Arthroscopic Biceps Ulnar Release Procedure (BURP) For Dogs with Medial Coronoid Disease
Robert J. McCarthy, DVM, MS, DACVS
Canine elbow dysplasia (CED) refers to a complex collection of developmental conditions of the elbow seen most frequently in large breed dogs. Breeds most frequently affected in the United States include Newfoundlands, Rottweilers, Bernese Mountain Dogs and Labrador retrievers. While CED can take several different clinical forms, by far the most common is fragmentation of the medial coronoid process (FMCP). Recent theories of FMCP suggest that the underlying etiology is related to generation of abnormal forces by the biceps brachii muscle complex that cause the medial coronoid process to be rotated against the distal humeral condyle. The term “humero-ulnar conflict” has been used to describe this situation. Lameness is initially the result of the conflict alone, and is later exacerbated when the medial coronoid process fragments off.
Consideration of the biceps brachialis muscle complex as the initiator of FMCP has led to the development of a new and novel treatment for this condition. Specifically, the muscle is cut at its insertion on the ulna. The developer of the procedure, Dr. Noel Fitzpatrick in the United Kingdom, has coined the term “biceps ulnar release procedure”, which allows for an excellent acronym, BURP. Dogs that are considered the best candidates for BURP are very young and have humero-ulnar conflict, but do not yet have fragmentation of the medial coronoid process. Because of this, clinicians must have a high degree of suspicion for the condition. Any dog of a high incidence breed with forelimb lameness and any changes on an elbow radiograph should be considered as having humero-ulnar conflict until proven otherwise.
BURP can be performed through a medial skin incision, but can also be accomplished using arthroscopic technique alone (Figure 1, Video 1). Initial studies indicate that there are no apparent negative effects associated with the procedure, and significant improvement in limb function has been documented. Veterinarians having a case considered to be a possible candidate for BURP should contact either Dr. Michael Kowaleski or Dr. Robert McCarthy at the Tufts Foster Hospital (508-839-5395 X84794).