Surgery STAT: Rehabilitation therapy of the elbow in dogs

Surgery STAT: Rehabilitation therapy of the elbow in dogs

A variety of treatments can get patients back comfortably on all fours.

EDITOR'S NOTE: SurgerySTAT is a collaborative column between the American College of Veterinary Surgeons (ACVS) and DVM Newsmagazine.

Next month, Dr. Canapp finishes his three-part series on elbow dysplasia in dogs by discussing medical management.

Last month, I discussed a new subset of elbow dysplasia known as traumatic fragmented medial coronoid process (TFMCP). In this second part of a three-part series, I cover rehabilitation therapy for the elbow after surgery.

Table 1 Key Principles of Rehabilitation
Rehabilitation after elbow arthroscopy follows a sequential and progressive multiphased approach to return the patient to its previous functional level as quickly and safely as possible. Key principles (Table 1) and a combination of techniques are used to decrease postoperative pain and inflammation, restore range of motion and improve muscle strength and condition. This provides long-term pain relief, facilitates better overall limb function and improves quality of life.

Table 2
The following information and Table 2, provide the basics of a rehabilitation program (goals, modalities, manual treatments and therapeutic exercises) and serve as a general guideline that can be tailored to fit each patient's individual needs through the healing process.

Rehabilitation modalities

Cryotherapy — Cooling causes vasoconstriction, reduced cellular metabolism and permeability, decreased motor and sensory nerve conduction velocity, analgesia and decreased muscle spasm. Apply ice around the entire elbow joint for 15 to 20 minutes three to six times daily.

Photo 1: A dog undergoing cryotherapy and intermittent compression after a bilateral elbow arthroscopy.
• Cryotherapy and intermittent compression — Both the rate and magnitude of tissue cooling are increased with this combined therapy (Photo 1). Cold reaches deeper into tissues, providing longer-lasting therapy, and the intermittent compression mimics natural muscle contractions, pumping fluids and cellular debris out of the injured area. This cyclical action reduces swelling, encouraging lymphatic return and improved blood flow.

Photo 2: Laser therapy in a dog after an elbow arthroscopy.
• Laser therapy — Laser irradiation enhances production of cellular ATP, thus mediating release of growth factors, cytokine reactions and cell replication and resulting in an acceleration of delayed tissue healing. Apply 4 to 6 joules per spot, covering the entire treatment area, daily for the first week, every other day during week two and then as needed (Photo 2).

Photo 3: Transcutaneous electrical nerve stimulation (TENS) in a dog after an elbow arthroscopy.
• Transcutaneous electrical nerve stimulation (TENS) — This modality provides pain relief through inhibition of the pain-gait theory and via descending inhibitory mechanisms (release of endogenous opiate-like substances). Apply treatments three to seven times a week, and decrease the frequency as pain and lameness subside (Photo 3).