Page 240 - Canine Lameness

212 14 Elbow Region

been described to change pronation from approximately 30–60° after transection of the medial
collateral ligament and supination from approximately 45–70° after transection of the lateral col-
lateral ligament. However, a large inter-animal variation was also reported (Farrell et al. 2007).
Therefore, comparison to the contralateral limb is recommended. NOTE: this test is also used to
evaluate for a pain response in dogs with ED as discussed in Section 14.6.2.

14.10.3 Diagnostics
Elbow luxations (congenital and traumatic) are generally suspected based on history (for
traumatic luxations) and palpation; the diagnosis is easily confirmed via radiography. For
TEL, craniocaudal projections clearly show displacement of the radius/ulna while lateral pro -
jections may be less obvious. The observer should also evaluate the radiographs for evidence
of chronic changes (such as osteoarthritis) or avulsion fragments of the collateral ligament
(Figure 14.9F) or other fractures since these findings may pose a contraindication for closed
reduction and require surgical intervention. For CEL, radiographic changes vary based on the
type of luxation and severity. If surgical treatment is planned, further imaging (CT) may be
indicated to assess the integrity of the coronoid process and degree of elbow incongruity, and
to aid in surgical planning.
ELBOW REGION 14.11 Panosteitis

Panosteitis is a developmental disease that affects the adipose components of the bone marrow of
long bones. The disease has also been reported in the literature as eosinophilic panosteitis, juvenile
osteomyelitis, as well as enostosis (i.e. medullary fibrosis). Histologically, the disease cycles through
a phase where adipose bone marrow is replaced with osseous tissue followed by regeneration of
the bone marrow to its original constitution. The disease was once thought to be of bacterial or
viral origin; however, currently the etiology is controversial, and newer theories have included an
association with high-protein diets and osseous compartment syndrome (Schawalder et al. 2002).
Moreover, the high incidence in German Shepherd Dogs suggests a genetic component. The dis-
ease is self-limiting and generally not associated with systemic signs. Treatment consists of rest
and pain management.

14.11.1 Signalment and History

Dogs affected with panosteitis most commonly present symptomatically between 5 and
18 months of age, although the disease has been reported in patients up to 5 years of age.
Lameness can be of varying degrees of severity and may affect one or multiple limbs simultane -
ously or sequentially since the disease frequently affects multiple bones (Bohning et al. 1970).
The latter explains one of the hallmark signs of panosteitis, a lameness that shifts from one leg
to another. Since the disease is self-limiting, owners may also report that the symptoms resolved
without treatment. Recurrence may occur, yet in most cases subsequent episodes are less severe.
Panosteitis is seen most frequently in German Shepherds (with a male predisposition), although
many other large/giant breeds and even small-breed dogs are reported to be affected. As such,
the disease should be considered a differential for any juvenile dog presented with shifting leg
lameness (Towle-Millard and Breur 2018).