Equine Antebrachial Compartment Syndrome Secondary to Flexor Muscle Myopathy With Subsequent Muscle Atrophy And Tendonitis: A Case Report.

This case report describes a 16-year-old jumping stallion that had a marked swelling over the left antebrachial area along with substantial lameness after a fall. The horse was weight bearing but lame (4/5; AAEP scale) at the walk with marked enlargement in the caudal aspect of the antebrachial region. After a static musculoskeletal examination, radiography and ultrasonography the horse was diagnosed with flexor muscle myopathy and presumptive extremity compartment syndrome. Following medical treatment, the horse improved clinically over several days. Six-months post injury the horse showed flexor muscle atrophy but was sound at the walk and trot. The horse was presented again 3 months later with an enlargement of the palmar left metacarpus that was diagnosed as a superficial digital flexor tendonitis. This report describes the episodes from the onset of extremity compartment syndrome until the superficial digital flexor tendonitis, discusses anatomical features of the region, physiopathology of compartment syndrome and the possible biomechanics behind the flexor muscle atrophy and the tendonitis.

Mid- to Long-Term Outcome after Arthroscopy and Proximal Abducting Ulnar Osteotomy Versus Arthroscopy Alone in Dogs with Medial Compartment Disease: Thirty Cases.

OBJECTIVE: The aim of this study was to determine owner-assessed mid- to long-term outcome for dogs with medial compartment disease treated arthroscopically with fragment removal with or without proximal abducting ulnar osteotomy (PAUL). STUDY DESIGN: This was a retrospective clinical study. MATERIALS AND METHODS: Records from 30 dogs with medial compartment disease treated with arthroscopy with or without PAUL were retrospectively reviewed over a 5-year period. Proximal abducting ulnar osteotomy cases were matched to arthroscopy-alone controls based on bodyweight and modified Outerbridge score. Outcome was assessed via owner questionnaire using the Canine Brief Pain Inventory (CBPI), frequency of non-steroidal anti-inflammatory drug (NSAID) administration and owner-assessed overall improvement. RESULTS: Canine Brief Pain Inventory score for dogs in the PAUL group was not significantly different from the control group (p = 0.54). Non-steroidal anti-inflammatory drug administration was similar between groups (p = 0.61) and there was no significant difference between modified Outerbridge score and outcome (p = 0.57) over a median of 43 months post-surgically (range: 7-66 months). Canine Brief Pain Inventory and NSAID use were affected by the age of the dog with dogs greater than 3 years of age at the time of surgery having a higher CBPI score and increased NSAID use regardless of the surgery that was performed. Overall, owner-assessed improvement was not different between groups (p = 0.72). CLINICAL SIGNIFICANCE: Proximal abducting ulnar osteotomy showed no owner-assessed benefit over arthroscopic medial coronoid fragment removal for dogs with medial compartment disease and modified Outerbridge score of 3 or greater. A prospective, blinded, controlled clinical trial is warranted to determine the appropriate clinical application of the PAUL procedure.

An atypical presentation of leiomyosarcoma causing extremity compartment syndrome of the crural region in a Dutch Warmblood mare: a case report.

A 12-year-old Warmblood mare was presented with an acute onset left hindlimb lameness associated with generalised soft tissue swelling of the entire limb and medial saphenous vein (MSV) thrombophlebitis. A presumptive diagnosis of extremity compartment syndrome (ECS) was made. Due to the clinical deterioration, emergency fasciotomy of the crural fascia and biopsy was performed. Histological and immunohistochemical examination of the samples confirmed a diagnosis of leiomyosarcoma likely originating from the tunica media of the MSV. This report is the first to describe an unique combination of ECS and thrombophlebitis associated with a leiomyosarcoma in a horse.

Compartment syndrome of the muscles of mastication in a working dog following a traumatic training incident.

