In last week's The Vet Is In, Dr. Palazollo described canine elbow dysplasia and its aspects. This week's article covers its diagnosis and treatment.
Lameness of one or both of the front legs is the primary symptom of elbow dysplasia. The lameness may be intermittent and difficult to detect. It might be more prominent after periods of rest or sleep (the elbow joint stiffens up from inflammation). There may also be periods of apparently normal gait, with lameness after strenuous play and activity.
During an exam, you might be asked to walk your dog on a leash so the problem can be more accurately assessed. If the lameness is mild, the owner may not be clear about which front leg is lame.
During an exam, the leg will be palpated up and down to feel for swelling, crepitation (subtle grinding), or excess warmth. The leg will be moved in many directions to determine range of motion. During this exam, your dog should be closely observed for expressions of discomfort.
Young dogs that are lame can have a problem in the shoulder joint, along with problems in the radius and ulna, so these areas should be checked carefully during this exam. The lameness from this disease, called osteochronditis dissecans (OCD), can look the same as lameness from elbow dysplasia.
Elbow dysplasia is diagnosed radiographically with your dog under sedation, since movement can make it difficult to visualize the subtle and complex changes that occur in the joint. Several different angles and views are needed. Even if your dog is lame on only one leg, both legs need to be radiographed for comparison. Elbow dysplasia can sometimes be diagnosed on the leg that is not yet lame, giving a head start on treatment.
There are three types of elbow dysplasia: fragmented coronoid process (FCP), ununited anconeal process (UAP), and osteochondritis dissecans (OCD). Two are shown here:
FCP. Photos courtesy of Long Beach Animal Hospital (LBAH).
Diagnosis can be difficult because of the chronic nature of the problem and the complexity of the joint. A radiologist that specializes in reading radiographs or an orthopedic surgeon that is experienced in this disease is usually needed for a definitive diagnosis.
Other tests that are used on occasion include joint taps, bone scans, CT scans and MRIs.
Surgery is the treatment of choice. Rest, pain management and non-steroidal anti-inflammatory medications can be used to minimize lameness and discomfort. Nutritional supplements such as glucosamine, chondroitin and omega-3 fatty acids may also be helpful. Acupuncture, laser therapy, massage and physical therapy are also worth considering. They might work, but the effects tend to be temporary.
Surgery may include arthrotomy (opening of the joint), or arthroscopy (the use of an arthroscope through a small opening) to correct a defect. Portions of bone or cartilage might need to be removed, and articular surfaces might need to be smoothed. Surgical intervention is best done on young patients early on in the disease process to help preserve as much normal joint as possible. In more advanced cases, a total elbow replacement may be needed.
Elbow dysplasia is a hereditary disease, inherited from the parents. Dogs with elbow dysplasia or with elbow dysplasia in a close relative should be removed from any breeding program. Any large-breed dogs being considered for breeding should have their elbows examined and radiographed once mature, and prior to breeding. The Orthopedic Foundation for Animals (OFA) has recommendations for screening of large-breed dogs (including for canine hip dysplasia).
To learn much more about dog diseases, including other dog bone diseases like hip dysplasia, please follow this link from our website.