Vet Buzz from Erin Troy, DVM, CCRP,
Muller Veterinary Hospital, Walnut Creek, CA
Elbow dysplasia is the most common cause of forelimb lameness in the young dog, especially of the larger breeds.
The elbow is a complicated joint because it is made up of three bones: the humerus in the upper limb, and the radius and ulna in the lower limb. Each of these bones needs to grow and develop simultaneously and the cartilage inside the joint must fit all surfaces of the bones.
There are several forms of elbow dysplasia including osteochondritis dessicans of the medial humeral condyle (OCD), fragmented medial coronoid process (FCP), ununited anconeal process (UAP), and ununited medial epicondyle (UME). These can be present singly or in combination and generally all forms produce a piece of loose cartilage or bone that floats around and irritates the joint. Left untreated, each of these primary forms leads to the secondary disease of arthritis. The longer the elbow goes without treatment the worse the arthritis is. The major changes in arthritis are irreversible.
Symptoms can include a mild to moderate foreleg lameness in dogs from 4 to 10 months. This is a critical stage for diagnosis because the longer one waits, the more arthritis will develop. The lameness can be on again off again making some families feel the situation is not a serious one. It is strongly recommended that all dogs be screened early for elbow dysplasia if any symptoms develop.
Diagnosis is made based on physical examination, radiographs, and in some cases CT, MRI and or arthroscopy.
Treatment is usually performed through arthroscopic surgery. Early intervention provides for the best long term outcome. In the dog where there was not an opportunity for an early diagnosis or treatment, other options for management are available. These include non-steroidal anti-inflammatory drugs (NSAIDs), chondroprotectants, disease-modifying Osteoarthritis drugs (DMOAD’s), analgesics, and various forms of physical rehabilitation. There are several newer surgical options including the sliding humeral osteotomy procedure (SHO) and a total elbow replacement which are still in the developmental stage.