Conditions of the Elbow Joint Flashcards
Elbow dysplasia conditions
- Fragmented coronoid process (FCP)
- Un-united anconeal process (UAP)
- Osteochondritis dissecans (OCD)
- Elbow incongruity
Elbow Dysplasia
- etiology, causes
Polygenic, heritable developmental disease causing incongruity of the elbow joint
* Incongruity
> Fragmented coronoid process
> Un-united anconeal process
* OCD
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Elbow dysplasia is inherited, polygenic, multifactorial
Elbow Dysplasia - common in what breeds?
- Rottweiler 46%
- Bernese Mountain Dog 40%
- Saint Bernard 30%
- Newfoundland 27%
- German Shepherd Dog 19%
- Labrador Retriever 15%
Most common cause of elbow lameness in young, growing, large breed dogs
Fragmented Coronoid Process (FCP)
Fragmented Coronoid Process (FCP)
- how common? in what dogs?
- what is wrong?
- can be concurrent with what condition?
- Most common cause of elbow lameness in young, growing, large breed dogs
- The coronoid process does not develop from a separate center of ossification
- FCP and OCD may coexist in the same joint
FCP – Clinical Signs, progression, sex…
- same as what other conditions?
- Insidious onset 5-6 months
- Slow progression
- Effusion, lameness, crepitation
- Male:female= 2:1
- Often bilateral
<><> - Same for OCD
- Or incongruity…
what anatomic abnormality may be important for FCP development?
A radius too short may be pivotal in FCP development
Elbow OCD
- clinical signs similar to what?
- easy to differentiate?
- what structure is affected (vs FCP)
- Clinical signs similar to FCP or incongruity
- Difficult to differentiate from other causes
> May coexist with other pathologies
<><><> - Medial humeral condyle (trochlea)
- (Opposite to FCP)
FCP / OCD Diagnosis
Radiographs:
* Non specific
* DJD
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CT Scan:
* Highest accuracy and sensitivity for diagnosis of FCP
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Arthroscopy
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Incongruity may or may not be present at time of diagnosis
FCP/OCD Treatment
- what options do we have? when are they useful?
- what can we do?
- Controversial
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Exploration: (Younger dogs, less DJD,…) - Removal of the loose fragment
- Maybe associated with severe cartilage erosion
- Removal of the diseased cartilage
- Correction on incongruity (Oblique ulnar osteotomy)
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Conservative (Older, advanced DJD,…) - Weight loss
- Moderate exercise
- NSAIDS
- Chondroprotectants
Dynamic Ulnar Osteotomy
- when should we do this?
- what do we do and why?
- how does it heal?
Tx for FCP / OCD of the elbow
* If incongruity is present or suspected
* Oblique osteotomy of the Ulna to allow it to “shift” down and decrease pressure on the coronoid or anconeus process
* Heals by second intention
FCP – Prognosis
- post op care?
- long term conditions?
- what is the best treatment?
Post operative care
* Limited exercise 4-8 weeks
* NSAIDs, DMOAs
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Long term prognosis is fair
* Maybe associated with severe cartilage
loss
* Lameness generally improves but persists
* Degenerative joint disease continues to progress
* May requires lifelong NSAIDs, DMOAs
* Objective data is missing…
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Legitimate questions exist regarding the best treatment and prognosis of elbow dysplasia in dogs.
Un-united Anconeal Process (UAP)
- who is susceptible?
- how it arises?
- how it should be normally?
- male vs female, bilateral vs uni?
- Large, young growing dogs
- Requires a separate center of ossification
> German shepherd, basset hound, St Bernard… - Normally fuses at 20 weeks (Diagnosis rarely made before 5 Months)
- Male-female: 2-1
- Bilateral 11-30%
Un-united Anconeal Process (UAP)
- pathophysiology
- Asynchronous growth may have a pivotal role
- Ulna too short
- Prevent fusion of anconeal process
UAP: Treatment options, when we use them
Non-displaced fragments:
* Screw fixation and “dynamic oblique ulnar osteotomy”
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Chronic or displaced fragments:
* Excision through a lateral approach
* Easiest