OBJECTIVE: To describe acute compartment syndrome (CS) of the muscles of mastication in a working dog associated with a traumatic training event. CASE SUMMARY: A 2.5-year-old male Belgian Malinois was evaluated for acute blindness, severe diffuse swelling of the head, and inability to close the jaw following a traumatic incident during a bite training drill. During the exercise, the maxillary canine teeth were locked on a bite sleeve. Magnetic resonance imaging of the head and ocular system identified diffuse muscle swelling and hyperintensity, most severe in the muscles of mastication. Ocular abnormalities were not identified. Rhabdomyolysis, CS, and indirect optic nerve injury were supported by measurement of increased intramuscular pressure. Bilateral decompressive fasciotomies over the masseter and temporalis muscles resulted in immediate and marked resolution of the swelling and jaw movement. Blindness, however, did not resolve. NEW OR UNIQUE INFORMATION PROVIDED: CS involving the muscles of mastication may occur as a complication of bite training and may result in irreversible and even life-threatening complications. Emergent decompressive fasciotomy is indicated to reverse swelling; however, visual deficits may not resolve.

Radial torsion in dogs with medial compartment disease.

OBJECTIVE: To evaluate the magnitude and direction of radial torsion (RT) in dogs with medial compartment disease (MCD). STUDY DESIGN: Case-control study. SAMPLE POPULATION: Twenty-eight healthy dogs and 28 dogs with confirmed MCD. METHODS: Computed tomography images of each dog's antebrachium were evaluated. Radial torsion was measured by using previously described landmarks on the proximal and distal radius. Differences between groups were tested with Student's t tests and Wilcoxon rank-sum tests. RESULTS: Healthy dogs had a mean RT angle of 3.44° (range, 1.28°-5.44°). Dogs with MCD had a mean RT angle of 11.84° (range, 2.31°-26.55°). Both groups included similar proportions of dogs with external (76% vs 77%) and internal (24% vs 23%) torsion. The direction of torsion (P = .21 and P = .69) did not appear to affect the magnitude of the RT angle. CONCLUSION: Dogs with MCD had an increased RT angle compared with healthy controls. The direction of torsion varied similarly between groups regardless of the disease status of dogs in this study. CLINICAL SIGNIFICANCE: The fourfold increase in the RT seen in dogs with MCD may contribute to the rotational overload proposed recently, potentially modifying the orientation of the elliptical radial head and the ligaments crossing the elbow joint.

Suspected Compartment Syndrome, Consumptive Thrombocytopenia, and Anemia Secondary to a Ruptured Arterial Aneurysm or Pseudoaneurysm Following Multiple Stifle Surgeries.

A 12 yr old male neutered beagle was presented on transfer to the intensive care unit with severe anemia, thrombocytopenia, and bruising detected 1 day after undergoing tibial plateau leveling osteotomy surgery. The patient had undergone extra-capsular stifle stabilization surgery 14 wk prior to treat ligament disease in the same knee. Laboratory testing and treatment for anemia, presumptive immune-mediated thrombocytopenia, and possible hemostatic disorder was initiated. A persistent anemia, progressive thrombocytopenia, and the development of a firm swelling and neurologic impairment in the limb raised concerns for compartment syndrome (CS). A musculoskeletal ultrasound revealed a large aneurysm in the caudal thigh surrounded by abnormal muscle tissue. The patient underwent amputation of the limb and recovered without further complication. Pathology findings were consistent with the development of femoral CS secondary to a ruptured peripheral arterial aneurysm or a pseudoaneurysm. A consumptive thrombocytopenia and regenerative anemia were attributed to periodic or progressive thrombosis of the vessel and regional hemorrhage. Postoperative CS can develop in combination with peripheral arterial aneurysm or pseudoaneurysm, and screening for vascular abnormalities as well as CS should be considered in complicated recovery from orthopedic surgery with compatible clinical signs including progressive soft tissue swelling, persistent anemia, and thrombocytopenia.

Acute masticatory muscle compartmental syndrome in a dog.

