Page 636 - Cote clinical veterinary advisor dogs and cats 4th

Elbow Dysplasia 289

large percentage of patients have concur- screw fixation causes compression of the continue to have progressive degenerative
rent coronoid disease. anconeal process to the ulna and leads to • Medical treatment consisting of weight
joint disease and need medical therapy.
VetBooks.ir in the diagnosis of coronoid disease to • If elbow incongruity exists, ulnar osteotomy control, exercise restriction, NSAIDs, and Diseases and Disorders
○ CT evaluation of both elbows is useful
bone fusion.
or ulnar ostectomy can be done to help
polysulfated glycosaminoglycan therapy is
differentiate fragmentation, fissuring, and
chondromalacia of the medial coronoid
some surgeons stabilize the osteotomy with
surgical treatment of OCD and FCP.
process. equalize lengths of the ulna and radius; reported to have an outcome similar to
• Arthroscopy is more sensitive than CT for an intramedullary pin.
cartilage lesions and can be used for diagnosis • Partial or total elbow replacement or elbow PEARLS & CONSIDERATIONS
and treatment. arthrodesis may be performed in dogs with
• Arthrocentesis (p. 1059) can be performed moderate to severe elbow osteoarthritis Comments
to rule out other causes of joint effusion. secondary to elbow dysplasia. • Clinical signs of FCP may not correlate with
radiographic evidence of disease.
TREATMENT Chronic Treatment ○ Initial radiographic change is mild
• Medical therapy, alone or after surgery (if osteophytosis on the anconeal process.
Treatment Overview osteoarthritis is present), can include nonster- ○ Some dogs may show mild or no radio-
In persistently lame dogs with elbow dysplasia, oidal antiinflammatory drugs (NSAIDs) graphic changes but be profoundly lame;
surgical treatment involves removal of the FCP, and chondroprotective/joint fluid modifying MRI, CT, or arthroscopy is needed for
OCD, or UAP fragment, which often improves agents (pp. 469 and 721). diagnosis.
limb function. In dogs with elbow incongruity, • Physical therapy may be useful to maintain ○ Conversely, some dogs are not lame but
surgery to improve congruity usually lessens range of motion in the elbow joint. have radiographic evidence of degenerative
lameness and may slow progression of osteoar- • Intraarticular injection of autologous joint disease.
thritis; nevertheless, degenerative joint disease adipose-derived mesenchymal stem cells or ○ Treatment is directed toward the patient,
progresses in most cases. platelet-rich plasma (PRP) may be useful not the radiograph.
in alleviating clinical signs associated with • Lameness may not be evident if bilateral
Acute General Treatment osteoarthritis. forelimb disease is present.
• Elbow arthroscopy by a medial portal is used ○ Anecdotes suggest some efficacy for • Because of the prevalence of bilateral disease,
for treatment of FCP and OCD and to assess alternative pain control modalities such both elbows may undergo arthroscopy with
elbow incongruity. as acupuncture (p. 1056), but there is no one anesthetic episode if clinically indicated.
○ The FCP is identified and removed with proof of efficacy. • The anconeal process does not fuse until 5
grasping forceps or a motorized shaver. months of age (7 months in bassets) and
○ Curettage or removal of the medial Nutrition/Diet cannot be diagnosed radiographically as
coronoid process by a subtotal coronoid • Prescription joint diets may help ameliorate ununited before that time.
ostectomy can be used when fissuring or signs of elbow osteoarthritis. • When manipulating the elbow to check for
chondromalacia is present without gross ○ High levels of omega-3 fatty acids to pain, avoid movement of the shoulder, which
fragmentation. maintain a healthy joint environment may obscure localization of the discomfort.
○ OCD lesion is identified and the carti- ○ Controlled calorie content to help main-
lage flap removed. A motorized shaver tain healthy weight Technician Tips
is used for removing fragments and to Sedation of the animal for radiographs allows
treat the underlying subchondral bone. Possible Complications better positioning and quality of the images.
Osteochondral autograft transfer as well Continued lameness, postoperative infec-
as a synthetic allograft transfer system may tion, implant failure if performing lag screw Client Education
be used as a treatment option for OCD fixation Because of the hereditary component of elbow
lesions. dysplasia, affected dogs should not be used for
• A sliding humeral osteotomy has been Recommended Monitoring breeding.
proposed to redistribute forces from the • Suture removal and recheck at 2 postoperative
medial to the lateral compartment of the weeks SUGGESTED READING
elbow, thereby decreasing pain associated • Repeat radiographs at 6 postoperative weeks Griffon DJ. Surgical diseases of the elbow. In Tobias
with medial coronoid disease. if an ulnar osteotomy, lag screw fixation KM, Johnston SA. Veterinary surgery small animal,
• In skeletally mature dogs, a UAP is often of the anconeal process, sliding humeral St. Louis, 2012, Saunders, pp 733-751.
surgically removed by a lateral approach. osteotomy, or partial/total elbow replacement
• In skeletally immature dogs, ulnar osteotomy was performed. AUTHOR: Raviv J. Balfour, DVM, DACVS
EDITOR: Kathleen Linn, DVM, MS, DACVS
may be used to reduce pressure on the
anconeal process and allow bony or fibrous PROGNOSIS & OUTCOME
union of the fragment.
○ This may be used simultaneously with lag • Surgery will help alleviate lameness for OCD,
screw fixation of the anconeal process. Lag FCP, and UAP, but most affected dogs will

www.ExpertConsult.com