In dogs, medial compartment syndrome is the most common type of compartment syndrome we see. It is caused by traumatic damage to the articular cartilage in an area of the inside of the elbow called the medial coronoid process and the medial humeral condyle. It is caused by acute or chronic repetitive trauma to the elbow which leads to an overload injury.
Diagnosis can be achieved by a combination of physical examination and imaging such as x-rays, CT, or arthroscopy. Diagnosis by physical exam alone can be challenging as many dogs surprisingly show little pain during examination, so imaging is usually recommended.
Surgical treatment is usually warranted. An arthroscopy to remove bony fragments or surgical procedures such as the sliding humeral osteotomy (SHO) or proximal abducting ulnar osteotomy (PAUL) may be recommended by a board certified veterinary surgeon.
During the SHO procedure, the humerus is cut in half and the bottom portion is repositioned to redistribute the loads in the elbow to areas of the joint with healthy cartilage and away from areas where cartilage has worn away and bone on bone pain is present. The two pieces of the humerus are then plated together with a specialized bone plate. Research suggests that this will decrease the load on the damaged portion of the joint by about 35%, helping to reduce a patient’s pain.
In the PAUL procedure the ulna is cut below the elbow to shift weight off of the damaged portion of the joint. A bone plate and screws are then placed to stabilize the two pieces of ulna.
One of our patients with the PAUL procedure
Injection of orthobiologics such as corticosteroids or hyaluronic acid can be helpful if cartilage has been degraded in the elbow joint.
Rehabilitation post surgery is heavily focused on pain management, swelling reduction, bruising reduction, and proper healing of the fracture placed. Rehabilitation techniques for this condition will include physical modalities such as laser, ultrasound, shockwave, PEMF, and TENS. Prescriptive exercise programs will include manual therapies that will improve passive and active range of motion of the affected joint, relieve compensatory taut muscles, and then exercises that will encourage the patient to flex and extend the joint first when unloaded and then during increasing amounts of load.
