Novel approach for the treatment of canine elbow hygroma with extracorporeal shockwaves

Abstract

A hygroma is a fluid filled cavity, which appears due to repetitive traumata over bony prominences. For canine elbow hygroma there is no satisfactory treatment option available. Small hygromas should not be treated at all. Larger hygromas that restrict the dog in daily life, are infected, painful, or ulcerated should be treated surgically with drainage or total excision. Surgical treatment of hygromas results in long rehabilitation times and is associated with a high complication rate. Extracorporeal shockwave therapy (ESWT) is widely used in human and veterinary rehabilitation medicine since several years. Even the mechanisms of action are not fully understood it has a wide range of indications. ESWT provides anti-inflammatory effects, promotes microcirculation, and is used for pain relief. In this case series of 4 consecutive cases in 3 dogs we treated hygromas with extracorporeal shockwaves each for 3 to 6 times usually on a weekly basis. All hygromas regressed completely and no complications were noted. Overall ESWT seems to provide a safe, easy-to-use, as well as cost-effective alternative treatment option for canine elbow hygroma.

Zusammenfassung

Das Hygrom des Ellbogens beim Hund ist ein um flüssigkeitsgefüllter Hohlraum, der durch wiederholte Mikrotraumata über Knochenvorsprüngen entsteht. Für das Hygrom des Hundes gibt es bislang keine zufriedenstelle Behandlungsoption. Kleine Hygrome sollten unbehandelt belassen werden. Kommt es jedoch zur Größenzunahme, zur Infektion oder Ulzeration oder zeigt das Tier Schmerzen, sollte eine chirurgische Intervention mittels Drainage oder kompletter Exzision stattfinden. Oft kommt es bei der Wundheilung zu Komplikationen und auch ein Wiederauftreten der Problematik ist beschrieben. Die extrakorporale Stoßwellentherapie (ESWT) wird mit einem großen Spektrum an Indikationen seit vielen Jahren in der Human- und Tiermedizin eingesetzt. Der Wirkmechanismus ist nicht abschließend geklärt, jedoch besitzt die ESWT antiinflammatorische Effekte, verbessert die Mikrozirkulation und lindert Schmerzen. In dieser Fallserie von 4 Fällen bei 3 Hunden wurden Hygrome mit ESWT im wöchentlichen Abstand je 3- bis 6-mal behandelt. Die Behandlungen verliefen komplikationslos und erfolgreich. Die ESWT ist eine sichere und ökonomische Behandlungsoption für das Ellbogenhygrom des Hundes.

Key words

ESWT - physical therapy - rehabilitation - non-surgical - dog - small animal

Schlüsselwörter

ESWT - physikalische Therapie - Rehabilitation - nicht-chirurgisch - Hund - Kleintier