CASE DESCRIPTION A5.5-year-old sexually intact male Bull Terrier was referred for evaluation because of sudden facial swelling and an inability to close its mouth. CLINICAL FINDINGS Physical examination revealed bilaterally elevated nictitating membranes, an inability to adduct the mandible without assistance, and severe, diffuse, firm masticatory muscle swelling. Computed tomographic examination of the head revealed symmetric bilateral enlargement of the temporalis, masseter, and pterygoid muscles with heterogeneous contrast enhancement. Intracompartmental pressures in the left and right temporalis muscles as measured with an invasive arterial blood pressure transducer were 72 and 96 mm Hg, respectively. TREATMENT AND OUTCOME Emergent fasciotomy of the temporalis and masseter muscles was performed, followed by medical management with corticosteroids and analgesics. The diffuse facial swelling resolved within 1 week after surgery. Results of serologic testing for antibody against masticatory 2M muscle fibers were negative. Results of histologic examination of temporalis muscle specimens were consistent with mild to moderate multifocal neutrophilic and histiocytic myositis with myofiber degeneration and necrosis. CLINICAL RELEVANCE Acute compartmental syndrome should be considered as a differential diagnosis for dogs with a sudden onset of severe skeletal muscle swelling, signs of pain, and dysfunction. Findings for this dog with acute compartmental syndrome isolated to the masticatory muscles suggested that emergent fasciotomy followed by medical management may be an effective technique for treatment of this rare disease in dogs.

Clinical outcomes associated with the initial use of the Canine Unicompartmental Elbow (CUE) Arthroplasty System(®).

We evaluated mid- to long-term outcomes with respect to function and complications in dogs undergoing canine unicompartmental elbow (CUE) arthroplasty for treatment of medial compartment disease of the elbow. This prospective multicenter case series is the first group of clinical cases to receive CUE arthroplasty. Cases (each elbow that underwent CUE performed by a participating surgeon) were enrolled into an electronic database and prospectively followed to determine and record all associated complications, as well as functional outcomes. There were 103 cases from 18 surgeons. Final follow-up time ranged from 6 to 47 mo with a mean and median of 10 mo. Canine unicompartmental elbow was associated with 1 catastrophic (1%), 11 major (10.7%), and 28 minor (27.2%) complications. Outcomes following CUE were reported as full function in 49 cases (47.6%), acceptable function in 45 cases (43.7%), and unacceptable function in 9 cases (8.7%). We conclude that CUE arthroplasty is an appropriate consideration for treatment of medial compartment disease of the elbow in dogs.

Résultats cliniques associés à l'utilisation initiale du système d'arthroplastieCanine Unicompartmental Elbow (CUE) Arthroplasty SystemMD. Nous avons évalué les résultats à long et à moyen terme relativement à la fonction et aux complications chez les chiens subissant une arthroplastie du coude unicompartimental canin (CUC) pour le traitement de la maladie compartimentale médiale du coude. Cette série prospective de cas multicentres représente le premier groupe de cas cliniques à recevoir une arthroplastie CUC. Les cas (chaque coude qui a subi une CUC réalisée par un chirurgien participant) étaient inscrits dans une base de données électroniques et suivis de manière prospective afin de déterminer et de consigner toutes les complications connexes ainsi que les résultats fonctionnels. Il y avait 103 cas provenant de 18 chirurgiens. Le temps de suivi final s'échelonnait de 6 à 47 mois avec une moyenne et une médiane de 10 mois. Le coude compartimental canin a été associé à 1 complication catastrophique (1 %), à 11 complications majeures (10,7 %) et à 28 complications mineures (27,2 %). Les résultats après l'arthroplastie CUC ont été signalés comme une fonction complète dans 49 cas (47,6 %), une fonction acceptable dans 45 cas (43,7 %) et une fonction inacceptable dans 9 cas (8,7 %). Nous avons conclu que l'arthroplastie CUC est une considération appropriée pour le traitement de la maladie compartimentale médiale du coude chez les chiens.(Traduit par Isabelle Vallières).

Use of a minimally invasive fasciotomy technique for treatment of antebrachial compartment syndrome in two horses.

