Elbow dysplasia

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Elbow dysplasia is a congenital disease of the canine elbow[3] and a leading cause of elbow osteoarthritis.

This disease is commonly observed in young large breeds such as Great Dane, Rottweiler, Labrador Retriever, German Shepherd and Burnese Mountain Dog[4] and is associated with a number of underlying etiologies:

This condition can occur unilaterally or bilaterally and usually becomes apparent at a young age (often by 6 months). The condition is aggravated by obesity and heavy exercise.

Affected dogs usually present with an intermittent but progresssivly worsening lameness of the foreleg, variable top-stepping and shifting lameness if both elbows are affected. There is reluctance to walk, reduced exercise activity and reluctance to have the elbow extended through full motion.

Diagnosis is based on clinical signs of elbow lameness and arthroscopic[6], radiographic or CT scoring of medial coronoid disease, medial humeral condyle changes, osteoarthritis and radioulnar incongruence[7].

A fragmented coronoid process (usually genetic in large-breed dogs)[8], blurring of the medial coronoid process cranial edge, ulnar trochlear notch sclerosis, a radioulnar step and the widening of the humeroulnar and humeroradial joint space are indicative of elbow dysplasia[9][10].

A differential diagnosis would include congenital elbow luxation, osteomyelitis, osteosarcoma, panosteitis and hypertrophic osteodystrophy.

Surgical repair is usually indicated for ununited anconeal process or fractured coronoid process.

Non-surgical intervention usually requires long term palliative treatment with NSAID-based medication such as carprofen, fentanyl, tramadol, meloxicam[11], gabapentin or in severe cases, prednisolone.

Use of exercise has significant benefits in long-term therapy associated with osteoarthritis, and leash-held walking is recommended in dogs that are not unduly ataxic or in pain[12].

Adjunct medication such as pentosan polysulfate, glucosamine, veterinary therapeutic diets rich in omega-3 fatty acids[13], curcumin[14] and root extracts of Brachystemma calycinum (an indigenous plant of southwestern China)[15] have predictable improvements in clinical amelioration of symptoms.

Products such as neutraceuticals[16] and fish oils[17] appear to not benefit pain scores in dog affected by this condition.

Managing chronic pain is the critical aspect of this relatively incurable disease, affording as good quality of life as possible based on economic feasibility and response to medical and physical therapy[18].

Screening has resulted in a gradual reduction in clinical severe cases by routine screening of potential sires[19].

References

  1. Vet Surgery Central
  2. Phillipe Duponant
  3. Stock KF et al (2011) Genetic analyses of elbow and hip dysplasia in the German shepherd dog. J Anim Breed Genet 128(3):219-229
  4. Hartmann P et al (2012) Multivariate prediction of breeding values for canine hip and elbow dysplasia as well as humeral osteochondrosis in the Bernese mountain dog. Berl Munch Tierarztl Wochenschr 125(9-10):432-440
  5. Cook CR &Cook JL (2009) Diagnostic imaging of canine elbow dysplasia: a review. Vet Surg 38(2):144-153
  6. Werner H et al (2009) Sensitivity and specificity of arthroscopic estimation of positive and negative radio-ulnar incongruence in dogs. An in vitro study. Vet Comp Orthop Traumatol 22(6):437-441
  7. Gasch EG et al (2012) Computed tomography of ununited anconeal process in the dog. Vet Comp Orthop Traumatol 25(6):498-505
  8. Temwichitr J et al (2010) Fragmented coronoid process in the dog: a heritable disease. Vet J 185(2):123-129
  9. Lappalainen AK et al (2009) Radiographic and computed tomography findings in Belgian shepherd dogs with mild elbow dysplasia. Vet Radiol Ultrasound 50(4):364-369
  10. Samoy Y et al (2012) Sensitivity and specificity of radiography for detection of elbow incongruity in clinical patients. Vet Radiol Ultrasound 53(3):236-244
  11. Wernham BG et al (2011) Dose reduction of meloxicam in dogs with osteoarthritis-associated pain and impaired mobility. J Vet Intern Med 25(6):1298-1305
  12. Bockstahler BA et al (2012) Hind limb kinematics during therapeutic exercises in dogs with osteoarthritis of the hip joints. Am J Vet Res 73(9):1371-1376
  13. Moreau M et al (2012) Effects of feeding a high omega-3 fatty acids diet in dogs with naturally occurring osteoarthritis. J Anim Physiol Anim Nutr (Berl) Jul 14
  14. Colitti M et al (2012) Transcriptome modification of white blood cells after dietary administration of curcumin and non-steroidal anti-inflammatory drug in osteoarthritic affected dogs. Vet Immunol Immunopathol 147(3-4):136-146
  15. Moreau M et al (2012) Brachystemma calycinum D. Don Effectively Reduces the Locomotor Disability in Dogs with Naturally Occurring Osteoarthritis: A Randomized Placebo-Controlled Trial. Evid Based Complement Alternat Med 2012:646191
  16. Vandeweerd JM et al (2012) Systematic review of efficacy of nutraceuticals to alleviate clinical signs of osteoarthritis. J Vet Intern Med 26(3):448-456
  17. Hielm-Bjorkman A et al (2012) An un-commissioned randomized, placebo-controlled double-blind study to test the effect of deep sea fish oil as a pain reliever for dogs suffering from canine OA. BMC Vet Res 8(1):157
  18. Fox SM (2012) Painful decisions for senior pets. Vet Clin North Am Small Anim Pract 42(4):727-748
  19. Worth AJ et al (2010) Reduction in the incidence of elbow dysplasia in four breeds of dog as measured by the New Zealand Veterinary Association scoring scheme. N Z Vet J 58(4):190-195
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