Publication History

Received: 04 September 2022

Accepted: 30 November 2022

Article published online:
11 August 2023

• References

• 1 MacPhail C, Fossum TW. Elbow Hygroma. In: Fossum TW, Hrsg. Small Animal Sugery. Philadelphia: Elsevier GmbH; 2019: 247-248
• 2 Johnston DE. Hygroma of the elbow in dogs. J Am Vet Med Assoc 1975; 167: 213-219
• 3 Newton CD, Wilson GP, Allen HL. et al. Surgical closure of elbow hygroma in the dog. J Am Vet Med Assoc 1974; 164: 147-149
• 4 Pavletic MM, Brum DE. Successful closed suction drain management of a canine elbow hygroma. J Small Anim Pract 2015; 56: 476-479 DOI: 10.1111/jsap.12315.
• 5 Green ML, Miller JM, Lanz OI. Surgical treatment of an elbow hygroma utilizing microvascular free muscle transfer in a newfoundland. J Am Anim Hosp Assoc 2008; 44: 218-223 DOI: 10.5326/0440218.
• 6 Angelou V, Papazoglou LG, Tsioli V. et al. Complete surgical excision versus Penrose drainage for the treatment of elbow hygroma in 19 dogs (1997 to 2014). J Small Anim Pract 2020; 61: 230-235 DOI: 10.1111/jsap.13117.
• 7 Ogden JA, Tóth-Kischkat A, Schultheiss R. Principles of shock wave therapy. Clin Orthop Relat Res 2001; 8-17 DOI: 10.1097/00003086-200106000-00003:. 10.1097/00003086-200106000-00003
• 8 Durant AM, D Applications of Extracorporal Shockwavein Small Animal Rehabilitation. In: Levine D, ; Millis, D., Hrsg. Canine Rehabilitation and Physical Therapy. Philadelphia: Elsevier Saunders; 2004: 381-391
• 9 Hotiana MZ, Khan LA, Talati J. Extracorporeal shock wave lithotripsy for bladder stones. Br J Urol 1993; 71: 692-694 DOI: 10.1111/j.1464-410x.1993.tb16067.x.
• 10 Maier M, Averbeck B, Milz S. et al. Substance P and prostaglandin E2 release after shock wave application to the rabbit femur. Clin Orthop Relat Res 2003; 237-245 DOI: 10.1097/01.blo.0000030173.56585.8f. 10.1097/01.blo.0000030173.56585.8f
• 11 Yan X, Zeng B, Chai Y. et al. Improvement of blood flow, expression of nitric oxide, and vascular endothelial growth factor by low-energy shockwave therapy in random-pattern skin flap model. Ann Plast Surg 2008; 61: 646-653 DOI: 10.1097/SAP.0b013e318172ba1f.
• 12 Mariotto S, de Prati AC, Cavalieri E. et al. Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Curr Med Chem 2009; 16: 2366-2372 DOI: 10.2174/092986709788682119.
• 13 Hsu RW, Hsu WH, Tai CL. et al. Effect of shock-wave therapy on patellar tendinopathy in a rabbit model. J Orthop Res 2004; 22: 221-227 DOI: 10.1016/s0736-0266(03)00138-4.
• 14 Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop 1991; 15: 181-184 DOI: 10.1007/bf00192289.
• 15 Moya D, Ramón S, Schaden W. et al. The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. J Bone Joint Surg Am 2018; 100: 251-263 DOI: 10.2106/jbjs.17.00661.
• 16 Wang CJ. Extracorporeal shockwave therapy in musculoskeletal disorders. J Orthop Surg Res 2012; 7: 11 DOI: 10.1186/1749-799x-7-11.
• 17 Johannes EJ, Kaulesar Sukul DM, Matura E. High-energy shock waves for the treatment of nonunions: an experiment on dogs. J Surg Res 1994; 57: 246-252 DOI: 10.1006/jsre.1994.1139.
• 18 Venzin C, Ohlerth S, Koch D. et al. Extracorporeal shockwave therapy in a dog with chronic bicipital tenosynovitis. Schweiz Arch Tierheilkd 2004; 146: 136-141 DOI: 10.1024/0036-7281.146.3.136.
• 19 Danova NA, Muir P. Extracorporeal shock wave therapy for supraspinatus calcifying tendinopathy in two dogs. Vet Rec 2003; 152: 208-209 DOI: 10.1136/vr.152.7.208.
• 20 Barnes K, Faludi A, Takawira C. et al. Extracorporeal shock wave therapy improves short-term limb use after canine tibial plateau leveling osteotomy. Vet Surg 2019; 48: 1382-1390 DOI: 10.1111/vsu.13320.
• 21 Kieves NR, MacKay CS, Adducci K. et al. High energy focused shock wave therapy accelerates bone healing. A blinded, prospective, randomized canine clinical trial. Vet Comp Orthop Traumatol 2015; 28: 425-432 DOI: 10.3415/vcot-15-05-0084.
• 22 Gallagher A, Cross AR, Sepulveda G. The effect of shock wave therapy on patellar ligament desmitis after tibial plateau leveling osteotomy. Vet Surg 2012; 41: 482-485 DOI: 10.1111/j.1532-950X.2012.00958.x.
• 23 Becker W, Kowaleski MP, McCarthy RJ. et al. Extracorporeal shockwave therapy for shoulder lameness in dogs. J Am Anim Hosp Assoc 2015; 51: 15-19 DOI: 10.5326/jaaha-ms-6175.
• 24 Dahlberg J, Fitch G, Evans RB. et al. The evaluation of extracorporeal shockwave therapy in naturally occurring osteoarthritis of the stifle joint in dogs. Vet Comp Orthop Traumatol 2005; 18: 147-152
• 25 Mueller M, Bockstahler B, Skalicky M. et al. Effects of radial shockwave therapy on the limb function of dogs with hip osteoarthritis. Vet Rec 2007; 160: 762-765 DOI: 10.1136/vr.160.22.762.
• 26 Ioppolo F, Tattoli M, Di Sante L. et al. Extracorporeal shock-wave therapy for supraspinatus calcifying tendinitis: a randomized clinical trial comparing two different energy levels. Phys Ther 2012; 92: 1376-1385 DOI: 10.2522/ptj.20110252.
• 27 Horn C, Mengele K, Gerdesmeyer L. et al. The effect of antibacterial acting extracorporeal shockwaves on bacterial cell integrity. Med Sci Monit 2009; 15: Br364-369
• 28 Yeaman LD, Jerome CP, McCullough DL. Effects of shock waves on the structure and growth of the immature rat epiphysis. J Urol 1989; 141: 670-674 DOI: 10.1016/s0022-5347(17)40929-3.
• 29 Giusti G, Penteado F, Santos J. et al. Effect of shock waves upon the growth plate in rabbits. Acta Ortopédica Brasileira 2005; 13
• 30 Van Arsdalen KN, Kurzweil S, Smith J. et al. Effect of lithotripsy on immature rabbit bone and kidney development. J Urol 1991; 146: 213-216 DOI: 10.1016/s0022-5347(17)37754-6.
• 31 Nassenstein K, Nassenstein I, Schleberger R. [Effects of high-energy shock waves on the structure of the immature epiphysis--a histomorphological study]. Z Orthop Ihre Grenzgeb 2005; 143: 652-655 DOI: 10.1055/s-2005-836903.
• 32 Barr FJ. Long Bones - juvenile. In: Barr FJK, R. M., Hrsg. BSAVA Manual of Canine and Feline Musculoskeletal Imaging: British Small Animal Veterinary Association. 2006: 19-33