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Case Reports
. 2017 Feb 1;3(1):2055116917695053.
doi: 10.1177/2055116917695053. eCollection 2017 Jan-Jun.

Surgical management of medial humeral epicondylitis, cubital synovial osteochondromatosis and humeroradial subluxation in a cat

Karen L Perry  1
Affiliations
Case Reports

Surgical management of medial humeral epicondylitis, cubital synovial osteochondromatosis and humeroradial subluxation in a cat

Karen L Perry. JFMS Open Rep. .

Abstract

Case summary: A 13-year-old domestic shorthair cat presented for evaluation of pain and difficulty ambulating. Orthopedic examination and CT facilitated a diagnosis of bilateral elbow synovial osteochondromatosis with medial humeral epicondylitis and concurrent osteoarthritis. Right humeroradial subluxation was evident on CT images, but no instability was evident preoperatively. Surgical treatment was elected, including external neurolysis of the ulnar nerve, removal of the areas of mineralization within the flexor carpi ulnaris muscle and medial arthrotomy to remove intra-articular mineralized bodies. Following closure, instability of the right elbow was noted with humeroradial subluxation necessitating placement of circumferential suture prostheses to provide satisfactory stability. Reassessment was performed 2, 6, 12, 24 and 40 weeks postoperatively and revealed maintenance of elbow stability and substantial improvement in mobility and comfort.

Relevance and novel information: While humeroradial subluxation has been reported in association with medial humeral epicondylitis on post-mortem examination, associated clinically significant instability has not been documented previously. Surgeons should be aware of the potential for this complication and check elbow stability following surgery. Despite this complication, a favorable medium-term outcome was achieved for this cat.

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Conflict of interest statement

Conflict of interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1
Figure 1
Preoperative craniocaudal radiographs of the (a) right and (b) left elbows performed prior to referral and three-dimensional reconstructions (c) craniocaudal, (d) caudocranial and (e) oblique orientations demonstrating the large mineral-attenuating synovial and periarticular foci surrounding both elbows. Particularly evident are the large mineral fragments in the medial flexor tendons (yellow arrows)
Figure 2
Figure 2
Sagittal slice from a (a) CT scan and (b) three-dimensional reconstruction from CT scan showing displacement of the right radius craniolaterally in relation to the humerus
Figure 3
Figure 3
Intraoperative photograph demonstrating ulnar nerve being retracted following external neurolysis. The extensive area of mineralization within the flexor carpi ulnaris muscle can also be seen within the tips of the forceps. This was then removed by blunt dissection
Figure 4
Figure 4
Intraoperative photograph demonstrating areas of mineralization removed from both the humeral head of flexor carpi ulnaris muscle and within the elbow, adjacent to a measuring device
See this image and copyright information in PMC

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