Tibial plateau leveling osteotomy is a very aggressive approach to this common problem. In my opinion it is a lot of surgery for little gain. You will be seeing this in the literature. Early surgical intervention of painful elbows in young dogs is strongly recommended. There are times when a young dog has pain upon extension of the elbow.
Radiographs are normal.
The differentials are OCD of the humeral condule and fragmented medial coronoid process. At times these cannot be seen radiographically. We perform arthroscopy just prior to arthrotomy in these patients. Exploration of the medial compartment of the joint could be recommended without arthroscopy. The prognosis for these patients is much better with early intervention - prior to degenerative joint disease forming.