CASE DESCRIPTION: An 18-year-old Paint stallion (horse 1) and a 17-year-old Morgan gelding (horse 2) were evaluated because of an acute onset of severe unilateral forelimb lameness. CLINICAL FINDINGS: Both horses were unable to bear weight on the affected forelimb and had a dropped elbow appearance. Radial nerve paralysis, triceps myopathy, and fractures of the humerus and ulna were ruled out. The caudal aspect of the affected antebrachium of each horse was very firm to palpation and became firmer when weight was shifted onto the limb. Ultrasonographic examination revealed swelling and suspected intramuscular hemorrhage of the caudal antebrachial muscles. On the basis of clinical examination and diagnostic imaging findings, both horses had antebrachial compartment syndrome diagnosed. Lameness did not substantially improve with medical treatment in either horse. TREATMENT AND OUTCOME: Caudal antebrachial fasciotomy was performed in each horse. Following sedation and local anesthetic administration, a bistoury knife was inserted through small incisions to perform fasciotomy. Horses remained standing throughout the procedure and were immediately able to bear weight on the affected limb without signs of discomfort. Horse 1 developed colitis and horse 2 developed a mild incisional infection, but both fully recovered and returned to their previous activities. CLINICAL RELEVANCE: Antebrachial compartment syndrome is a rare cause of severe unilateral forelimb lameness and should be considered as a differential diagnosis in horses with a dropped elbow appearance. Both horses of this report had a successful outcome following antebrachial fasciotomy.

Theory and development of a unicompartmental resurfacing system for treatment of medial compartment disease of the canine elbow.

Medial compartment disease (MCompD) of the canine elbow can be defined as clinical signs attributable to articular cartilage loss of the medial coronoid process (MCP) of the ulna and medial aspect of the humeral condyle without significant lateral compartment pathology. Whereas outcomes associated with treatment of defined cohorts of dogs with MCompD have not been published, the impressions of many surgeons are that non-surgical management or surgical treatment of the MCP alone does not result in long term highly functional outcomes. Thus, alternative surgical options for treatment of MCompD have been developed including various osteotomies and total elbow replacement (TER) with "successful" outcomes reported in case series. Results and data on safety have been reported for relatively few of these procedures and when reported, major complication rates have been >10% and catastrophic complications have been reported. Accordingly, we sought to develop a surgical technique with the objective of obtaining higher levels of safety and efficacy in the treatment of dogs with MCompD. This report describes the rationale for, and development of, a unicompartmental resurfacing system for treatment of MCompD in the canine elbow.

Compartment syndrome associated with expansile antebrachial tumors in two dogs.

CASE DESCRIPTION: A 10-year-old spayed female Jack Russell Terrier and a 7-year-old neutered male mixed-breed dog were evaluated because of acute, progressive, unilateral forelimb lameness associated with signs of pain and turgid antebrachial swelling. CLINICAL FINDINGS: For either dog, there were no salient pathological or diagnostic imaging abnormalities. A diagnosis of compartment syndrome was confirmed on the basis of high caudal antebrachial compartmental pressure in the affected forelimb. TREATMENT AND OUTCOME: Both dogs underwent surgical exploration of the affected forelimb. In each case, an intramuscular tumor (mast cell tumor in the Jack Russell Terrier and suspected sarcoma in the mixed-breed dog) was detected and presumed to be the cause of the high compartmental pressure. At 6 months following tumor excision, the dog with the mast cell tumor did not have any clinical signs of disease. The dog with a suspected sarcoma underwent tumor excision and forelimb amputation at the proximal portion of the humerus followed by chemotherapy; the dog was euthanized approximately 1 year following treatment because of pulmonary metastasis. CLINICAL RELEVANCE: Compartment syndrome is a serious but rarely reported condition in dogs and is typically ascribed to intracompartmental hemorrhage. These 2 cases illustrate the potential for expansile intramuscular antebrachial tumors to cause compartment syndrome in dogs.

Acute compartment syndrome in the pelvic limb of a cow following biopsy of a skeletal muscle-associated hemangiosarcoma.

CASE DESCRIPTION: A 6-year-old Holstein cow was examined because of chronic lameness and swelling near the stifle joint of the left pelvic limb. CLINICAL FINDINGS: A mass was palpated in the soft tissues lateral to the proximal aspect of the left tibia. Multiple attempts to obtain a biopsy specimen of the mass resulted in acute compartment syndrome of the femoral compartment (tensor fasciae latae and biceps femoris muscles) and lateral tibial compartment (cranial tibial and peroneus tertius muscles) with associated sciatic nerve paralysis. TREATMENT AND OUTCOME: Surgical decompression via tensor fasciae latae and biceps femoris incision resolved the sciatic nerve paralysis. On the fifth day following surgery, the cow began to develop signs of increased respiratory effort. Thoracic radiography revealed a pulmonary metastatic micronodular pattern. The cow was euthanized because its condition deteriorated. Metastatic hemangiosarcoma was confirmed at necropsy, and the primary tumor was the mass that was lateral to the tibia and within the biceps femoris muscle. CLINICAL RELEVANCE: Hemangiosarcoma should be considered a differential diagnosis for lameness in cattle when no orthopedic cause can be identified. Close patient surveillance is strongly recommended in the event that a vascular tumor is present because catastrophic consequences are possible. To our knowledge, this is the first report of acute compartment syndrome in a pelvic limb of a bovine patient and the only report of hemangiosarcoma in the skeletal muscle of cattle.

