Page 230 - Canine Lameness

202 14 Elbow Region

developing a condylar fracture, in which case treatment is much simpler and associated with less
cost and a better prognosis (Moores and Moores 2017). Treatment consists of surgical fixation
across the condyles to prevent fracture development (Hattersley et al. 2011).

14.4.1 Signalment and History
Spaniel breeds are predisposed to IOHC (Moores et al. 2012), however, many other breeds (including
Yorkshire Terriers, Labrador Retrievers, German Shepherd Dogs, Rottweilers, and Mastiff) may also
be affected by this condition. Dogs typically present for lameness due to IOHC later in life with a peak
age at presentation of three to four years. However, recent awareness of the condition (particularly in
the United Kingdom) has allowed for earlier diagnosis prior to the patient showing clinical signs.
Early clinical signs of lameness may result from micromovement of the condyles (without fracture),
but if the condition remains undiagnosed, animals may present later with more acute lameness once
condylar fractures occur (Figure 14.4; Witte et al. 2010). Therefore, the degree of lameness and acuity
can be highly variable amongst the different patients presenting with this condition. Certain features
of the patient history, taken together with the patient signalment, should alert the clinician to con-
sider IOHC as an underlying cause when patients are presented with acute condylar fractures:
Owners may have observed a lameness prior to the non-weight-bearing lameness associated
ELBOW REGION ● Condylar fractures because of IOHC may occur after minimal trauma (similarly to condylar
●
with the fracture (prodromal lameness).
fractures in immature animals).
In such cases, diagnostics of the non-affected limb should be considered to evaluate whether pro-
phylactic treatment should be considered (in addition to treating the affected limb).

14.4.2 Physical Exam
In patients with IOHC, pain is most pronounced with hyperextension of the elbow and in some
cases upon palpation of the lateral epicondylar region. However, it is important to note that physi-
cal exam findings may be deceiving as in some cases, dogs with IOHC may possess normal ROM
with no effusion, crepitus, or periarticular thickening (Butterworth and Innes 2001). Therefore,
diagnostics should be recommended in any middle-aged Spaniel breed (or other predisposed
breeds) with undiagnosed lameness even in face of a normal elbow examination.

14.4.3 Diagnostics
Diagnosing IOHC can be challenging and may require advanced imaging. Radiographs may show
a radiolucent line extending through the condyles or a smooth proliferation along the lateral supra-
condylar crest indicating stress remodeling (Figure 14.4) of this area due to instability of the con-
dyles (Marcellin-Little et al. 1994). If such findings are not observed, IOHC or HIF may not be
ruled out and advanced imaging should be considered as the next step. It is most common to use
CT, although MRI has also been reported (Piola et al. 2012). Since IOHC is bilateral in ~25% of the
dogs, both limbs should be evaluated. This is easily accomplished using CT, thus making it the
ideal imaging modality. Bilateral radiographs may be considered instead if CT is unavailable,
recognizing that some lesions may be missed since the radiographic beam must be parallel to the
fissure line to accomplish a diagnosis. Therefore, oblique radiographs (including a 15° craniome-
dial caudolateral view) should be performed if radiographs are used as the sole diagnostic tool
(Hattersley et al. 2011).