Downeast Dog News
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“OH, MY ACHING ELBOW”

Canine Elbow Dysplasia
By Dr. Meghan Sullivan, DVM | Oct 01, 2021

Canine elbow dysplasia is an inherited syndrome that is made up of four separate diseases. This is usually caused by growth disturbances in the elbow joint which consists of the humerus, ulna, and radius. Elbow dysplasia is most often seen in large to giant breed dogs such as German Shepherds, Rottweilers, Labradors, and Golden Retrievers. Some breeds such as German Shepherds, Mastiffs, and Bernese Mountain dogs have a predisposition to ununited anconeal process. Dogs with elbow dysplasia will often present with lameness between 5 and 12 months of age.

The four components of elbow dysplasia include (get ready for this mouthful!) fragmented medial coronoid process (FMCP- medial coronoid disease), ununited anconeal process (UAP), incongruity, and osteochondrosis desiccans (OCD). Any of these abnormalities will result in joint inflammation and cartilage damage which cause progressive osteoarthritis. The symptoms of elbow dysplasia include front leg lameness that is progressive. Elbow dysplasia affects both front legs in 35% of affected dogs. The most common symptom is intermittent lameness which often follows vigorous exercise (especially in “weekend warrior” pups).

Diagnostics include a physical examination to detect any lameness, pain during manipulation of the joint, effusion (swelling) within the joint, and thickening of the joint. While standard radiographs can detect arthritis, joint swelling, and ununited anconeal processes, they have a low ability to detect a fragmented medial coronoid process because of the overlapping bones. Advanced imaging such as computed tomography (CT scan) has a superior ability (approaching 90%) to reveal FMCP, and hence, is the “gold standard” for diagnosis of FMCP Elbow arthroscopy (using fiberoptic instruments) is another method (the most sensitive to diagnose medial coronoid disease) for both detecting and treating the syndrome.

Treatment for elbow dysplasia depends on first identifying the underlying defect (s). Surgery is recommended to improve the patient’s quality of life, reduce joint pain, and minimize lameness. Arthroscopic surgery is the minimally invasive technique for diagnosing, as well as treating the elbow joint. Arthroscopy is performed under brief general anesthesia and a camera is placed into the joint to evaluate the cartilage and joint. It is used to visualize any fragments (which are highly irritating to the joint surfaces) within the joint, which can be removed during the same procedure. Postoperative recovery includes moderate exercise restriction for about 6 weeks and then patients can return to normal.

Unfortunately, elbow dysplasia does result in progressive arthritis and is not curative. However, with the early and appropriate invention, your dog’s athletic ability can be preserved and lameness/ pain diminished for an extended period. The reported prognosis for improvement is between 50-100%. That means more comfortable hikes, runs, hunts, and group play for your best friend!

As joint arthritis progresses, other modalities that may be beneficial include joint Shockwave (PulseVet ®) therapy, joint injections with PRP (platelet-rich plasma), HA (hyaluronic acid), or stem cells. Collectively, these treatments can decrease inflammation, promote healing, and decrease joint pain.

For patients with severe lameness, joint pain, and damage, an additional surgery can be performed called the “PAUL” surgery. PAUL stands for proximal abducting ulnar osteotomy which helps to shift weight away from the damaged part of the joint to a healthier part of joint. This surgery has shown good success in improving patient comfort levels.

The newest modality currently available for the management of synovitis (inflammation of the joint) is Synovetin OA®. This technique uses novel, conversion electron therapy (sounds crazy but true) to specifically target the inflammatory cells within the injected joint. It is a targeted treatment to provide pain and inflammation relief for animals with arthritis. Treatment entails one joint injection (into one or both elbows) and has been shown to relieve pain and inflammation for up to 1 year! Overall, elbow dysplasia is a very manageable condition. The key to success is a timely and accurate diagnosis. A consultation with an orthopedic specialist, DACVS (Diplomate of College of Veterinary Surgeons) would be the best way to diagnose your pup and discuss all available treatment options to reduce pain and increase patient mobility!

 

Dr. Meghan Sullivan, DVM

Diplomate, American College of Veterinary Surgeons

Portland Veterinary Emergency and Specialty Care