Pressão intra-abdominal em cães / Intra-abdominal pressure in dogs

Sob consenso recente em pacientes humanos, os valores basais da pressão intra-abdominal (PIA) e seus prováveis limiares em casos mórbidos, foram estipulados com intuito de favorecer a homogeneidade de estudos científicos, além de fornecer diretrizes para conduta diagnóstica e terapêutica destes pacientes. Valores basais e alterações na pressão intra-abdominal em animais não são ainda suficientemente conhecidos e cientificamente determinados. Médicos veterinários necessitam conhecer melhor os estados mórbidos que cursam com Hipertensão Intra-Abdominal (HIA) ou Síndrome de Compartimento Abdominal (SCA). O presente estudo objetivou testar em cães a técnica já descrita sob consenso na medicina como modelo de mensuração da pressão intra-abdominal, assim como determinar os valores normais para a espécie. Foram utilizados 15 cães hígidos, machos e fêmeas, homogêneos e todos sem raça definida. A mensuração da pressão intra-abdominal foi realizada por meio da técnica indireta de sondagem vesical e utilização de coluna de água com régua graduada em cm de H2O, sendo seu valor final convertido para a unidade de mm de Hg. Foi observado valor mínimo subatmosférico (abaixo de zero mm de Hg) até o valor máximo de 3,75 mmHg. Houve importante variação entre os valores encontrados individualmente em determinados cães, colocando sob discussão questões como massa corporal, freqüência/volume total de solução fisiológica a ser infundida e agitação destes pacientes no momento do exame. Os valores limítrofes encontrados são considerados fisiológicos, indicando confiabilidade da técnica e possibilidade do seu emprego clínico. A ausência de sedação e utilização de sonda uretral não inviabilizou a realização da mensuração, porém podendo culminar numa sub ou superestimativa dos valores encontrados.

In order to favor the homogeneity of scientific studies and to provide guidelines on the diagnosis and therapy, human basal values of the intra-abdominal pressure (IAP) and their probable thresholds in morbid cases were recently established. However, basal values and changes in the intra-abdominal pressure in animals are still partly unknown and not scientifically confirmed. Veterinarians have the need to expand their knowledge on morbid conditions that develop with Intra-Abdominal Hypertension (IAH) or Abdominal Compartment Syndrome (ACS). The present study aims to test in dogs the technique adopted in human medicine as a model for measurement of intra-abdominal pressure (1) and determine normal values for the species (2). Fifteen known mongrel healthy dogs, males and females and homogenous were tested. The measurement of IAP was done through an indirect technique which involves catheterizing the bladder and using a water column with a graduate ruler in cm of H(2)0 - its final value converted to mm of Hg. The values observed ranged from a minimum sub atmospheric value (below of zero mm of Hg) to 3,75 mmHg. There was a considerable variation within the individual values observed in some animals, bringing up considerations related to body mass, frequency/total volume of the physiologic solution to be administered and inquietude of these dogs during the treatment. The thresholds values found are considered physiologic, indicating reliability of the technique and possibility of its clinical use. The absence of sedation and the use of urethral catheter did not compromised the measurement, however could have resulted in under- or overestimation of the values found.

Acute compartment syndrome complicating an intramuscular haemangiosarcoma in a dog.

Acute compartment syndrome in dogs is a rare complication of muscle trauma, but it has not been previously reported as a consequence of neoplasia in dogs. This case report describes the occurrence of a compartment syndrome of the femoral compartment in an 11-year-old, male, mixed-breed dog caused by acute bleeding of an intramuscular haemangiosarcoma. The compartment syndrome was relieved by immediate fasciotomy. The dog was euthanased following acute recurrence of clinical signs seven weeks after surgery.

