Medial humeral epicondylitis: a retrospective case series of nine cats (17 elbows).

Abstract

Case series summary The aim of this study was to describe the clinical findings, diagnostic results and response to both non-surgical and surgical therapy in cats with medial humeral epicondylitis (MHE). The medical records of one institution were searched for cats with a radiographically confirmed diagnosis of MHE where non-surgical therapy alone or both non-surgical and surgical therapy had been trialed. Nine cats (17 elbows) were included. None of the cats had a history of outdoor access. Orthopedic examination revealed pain upon palpation over the medial epicondyle (n = 15), elbow pronation/supination (n = 7) or carpal flexion (n = 7) and palpable mineralization distal to the medial epicondyle (n = 7). Epicondylitis was radiographically graded as mild (n = 8), moderate (n = 7) or severe (n = 2). CT was performed in 10 elbows and revealed additional information in seven, including intra-articular mineralized bodies in five elbows. Ultrasound was performed in four elbows and revealed fluid surrounding the flexor carpi ulnaris muscle. After non-surgical management, four cats showed no response, four showed a partial response and one showed a complete response. Cats with less advanced radiographic changes appeared to show more favorable responses. Four cats (seven elbows) underwent surgical treatment with ulnar neuritis being evident in all. Lameness resolved postoperatively in three cats (five elbows).Relevance and novel information An insidious onset of moderate-grade lameness associated with pain on palpation caudodistal to the medial epicondyle should increase the index of suspicion for MHE and prompt assessment for the presence of palpable mineralization and pain on carpal flexion. Ulnar neuritis is common in cats with MHE and they frequently present with free articular mineralized bodies. Radiographs can only detect advanced or chronic stages of MHE, by which time non-surgical management is likely to be ineffective. Earlier diagnosis using ultrasound may improve the prognosis after non-surgical management.