Common conditions of the forelimb

Question 1

What do we look for when assessing FL lameness?

Answer 1

Head nod
Sink on Sound

Question 2

What is the grading scheme out of 5 for lameness?

Answer 2

0: none
1: mild, lameness consistent at trot
2: mild-mod, obvious as walk, worse at trot
3: mod, obvious lameness both gaits
4: mod-severe, intermittent non-weight bearing
5: severe, non-weight bearing

Question 3

What could cause shoulder lameness in young dogs?

Answer 3

ostepchondritis dissecans (OCD)
shoulder oa, shoulder soft-tissue injuries rotator cuff, trauma, instability

Question 4

Where is osteochondrosis most often found in dogs?

Answer 4

elbow and shoulder
then stifle, tarsus

developmental disease in fast growing often high performance patients

Question 5

How does osteochondrosis develop?

Answer 5

during development, cartilage becomes bone
requires blood supply: endochondral ossification

if problem with vasculature in cartilage: cartilage doesn’t form bone, thickened plug avascular, necrotic cartilage, may cause fissure/flap formation

Question 6

What are the signs on Hx and PE indicating OCD of canine shoulder?

Answer 6

usually around 4-8mo
progressive FL lameness uni or bilateral

FL lameness, may have muscle atrophy shoulder region, pain on shoulder extension or flexion (not usually palpation)

normal xrays show very smooth margin of the bone, OCD has mineralised flap

Question 7

What is the source of the pain in OCD?

Answer 7

the flap: surgical removal recommended and curettage defect

Question 8

What is the prognosis for OCD?

Answer 8

if minimal OA, excellent long term prognosis if treated when young

bigger lesions and presenting when older = worse OA

Question 9

What are the tx options for OCD?

Answer 9

surgical removal: arthrotomy, arthroscopic

spontaneous break off: improves comfort but could interfere with biceps

conservative: symptomatic improvement but flap removal is better

Question 10

When are shoulder luxations prone to happen?

Answer 10

young toy breed - dysplastic
trauma associated

surgical management only

Question 11

When are animals prone to shoulder instability?

Answer 11

most commonly medial
degeneration middle aged dogs

conservative/surgical

Question 12

When are animals prone to bicipital disease?

Answer 12

degeneration middle aged dogs
acute overload

medical then sx tx

Question 13

What animals are more prone to elbow disease?

Answer 13

MN large breed (rottie, lab)

bimodal peak disease
61% bilateral

Question 14

What is elbow dysplasia?

Answer 14

umbrella term for several developmental pathologies

named developmental elbow disease and all the conditions cause OA

Question 15

What are the 3 main conditions of developmental elbow disease?

Answer 15

fragmented medial coronoid process FCP/medial coronoid disease MCD

osteochondrosis humeral trochlea

ununited anconeal process UAP

*MCD is most common

Question 16

What kind of dogs get elbow dysplasia frequently?

Answer 16

young medium-giant breeds or smaller chondrodystrophic dogs
35% bilateral

genetic heritability: rottweilers, retrievers, bernese mountain dogs
males

Question 17

How do dogs develop elbow dysplasia?

Answer 17

growth disturbance causing asynchronous growth and abnormal loading

radial-ulna incongruity

Question 18

Where is the pressure if the radius is short?

Answer 18

on medial coronoid

Question 19

Where is the pressure if the radius is long?

Answer 19

anconeal process

Question 20

Where is the pressure if there is trochlea notch dysplasia/hymero-ulna conflict?

Answer 20

broad, crazy, multiple points

Question 21

When is FL lameness from elbow dysplasia usually found?

Answer 21

5-7mo but most diagnosed at 12mo
insidious chronic lameness
worse post rest or exercise +++

frequently bilateral, possibly shift sides, improve on NSAIDs

Question 22

What are the signs on clinical exam for elbow dysplasia?

Answer 22

rotation paw
elbow close/away body
reduced weight bearing
muscle atrophy
elbow effusion: caudal and lateral to lateral epicondyle

ensure isolate elbow: don’t manipulate shoulder and carpus together

Question 23

What are the 3 xray views needed for elbows?

Answer 23

CrCd
MLn
Mlf

Question 24

What can radiographs help diagnose regarding elbow dysplasia?

Answer 24

usually: ununited anconeal process UAP, OCD humerus, incongruity
CT/arthroscopy can confirm dx

superimposition makes diagnosing medial cornoid disease MCD difficult

Question 25

What dogs are prone to ununited anconeal process?

Answer 25

GSD, basset hounds, american bulldog
50%+ bilateral

Question 26

What are the clinical signs of ununited anconeal process?

Answer 26

mod-severe lame
elbow pain
effusion

once over 20ww on xray

Question 27

What is the treatment for ununited anconeal process and prognosis?

Answer 27

conservative: poor v lame
removal: improvement but long term OA ++
Osteotomy: improve, poss heal, some OA
repair+/-osteotomy: improve, most heal, min OA

Question 28

What is medial coronoid process disease?

Answer 28

most common elbow dysplasia
elbow pain and maybe xray OA especially in full flexion/extension

Question 29

What signs indicate medial coronoid process disease

Answer 29

5-7mo most diagnosed at 12 mo
insidious to chronic lameness
worse post rest or exercise ++

Question 30

What is the conservative treatment for medial coronoid disease?

Answer 30

weight restriction
regular exercise (frequent short walks)
hydro
NSAIDs
Omega 3

Question 31

What are the non-conservative treatment options for medial coronoid disease?

Answer 31

arthrotomy or arthoscopy: remove fragment +/- reduce size medial coronoid, allows more rapid movement

ulna osteotomy: change loading in elbow, usually if incongruency present but NOT advisable

Question 32

What is the prognosis for elbow dysplasia?

Answer 32

Life-long disease process
OA will progress, can have several flare ups

Ends up as OA management but could have many years of good function

Question 33

What is humeral intracondylar fissures HIF?

Answer 33

partial complete gap in the humeral condyle
NOT elbow dysplasia

best diagnosed on CT