Elbow Dysplasia in Dogs

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Elbow dysplasia refers to the abnormal development of certain parts of the elbow joint during the growing phase of a dog's life. Some areas of the joint may have a disruption of normal cartilage development or failure to fuse during growth resulting in an uneven joint surface, inflammation, joint swelling, lameness and arthritis.

The exact cause of elbow dysplasia is unknown, but it is probably due to a combination of genetic factors, over-nutrition with rapid growth, trauma and hormonal factors. Affected dogs are usually large breeds, including: Labrador retrievers, golden retrievers, Rottweilers, Bernese mountain dogs, Newfoundlands, German shepherds and chow chows. Signs usually begin between 5 to 12 months of age.

Elbow dysplasia results in elbow arthritis which may be associated with joint stiffness (reduced range of motion) and lameness.

What to Watch For

  • A sudden or gradual onset front leg lameness
  • Morning stiffness
  • Stiffness after a period of rest

  • Diagnosis

    Diagnostic tests needed to recognize elbow dysplasia, and identify or exclude other diseases, include:

  • A complete medical history and physical examination. Your veterinarian will walk and trot your dog, looking for front leg lameness. The lameness may be present in both front legs, producing a stiff gait and shortened stride. Pain may be produced on elbow flexion, with or without inward rotation of the paw or elbow extension.

  • Radiographs of the elbow should be taken, with several different views in order to identify even subtle abnormalities. Occasionally CT scans are needed for diagnosis. Both elbows should be examined as the problem often affects both right and left elbow joints.

    Treatment

  • Medical management is usually recommended for dogs with occasional lameness or dogs with significant arthritis. Such management would include the use of anti-inflammatory drugs such as deracoxib or aspirin; nutraceuticals, such as Cosequin or Adequan; regular, moderate exercise programs and appropriate weight control.

  • Surgical management would include procedures to remove damaged or fragmented pieces of cartilage, either directly by making an incision to open the joint or by arthroscopy. Cutting the ulna, one of the three bones that form the elbow joint, thereby avoiding direct intervention with the joint itself, can treat one form of elbow dysplasia. Surgery is most effective in younger dogs, before arthritis develops. It usually improves function but will not prevent some arthritis from developing in the dysplastic elbow joint.

    Home Care and Prevention

    After surgery, the leg is usually placed in a soft padded bandage for two weeks after which time stitches are removed. For the first 4 to 6 weeks after surgery, exercise is restricted. This can be difficult to enforce in young active puppies.

    After this time your pet can undergo a gradual increase in exercise. In some cases, intermittent lameness may persist despite surgery. It is usually mild and may improve with medical management.

    The exact cause of elbow dysplasia remains unknown, but it is almost certainly multifactorial, meaning that the abnormal development of your dog's elbow joint occurs because of a combination of genetic, growth rate, nutritional, hormonal and traumatic factors.

    Of these contributing factors, genetics and nutrition are probably the easiest to consider in terms of prevention of elbow dysplasia. When selecting a pedigree breed known to have a predisposition for elbow dysplasia, it would be helpful to know whether the parents had evidence of elbow dysplasia, or not. For this reason, a scoring scheme for elbow dysplasia has been set up by the Orthopedic Foundation For Animals (OFA). Dogs can be registered when they are over 24 months of age by submitting elbow X-rays to the OFA. They will be evaluated and scored as being normal or abnormal. Abnormal elbows will be graded from I through III, depending on increasing severity of change. This registry is described as "closed" in that it gives out information only on normal dogs to parties other than the breeder (owner). Clearly, it is preferable to purchase a puppy where the sire and the dam have been found to have certified, normal elbows.

    An "open" registry for elbow dysplasia to consider is the Institute for Genetic Disease Control at Davis, California.

    Certain puppy diets have a high protein content that has been cited as a possible reason for bony developmental abnormalities such as elbow dysplasia. Obviously not all puppies on such diets get elbow problems. Monitor your pet's rate of growth by measuring weight and height. If your dog seems to be growing too fast, it may be advisable to change the diet to a lower-protein, adult diet, after consultation with your veterinarian.

    Despite medical and surgical intervention, dogs with dysplastic elbows will go on to develop some degree of elbow arthritis. However, early diagnosis and treatment may help to minimize this problem. Prompt evaluation of a forelimb lameness that gets worse with exercise is recommended.

  • Elbow dysplasia is just one of a number of bone and joint diseases that affect young, growing dogs. A number of diseases that cause front leg lameness need to be considered and excluded by your veterinarian. These include:

  • Osteochondrosis (OCD) of the shoulder joint. Abnormal cartilage development in the shoulder joint can produce a very similar lameness to elbow dysplasia. However, on physical examination pain is localized to the shoulder and not the elbow. A defect is found on shoulder radiographs (X-rays).

