich plasma is injected into the injured tendon, which can accelerate tissue repair.
Orthoses/SplintsStabilize the affected area, relieve the tendon and ensure healing.
Operational options:tendon suture or Reinsertion on the bone, if the tendon is completely torn or a piece of bone has been torn off (avulsion)
Postoperative immobilization using a splint or plaster cast for several weeks
Subsequent physiotherapy, in order to gradually reintroduce muscle and tendon structures to stress
Advantages and limitationsConservative treatments are less invasive, carry a lower risk of infection, but require discipline and time until the tendon can withstand stress again.
Surgery can enable faster and more stable healing in severe cases, however, it increases the risk of wound healing disorders or scarring.
What can I, as a pet owner, do at home to support the healing process?
The healing process for a tendon injury often takes several weeks to months. A structured plan can help speed up the process and avoid improper strain.
Limited, targeted movementShort walks on a leash (5-10 minutes, depending on veterinary advice), spread throughout the day
Gradually increase walking time, always in consultation with the veterinarian or physiotherapist.
Regular therapy sessionsIf prescribed: underwater treadmill and professional physiotherapy
Daily Home exercises such as moderate stretching, controlled weight shifts, balance training on unstable surfaces (e.g. balance cushions, if recommended by a professional)
Massage and heat/cold therapyFor relaxation and improved blood circulation in the muscles and tendons.
Cold (Cryotherapy) in the acute phase for pain relief
warmth more likely in the later stages or in cases of chronic conditions
Rest areas and facilitiesA non-slip surface (e.g., a carpet runner on smooth surfaces) to prevent slipping.
Soft, easily accessible lying surfaces so that the dog doesn't have to jump or climb.
Regular weight checksThe dog should not gain weight, especially during rest periods; adjust the food ration if necessary.
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 in tendons is lower.
Typical time periods:Slight strain: Initial improvement often occurs after just 2–4 weeks of consistent rest and therapy.
Partial tear: 2–3 months until the tendon can withstand moderate stress 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 In dogs: Younger and healthy animals often recover faster.
Extent of injuryIn cases of extensive or multiple damage, the tissue needs more time to heal.
Therapy adherenceConsistent adherence to rest periods, orthopedic aids (e.g., orthoses) and rehabilitation measures is crucial.
Long-term outlookMany dogs can participate almost without restrictions in everyday life or even in sporting activities after successful therapy.
Nevertheless, a slight thickening of the tendon often remains, which does not necessarily lead to functional limitations.
Highly active working dogs (sports, rescue, hunting) are at risk of re-exercise. Therefore, a tailored training and recovery plan is essential.
Tendon strain in dogs
Diagnosis
An accurate diagnosis is key to the successful treatment of a tendon injury. It typically consists of:
- Clinical examination: Check for lameness, swelling, and pain response upon palpation.
- X-ray: Exclusion of bone fractures (fractures)
- Ultrasound: Illustration of tendon lesions and comparison with the contralateral side
- Possibly an MRI or CT scan: For more detailed soft tissue or bone images
These methods make it possible to determine if 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 a manner as possible.
- Rest and controlled movement
- Shockwave therapy and laser therapy
- PRP injections (platelet-rich plasma)
- Physiotherapy (e.g. underwater treadmill, massage)
- Orthoses or splints for stabilization
In cases of incomplete tendon rupture (i.e., without instability in the joint), this form of therapy is usually sufficient.
- Regular check-ups at the veterinarian
- Gradual development of the training
- Gradual increase in workload to prevent relapses
- Longer healing time than with muscle injuries
With consistent treatment and patience, a near-complete recovery is possible. However, a slight thickening of the tendon often remains.
Conclusion
Early detection and treatment of tendon injuries are crucial to maximizing healing outcomes and preventing the formation of excessive scar tissue. Depending on the severity of the injury, both surgical and conservative therapies may be used, and the prognosis is often good with timely treatment – even if the tendon cannot fully regain its original biomechanics. Physiotherapy can improve mobility, alleviate pain, and reduce the risk of re-injury.
(1) Tendon injury in dogs It can manifest as a sudden lameness.
(2) Tendon injury in dogs This occurs particularly in very active animals.
(3) Tendon injury in dogs is often triggered by overuse or awkward movements.
(4) Tendon injury in dogs This can also be exacerbated by being overweight.
(5) Tendon injury in dogs It often shows significant swelling and pain at the affected area.
(6) Tendon injury in dogs It usually requires a careful diagnosis using X-rays or ultrasound.
(7) Tendon injury in dogs If lameness persists, it should always be checked by a veterinarian.
(8) Tendon injury in dogs It is usually treated conservatively, unless there is a complete tendon rupture.
(9) Tendon injury in dogs It can heal faster with physiotherapy, such as underwater treadmills or massages.
10) Tendon injury in dogs often benefits from anti-inflammatory medication and controlled exercise.
(11) Tendon injury in dogs It can also be supported by shock wave therapy or laser therapy.
(12) Tendon injury in dogs requires close monitoring of the healing process.
(13) Tendon injury in dogs This sometimes necessitates wearing a splint or orthosis.
(14) Tendon injury in dogs It can worsen or recur if the affected leg is subjected to stress too soon.
(15) Tendon injury in dogs It usually heals more slowly than a simple muscle strain.
(16) Tendon injury in dogs It therefore requires patience and consistent follow-up care.
(17) Tendon injury in dogs However, in many cases, timely treatment leads to a good prognosis.
(18) Tendon injury in dogs This can be effectively prevented through warm-up exercises and a balanced training concept.
(19) Tendon injury in dogs It occurs primarily in sporting dogs or hunting dogs.
(20) Tendon injury in dogs However, it can also occur in older animals that slip on smooth floors.
(21) Tendon injury in dogs Severe cases sometimes require surgery.
(22) Tendon injury in dogs However, this does not mean the end of sporting activities, provided it is handled correctly and consistently.
Teach
- Tendon injuries should always be considered in sporting and working dogs exhibiting lameness or loss of performance.
- A thorough medical history and orthopedic examination are essential. Besides fractures, lacerations, 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 workup for assessing bones and soft tissues. CT or MRI scans can be used for additional detailed information if necessary.
- Tendons take a long time to heal, and there is a risk of re-injury.