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290 Elbow Hygroma

Elbow Hygroma
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BASIC INFORMATION
• CBC, serum biochemistry and urinalysis: PROGNOSIS & OUTCOME
Definition usually unremarkable Good with proper conservative management
Soft-tissue swelling on lateral elbow containing • Fine-needle aspirate (FNA)
serum that is located between skin and bony ○ Cytology: rule out neoplasia PEARLS & CONSIDERATIONS
prominence (olecranon) ○ Culture and sensitivity: if abscess is
suspected Comments
Epidemiology • Radiographs • Do not attempt surgical intervention or
SPECIES, AGE, SEX ○ Affected elbow to rule out underlying surgical excision of an elbow hygroma.
• Short-haired large/giant dog breeds orthopedic disease, such as fracture or ○ Complications are serious, common,
• Usually younger than 2 years of age degenerative joint disease and may become chronic after excisional
○ Pelvis and stifle: rule out degenerative joint surgery.
RISK FACTORS disease (hip dysplasia and chronic cruciate ○ If surgery is considered as a last resort,
• Lying on hard surfaces ligament disease) refer to a veterinary soft-tissue surgical
• Thin skin and small amount of subcutaneous specialist.
fat TREATMENT • Injections with glucocorticoids are contra-
• Pressure coupled with inflammation from indicated and should not be used.
repetitive trauma leads to edema and fibrous Treatment Overview • A thorough orthopedic evaluation (p. 1143)
tissue formation. Goals are to decrease continued trauma and should be performed in all cases.
• Associated orthopedic disorders provide protection of the hygroma to allow ○ Especially for evidence of hip dysplasia or
○ Hip dysplasia healing of the fibrous tissues. chronic cranial cruciate ligament disease
○ Bilateral cranial cruciate ligament disease • Best treatment of an elbow hygroma is for
(chronic partial tears) Acute and Chronic Treatment the patient to wear proper padded elbow
• Treat or correct underlying orthopedic sleeves and to pad the bedding/environment.
Clinical Presentation disease. ○ The pressure point must be off-loaded for
HISTORY, CHIEF COMPLAINT • Drainage with Penrose drains or closed healing.
• Gradual enlargement of a fluid-filled swelling suction drains can be successful, but recur-
over the lateral aspect of the olecranon rence rates are high. Prevention
• Hygromas may become infected or may • Avoid excisional surgery: hygroma resection • Large dogs should be restricted from lying
ulcerate, open, and drain. with primary surgical closure is difficult, on hard surfaces.
recurrence rates are high, and complications ○ Especially if there are already orthopedic
PHYSICAL EXAM FINDINGS (dehiscence, infection) are common. problems
• Fluid-filled swelling located on the lateral • Adjustable padded neoprene/polyester • Proper bedding for dogs
aspect of the olecranon elbow sleeves are available. Long-term use • Proper treatment of orthopedic diseases in
• May be unilateral or bilateral is possible. Commercially available foam pipe large-breed dogs
insulation material has been used effectively.
Etiology and Pathophysiology • Bandaging to protect area is difficult. Technician Tips
• Repetitive pressure or trauma to the elbow • Provide padded bedding. • Commercial products are available for the
leads to accumulation of serum in the prevention and treatment of elbow hygromas.
subcutaneous tissues Possible Complications • Familiarity with the foam pipe insulation
• Chronic lesions lead to thickening of skin, • Recurrence bandage is greatly helpful for management
subcutaneous fibrous tissue development • Infection of elbow hygromas and elbow wounds.
○ Repeated needle drainage
DIAGNOSIS ○ Surgical intervention Client Education
• Chronic non-healing wound It is much easier to prevent than to treat elbow
Diagnostic Overview ○ Infected hygroma hygromas.
Diagnostics are aimed at differentiating between ○ Surgical wound dehiscence
a normal elbow callus, hygroma, abscess (infected ○ Continued trauma to the hygroma SUGGESTED READING
hygroma), or a neoplastic lesion, as treatments Pavletic MM: Use of commercially available foam
differ for each problem. It is important to deter- Recommended Monitoring pipe insulation as a protective device for wounds
mine if orthopedic disease is present that may • Observe the affected elbow for evidence of over the elbow joint area in five dogs. J Am Vet
necessitate additional therapy to help offload ○ Recurrence Med Assoc 239(9):1225-1231, 2011.
the elbows. ○ Infection of the overlying skin AUTHOR: Otto I. Lanz, DVM, DACVS
○ Necrosis of the overlying skin
Differential Diagnosis • Monitor for signs of underlying orthopedic EDITOR: Elizabeth A. Swanson, DVM, MS, DACVS
• Abscess disease.
• Neoplasia

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