Femoral compartment syndrome due to haemangiosarcoma in the semimembranosus muscle in a dog.

A five-year-old, entire male German shepherd dog was presented to the Veterinary Teaching Hospital-Koret School of Veterinary Medicine because of an acute, painful swelling of the right thigh and severe lameness of two-weeks duration. On physical examination, a firm and painful mass was detected in the hamstring region. Radiography and ultrasonography revealed a soft tissue mass, with a 250 cc fluid accumulation craniomedial to it. Intracompartmental pressure measurement with a Wick catheter demonstrated significantly elevated pressure within the right caudal femoral compartment (25 to 28 mmHg compared with 5 to 7 mmHg in the unaffected leg). Surgical exploration of the area was undertaken, fasciotomy and mass excision were performed, and resolution of the clinical signs was achieved. The mass was identified by histopathology results as haemangiosarcoma. Two and a half months after surgery, which was followed by adjunct chemotherapy (doxorubicin), the dog was readmitted with a subcutaneous mass in the same area, although he was not lame at this time. Radiographs of the thoracic cavity demonstrated widely disseminated metastases in the lungs. At that point, the owner elected to have the dog euthanased.

Ischemic bandage injuries: a case series and review of the literature.

OBJECTIVE: To determine the prognosis and distribution of ischemic injuries caused by inappropriate bandaging of the lower limb in dogs and cats. STUDY DESIGN: Retrospective clinical study. ANIMAL POPULATION: Eleven client-owned animals, including 9 dogs and 2 cats with a history of injuries consistent with incorrect application of a bandage. METHODS: Medical records for dogs and cats referred to the Queen's Veterinary School Hospital with limb wounds between 1995 and 1999 were reviewed for clinical history and referring veterinary surgeons' reports, indicating that the injury was directly related to the application of a bandage to the limb. RESULTS: The indications for bandage application included 2 postoperative cruciate ligament ruptures, 2 lacerations, 3 internal fixations, an onychectomy, a shoulder dislocation, a dog bite, and a tendon strain. None of the patients had other body systems involved or underlying or concurrent diseases. Five different types of bandage were described (support, Robert Jones, pressure, splint, and Velpeau), and no particular age or breed was overrepresented. Of the 11 animals, 5 required full-thickness skin grafts, 3 had to have digits amputated, and 2 required limb amputations. Nine animals survived, but only 4 became fully functional on the affected limb. CONCLUSIONS: Bandage-related injuries are potentially serious sequelae to a routine procedure. A guarded prognosis should be given when there is loss of deeper structures. CLINICAL RELEVANCE: A review of bandaging principles is presented. Method of application, choice of materials, and close monitoring of the bandage are important factors in preventing iatrogenic injury.

[Are degenerative joint diseases chronic compartment syndromes?]. / Sind degenerative Gelenkserkrankungen chronische Kompartmentsyndrome?

An increase of the intraosseous pressure is observed in the epiphyses of bones involved in degenerative joint disease. The increase of pressure may be caused by an accumulation of osmotically active substances in the interstitium as it has been described in case of the Compartment Syndrome. Based on the postulated pathophysiological mechanism a causative therapy of the degenerative joint disease is proposed.

Postanesthetic compartmental syndrome in a horse.

After surgery, high intramuscular pressures were measured in a horse with clinical signs of postanesthetic myopathy that developed following a 2.25-hour surgical procedure. In the postoperative period, tests for muscular and neurologic integrity were made, including measurement of intracompartmental muscle pressure.

Osteofascial compartment syndrome in the dog.

Experimentally induced osteofascial compartment syndrome (OFCS) has been reported in the craniolateral compartment of the canine crus. In this study, anatomic dissections and contrast radiographs were used to describe three additional osteofascial compartments in canine limbs. Experimental OFCS was produced in four different compartments, and caused muscle and nerve pathology in each. When compartment pressures were evaluated in traumatized animals, moderate elevations in compartment pressures were found. A compartment syndrome that developed in one dog was surgically decompressed, returning elevated pressures to a safe level.