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Elbow dysplasia in dogs by Dr Bardet, at Clinic Abvet, Neuilly-sur-Seine

What is elbow dysplasia?

The word dysplasia means developmental abnormality. The elbow is a joint made up of three bones. When the development of these bones is abnormal, the joint surfaces do not articulate perfectly and joint pressure can concentrate on specific points on the joint surfaces, which can cause several diseases. As with hip dysplasia, a much better-known disease, elbow dysplasia, which encompasses several diseases, most often leads to elbow arthrosis and lameness. Elbow dysplasia is a term that covers 4 different conditions: osteochondritis dissecans (OCD), nonunion of the anconeal apophysis (NAA), fragmentation of the coronoid process (FPCM), and elbow incongruity. Only the last two diseases will be developed here.

Fragmentation of the coronoid medial process (FPMC) is the detachment of a small fragment of bone and cartilage between the ulna and radius.

Macroscopic view of an elbow showing the fragmented coronoid process

The incongruity of the elbow is characterized by an imperfect conformation of the joint which does not fit perfectly.

Elbow incongruity associated with a short radius and abnormally large joint spaces

Medial compartment syndrome of the elbow with disappearance of articular cartilage

How can I tell if my dog has elbow dysplasia?

Elbow dysplasia is a lameness of one or both front limbs, in the latter case the lameness is more difficult to recognize. The lameness is aggravated by exercise and rest. The disease is recognized in young dogs of large or giant growing size but sometimes in older dogs. However, elbow dysplasia and associated osteoarthritis is the most common cause of forelimb lameness in dogs of all ages and sizes.

What causes elbow dysplasia?

The origin of elbow dysplasia is mainly hereditary with over 100 genes identified. However, environmental factors such as obesity during growth and inappropriate nutrition can influence the development of elbow dysplasia. Due to the multitude of genes involved, the availability of a genetic detection test is unlikely in the near future.

What are the long-term consequences of elbow dysplasia?

Any dog with elbow dysplasia will develop some degree of osteoarthritis to a greater or lesser extent. This may be the result of a fragment of bone and free cartilage in the joint, acting as a grain of sand in the shoe, or an incongruity (misalignment of the joint surfaces) not treated surgically. Surgical treatment of elbow dysplasia aims to treat the cause of the disease but also to prevent the progression of osteoarthritis. Medical treatments treat pain and maintain mobility without preventing the progression of osteoarthritis. The clinical course of osteoarthritis of the elbow is unpredictable, some dogs tolerate it very well and others suffer more. Some dogs develop a medial compartment syndrome of the elbow (medial elbow compartment syndrome) which warrants more extensive and appropriate treatment.

How is elbow dysplasia diagnosed by Dr Bardet at Abvet Clinic?

Diagnosis of elbow dysplasia is based on all the symptoms reported by the owners, the breed of dog, the orthopedic examination, the X-rays or even the CT scan and arthroscopy. An early diagnosis is best because the prognosis after treatment is better before the age of 8 months. In the case of lameness of a previous dog which does not respond to a course of anti-inflammatory drugs, it is important to consider that it is not a growth lameness but probably a dysplasia of the elbow which justifies a specialized consultation.

The orthopedic examination by Dr Bardet at ABVet Clinic?

The orthopedic examination reveals lameness on one or both forelimbs and very often an abnormal posture of the limb with the extremity turned outwards.

Frequent posture in German Shepherds with dysplasia of the right elbow with external rotation of the extremity.

The clinician then locates the pain in the elbow and will propose various possible investigations.

Radiography of elbow dysplasia

X-rays of the elbow are often performed by the attending veterinarian. The official diagnosis of elbow dysplasia is made at 12 months of age using 3 x-rays. However, it is imperative to obtain an early diagnosis if elbow dysplasia is suspected. A mid-lateral X-ray in maximum flexion ideally allows the lesions to be visualized.

The absence of radiographic lesions does not exclude the presence of elbow dysplasia. In the absence of radiographic lesions but in the presence of suggestive clinical signs, a CT scan of the elbows is justified.

Computed tomography examination of the elbow at ABvet Clinic ?

A CT scan of the elbows is a complementary examination in the same way as an arthroscopy. It allows a complete evaluation of all the lesions associated with elbow dysplasia. It is a very sensitive examination and facilitates the identification of fragments and the nature of the dysplasia.

X-ray of an elbow with dysplasia

CT-scan showing the presence of a fragmented coronoid process (PCF)

T-scan of the dysplastic elbow showing an abnormally large joint spaces

What are the treatments for elbow dysplasia in dogs at by Dr Bardet at the Abvet Clinic?

Non-surgical conservative treatments recommended in Paris

Non-surgical conservative treatment is sometimes recommended in the case of subtle symptoms and in the absence of dysplasia and incongruence shown on X-rays. Conservative treatment includes weight reduction, exercise modification and medication (non-steroidal anti-inflammatory drugs, chondroprotectors, growth factor-enriched plasma, stem cells). This treatment can also be used in dogs awaiting surgical treatment. Surgical treatments

1- Removal of fragments under arthroscopy

In dogs in which the fragmented coronoid process appears isolated without incongruence, arthroscopy is the ideal solution (video). In this case neither the CT scan nor the arthroscopy showed any lesions other than the fragment. Your pet is then treated on an outpatient basis (operated on and returned the same day). The prognosis depends on the degree of pre-operative osteoarthritis and dysplasia but is generally very favorable.

2- Dynamic ulnar osteotomy

For some elbows, the fragmentation of the coronoid process is secondary to a short radius and the incongruity is severe and will remain permanent. It is now recognized that sectioning the proximal ulna (osteotomy) allows the tip of the medial coronoid process to be relieved and reduces joint stress and secondarily lameness and osteoarthritis.

Diagram of a dynamic ulnar osteotomy explaining the discharge of the coronoid process

3- The CUE unicondylar elbow prosthesis

The CUE unicondylar elbow prosthesis is indicated for patients with medial compartmental elbow syndrome when the lateral compartment is normal. This unicondylar prosthesis uses a titanium humeral implant that articulates to the titanium inlaid polyethylene implant implanted in the medial coronoid process opposite the humeral implant.

Diagram of the CUE unicondylar prosthesis with its implants and their positioning

Postoperative view of the CUE elbow prosthesis in the dog

Initial clinical results report a success rate of 91% of cases. Complications were mainly associated with loosening of the polyethylene implant inserted without fixation in the medial coronary process. The new bio-integrable ulnar implant suggests a significant reduction in the number of complications.

The total elbow prosthesis in dogs

The total elbow prosthesis is reserved for animals suffering (photos 16 and 17) from very severe generalized osteoarthritis of the elbow with loss of cartilage and a significant reduction in mobility. This is again an operation of last resort when all other solutions have been used. The Tate total elbow prosthesis is the one with the best clinical results. The material consists of a cementless implantable cartridge. The technique uses a milling of the joint surfaces with a sophisticated guidance system.

View of the TATE total elbow prosthesis and its implantation diagram

Postoperative view after implantation of the TATE total elbow prosthesis

This prosthesis is indicated on animals that do not respond to any other treatment and when they are more than 9 to 10 years old. Functional recovery is slow as it requires 6 to 8 months of physical therapy. The rate of minor and major complications is around 20%. It is important to recognize and treat elbow lameness very early and to understand the physiopathology in order to apply a reasoned diagnostic approach and to choose an appropriate treatment technique. Despite this apparent complexity, the quality of clinical results has evolved considerably with the different techniques developed in recent years, even if osteoarthritis sometimes remains problematic. We have gone from a time when only the removal of PCF was the rule to multitude choices.

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