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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 24453
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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My lab puppy...5 months old has a puffiness on her right

Customer Question

My lab puppy...5 months old has a puffiness on her right knee...seems soft to touch. She is not in pain. What to do?
Submitted: 1 year ago.
Category: Dog Veterinary
Customer: replied 1 year ago.
It's like the size of a ping pong ball...feels like liquid inside.
Customer: replied 1 year ago.
Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Expert:  Dr. Michael Salkin replied 1 year ago.

Can you upload a photo of this puffiness to our conversation? You can use the paperclip icon in the toolbar above your message box (if that icon is visible) or you can use an external app such as imgur.com or dropbox.com. In general such puffiness indicates joint effusion - excess joint fluid - as might be seen secondary to considerable trauma to the stifle (knee) - particularly anterior cruciate ligament damage. These dogs, however, are dead lame. Are you perhaps referring to her hock rather than her knee? A hygroma (serum filled swelling between the skin and bony pressure points) might be nonpainful.

I regret that I'm not allowed to communicate with customers by phone. Please stay in this conversation.

Customer: replied 1 year ago.
it is her hock. I will send a photo.
Customer: replied 1 year ago.
I can't find the paper clip.
Customer: replied 1 year ago.
Here is pic.
Expert:  Dr. Michael Salkin replied 1 year ago.

Ah! An elbow hygroma...the most common kind. Here's a synopsis of this for you taken from Clinical Veterinary Advisor, 3rd Ed., Cote', 2015:

Definition

Soft-tissue swelling containing serum that is located between skin and bony prominence (olecranon)

Epidemiology

Species, Age, Sex

  • Short-haired large/giant breeds of dogs
  • Usually younger than 2 years of age

Risk Factors

  • Lying on hard surfaces
  • Thin skin and small amount of subcutaneous fat
  • Pressure coupled with inflammation from repetitive trauma can lead to edema and fibrous tissue formation.
  • Associated orthopedic disorders

Clinical Presentation

History, Chief Complaint

  • Gradual enlargement of a fluid-filled swelling over the lateral aspect of the olecranon
  • hygromas may become infected or ulcerate, open, and drain

Physical Exam Findings

  • Fluid-filled swelling located on the lateral aspect of the olecranon
  • May be unilateral or bilateral

Etiology and Pathophysiology

  • Repetitive pressure or trauma to the elbow
  • Leads to accumulation of serum in the subcutaneous tissues
  • Chronic lesions lead to thickening of skin, subcutaneous tissues, and fibrous tissue development

 Diagnosis

Differential Diagnosis

  • Abscess
  • Neoplasia

Initial Database

  • Complete blood count (CBC), serum biochemistry and urinalysis
  • Fine-needle aspirate (FNA)
    • Cytology—rule out neoplasia
    • Culture and sensitivity—if abscess is suspected
  • Radiographs
    • Affected elbow to rule out underlying orthopedic disease such as fracture or degenerative joint disease
    • Pelvis and stifle—rule out degenerative joint disease (hip dysplasia and chronic cruciate ligament disease)

 Treatment

Treatment Overview

Goals are to decrease continued trauma and provide protection of the hygroma to allow healing of the fibrous tissues.

Acute and Chronic Treatment

  • Treat or correct underlying orthopedic disease.
  • Corticosteroid injections are proven to be contraindicated.
  • Drainage with Penrose drains or closed suction drains can be successful, but recurrence rates are high.
  • Resection of the hygroma with primary surgical closure is difficult, recurrence rates are high, and complications common; therefore, excisional surgery should be avoided.
  • Adjustable padded neoprene/polyester elbow sleeves are available. Long-term use is possible. Commercially available foam pipe insulation material has been used effectively.
  • Bandaging to protect area is difficult.
  • Provide padded bedding when possible.

Possible Complications

  • Recurrence
  • Infection
    • Repeated needle drainage
    • Surgical intervention
  • Chronic non-healing wound
    • Infected hygroma
    • Surgical wound dehiscence
    • Continued trauma to the hygroma

Recommended Monitoring

  • Observe the affected elbow for evidence of:
    • Recurrence
    • Infection of the overlying skin
    • Necrosis of the overlying skin
  • Monitor for signs of underlying orthopedic disease.

 Prognosis & Outcome

  • Good with proper conservative management
  • Surgery should be considered only after proper conservative management techniques have been rigorously pursued.

 Pearls & Considerations

Comments

  • Do not attempt surgical intervention or surgical excision of an elbow hygroma.
    • Complications are serious, common, and may become chronic following excisional surgery.
  • Injections with corticosteroids are contraindicated and should not be used.
  • A thorough orthopedic evaluation should be performed in all cases.
    • Especially for evidence of hip dysplasia or chronic cranial cruciate ligament disease
  • Best treatment of an elbow hygroma is for the patient to wear proper padded elbow sleeves and to pad the environment.

Prevention

  • Dogs should be restricted from lying on hard surfaces.
    • Especially if there are orthopedic problems already present
  • Proper bedding for dogs
  • Proper treatment of orthopedic diseases in large-breed dogs

Client Education

  • Much easier to prevent than to treat elbow hygromas
    • Consult a veterinarian as soon as an elbow hygroma is suspected. Please continue our conversation if you wish.
Customer: replied 1 year ago.
Thank you. I will call her vet Monday.
Expert:  Dr. Michael Salkin replied 1 year ago.

You're quite welcome. I'm pleased to hear that she'll be well-attended to. I can't set a follow-up in this venue and so would appreciate your returning to our conversation with an update - even after rating - at a time of your choosing.