  • Panosteitis. Panosteitis is a disease of young, large dogs, which tends to produce lameness that shifts from one leg to another (shifting leg lameness) and where there is pain on deep palpation of certain bones. The exact cause of this bony inflammation is not known and may be mistaken for elbow pain if the bones around the elbow joint are affected. Radiographs of the elbow are normal or show changes consistent with panosteitis, not elbow dysplasia.

  • Hypertrophic osteopathy (HO). HO is a puppy disease that tends to produce swollen limbs, particularly around the carpus (wrist), and with this, fever, lethargy and reluctance to move. Radiographs would confirm the diagnosis and thus differentiate it from elbow dysplasia.

  • Trauma. Elbow dysplasia should be differentiated from other causes of traumatic front leg lameness.

  • Veterinary care should include diagnostic tests and subsequent treatment recommendations. Diagnostic tests needed to recognize elbow dysplasia, and exclude other diseases, include:

  • Physical examination. Lameness is usually evident when your pet is walked or trotted; however, it may be more difficult to detect when both front legs are affected. There may be some difficulty getting up from a lying down position and your dog may appear stiff and have a short stride which may cause the gait to appear stilted and choppy.

  • Orthopedic examination. Pain can often be elicited on manipulation of the elbow joint and the exact location of the lesion(s) will determine what type of elbow motion produces a problem.

    There are three major abnormalities that contribute to elbow dysplasia: an united anconeal process (UAP), a fragmented coronoid process (FCP) and an osteochondritis dissecans lesion of the humerus within the elbow joint (OCD).

  • UAP tends to produce pain on elbow extension.
  • FCP tends to produce pain on elbow flexion with inward rotation of the paw.
  • OCD tends to produce pain on elbow flexion.

    Combinations of these lesions are not uncommon.

  • Your veterinarian will keep the shoulder in a neutral position during the examination so as not to attribute a shoulder problem to the elbow.

  • Radiography of both elbows is important for diagnosis. Often, sedation or general anesthesia will be required to position your dog for these X-rays.

  • Of the three different forms of elbow dysplasia, FCP is usually the most difficult to diagnose. In some of these cases CT scan or another form of radiography called linear tomography can be helpful.

  • Sometimes, in more chronic cases, radiographs will just reveal the arthritic changes around the joint secondary to the underlying abnormalities.

    Treatment In-depth

    Treatments for elbow dysplasia may include conservative medical management or surgery.

  • If your dog has mild or intermittent clinical signs, or more advanced arthritis around the elbow joint, medical treatment is extremely important. Lameness may recur with hard exercise but often responds to a few weeks of rest and anti-inflammatory medication. Exercise should be modified to be moderate and regular in order to maintain good muscle tone, but not to load the joints excessively. Swimming, dependent on availability and your dog's interest, is an excellent adjunctive form of exercise.

  • Surgery is most appropriate for young dogs with minimal secondary arthritic changes in the elbow or cases in which medical management is not producing a favorable result.

  • For FCP and OCD, the damaged or fragmented cartilage within the joint is removed. This can be done either by directly opening the elbow joint or by arthroscopy, the use of fiber optic instruments to look inside the joint and remove abnormal pieces of cartilage through "key-hole" incisions. Arthroscopy has the advantage of being less traumatic to the elbow joint, and therefore a faster recovery from the procedure is common.

  • For UAP, the problem is thought to stem from too much direct pressure on this portion of the joint by the humerus. This effect can be prevented by cutting the ulna just below the joint, allowing the muscles in the area to "adjust" the joint surfaces and relieve the pressure on the UAP. This ununited piece of cartilage can subsequently unite in most cases

    A soft-padded bandage can be helpful after surgery to reduce swelling. This should be kept clean and dry by placing a plastic bag over the foot when your dog goes outside to go to the bathroom. Check the toes at the bottom of the bandage daily for evidence of swelling, excessive sweating or pain.

    Confining a puppy for 4 to 6 weeks after surgery can be extremely difficult and frustrating for both you and your pet. However, it is essential to maximize the success of the surgical procedure. The abnormal cartilage that has been removed has to heal and this becomes more difficult if the elbow is working too hard. Very occasionally, sedatives may be recommended by your veterinarian to get through this phase of the recovery.

    Ideal confinement includes: restriction to a single room or small portion of the home; no going up or down stairs; no jumping on or off furniture; leash-walking only to go to the bathroom and then going straight back inside.

    Staple or suture removal would take place at 10 to 14 days after surgery. Where the incision(s) are exposed, they can be examined on a daily basis for swelling, discharge or redness.

    After the period of rest, exercise should be slowly and gradually increased over the next 4 to 6 weeks, starting with short leash walks, then getting gradually longer with greater freedom around the house to include the use of stairs.

    Where the ulna has been cut, follow-up X-rays will probably be necessary at 6 weeks after surgery in order to assess bone healing.

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