Page 243 - Canine Lameness

14.13 Flexor Enthesopathy 215

14.12.2 Physical Exam
Lameness associated with septic arthritis is generally severe and associated with substantial pain
upon joint manipulation. Periarticular joint swelling (in severe cases pitting edema) and local heat
is common and can be severe at times (Video 14.3). Other symptoms associated with postsurgical
septic arthritis may include discharge (varying from serous purulent) from the incision site, licking
of the surgical site, or exposure of the implant. Some animals present with pyrexia and/or local lym-
phadenopathy; however, a lack of either or both does not rule out septic arthritis as a diagnosis.

Video 14.3

Clinical presentation of septic elbow arthritis mimicking a neurologic problem.

14.12.3 Diagnostics
A diagnosis of septic arthritis is made based on a combination of clinical symptoms, physical exam
findings, cytology, and joint fluid culture. However, cytologic findings in septic arthritis vary
(Chapter 9) and rarely show the pathognomonic finding of intracellular bacteria. Similarly, a nega-
tive culture has been reported in up to 50% of dogs with septic arthritis (Clements et al. 2005).
Therefore, because some cases with suspected septic arthritis may not be diagnosed definitively, ELBOW REGION
response to antibiotic therapy may be used to solidify a tentative diagnosis.
Radiographs may be used to diagnose chronic changes associated with ongoing septic arthritis.
Such changes may include secondary degenerative or erosive changes and signs of osteomyelitis
(Figure 14.12C). For some joints (such as stifle), substantial joint effusion can be seen radiographi-
cally and be a helpful indicator of intra-articular disease.

14.13 Flexor Enthesopathy

Flexor enthesopathy (FE) is defined as pathologic changes of the flexor muscles originating at the
medial epicondyle of the humerus (De Bakker et al. 2012). The disease has previously been reported
under the names ununited medial epicondyle and medial humeral condylar osteochondritis dis-
secans. This disease can be a single disease entity (primary FE) or may occur together with other
elbow pathologies such as MCD (concomitant or secondary FE). Treatment of the primary form
focuses on treating the affected muscles while the concomitant form is frequently treated by
addressing the concomitant pathologies (De Bakker et al. 2013).

14.13.1 Signalment and History

FE has been described in several large medium-sized breeds. The incidence has been reported to
be 15% in nonclinical Labrador Retrievers (Paster et al. 2009) and 40% in dogs presented for lame-
ness thought to be due to elbow pathology (De Bakker et al. 2012).

14.13.2 Physical Exam
Palpation of the origin of the flexor muscles may reveal thickening and occasionally the calcified
bodies can be palpable. Pain upon stretching of the flexor muscles (carpal extension while flexing