For cats suffering from MHE, a joint condition that can be severely debilitating, surgical treatment may be the most effective way to get them back to doing what they do best—climbing, playing, and running.
Medial humeral epicondylitis (MHE) occurs when mineral deposits develop around the elbow joint. When large quantities of the mineral deposits accumulate, they can cause nerve compression. These deposits may cause severe pain and often do not respond to conventional medical therapy. Veterinarians suspect that MHE occurs due to repetitive injury of the flexor tendons on the inside of the elbow. This overuse likely occurs due to a cat’s active lifestyle.
“Cats may present with varying degrees of lameness, or sometimes it can be an incidental finding,” said veterinary orthopedic surgeon Dr. Karen Perry. She’s currently working to improve diagnosis, treatment, and awareness of MHE. “A cat’s lifestyle plays a major role in the development of the disease. In the early stages, it may be possible for us to reduce progression of MHE by simply modifying the cat’s environment, but if we don’t treat accordingly, the condition will likely progress, and in the later stages, it can severely impact a cat’s quality of life by inhibiting movement and causing pain. In these later stages, surgery is often the only option.”
MHE is relatively unknown in the veterinary community, which means it is often misdiagnosed. It also can be hard to recognize, as the signs that are visible on radiographs take time to develop. In the early stages, visible signs are not there at all, and when the signs become apparent, they can be very subtle. In humans, ultrasound is often used in these early stages, but there is limited awareness of this modality in cats. This difficulty in recognition means that MHE often goes undiagnosed and untreated until it progresses to the later stages.
The first step is to get the word out in the veterinary community that MHE is an important and debilitating condition. We need to raise awareness. It needs to be considered early on so that treatment can be instigated and we can minimize discomfort for these cats. The goal is to maintain quality of life and to avoid surgery when possible. —Dr. Perry
The second step is research. Most cats treated surgically for severe cases of MHE have shown significant initial improvement, both in mobility and pain. However, none of the cats treated surgically have been tracked long enough for researchers to assess the overall effectiveness of the surgery and whether recurrence of the mineralized bodies is likely in the future.
Additionally, surgically treating cats with MHE is sometimes controversial. Many of these cats have multiple joint problems, which complicates their management. Also, because MHE cats tend to be older and may have other medical conditions, owners and veterinarians alike may be more reluctant to pursue surgery. This means that the outcomes following surgery have been largely unknown—until recently.
The cats we have performed surgery on were in the later stages of the condition and were severely debilitated by MHE. They had nerve compression, severe pain, and limited mobility. But even in these advanced cases, the surgeries have been successful. The cats became dramatically more comfortable. In my opinion, we need to consider surgical treatment for MHE cases more often. Unfortunately, positive results aren’t yet known to most veterinarians, so there is still a reluctance to perform the procedures. —Dr. Perry
Dr. Perry is working to produce the necessary literature that will follow cats treated surgically for MHE and allow the long-term results to be evaluated.
“Currently, we’re following an 11-year-old cat named Abbey,” said Dr. Perry. “Abbey was being treated for arthritis for more than a year with no real improvement, so her MHE continued to progress. When we diagnosed her with MHE, her case was severe and surgery was the only option.”
There were two stages to Abbey’s surgery. First, Dr. Perry removed the mineralized bodies and sections of tendon and muscle tissue that were causing nerve compression. Then she repaired the defect by reattaching the debrided tendons and muscles to the surrounding, healthy structures. The surgery immediately improved Abbey’s level of comfort.
Since recovering from surgery, Abbey, who also was diagnosed with arthritis and osteochondromatosis, has been working with Dr. Sarah Shull at MSU’s Dr. Elwood and Linda Collins Rehabilitation Center. Abbey started with laser therapy, icing, passive range of motion exercises, and acupuncture. At four weeks post-surgery, she began massage and walking on the underwater treadmill to build strength and mobility.
Dr. Perry is hoping to spread the word about MHE diagnosis and treatment by sharing patient stories like Abbey’s.
We expect Abbey to continue to improve. As we continue working with her, we will be able to monitor her progress and results to help assess the long-term potential benefits of this surgery for other cats suffering with MHE. —Dr. Perry