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
<><><><>
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
<><>
CT Scan:
* Highest accuracy and sensitivity for diagnosis of FCP
<><>
Arthroscopy
<><>
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
<><>
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)
<><>
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
<><><>
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…
<><><>
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”
<><>
Chronic or displaced fragments:
* Excision through a lateral approach
* Easiest
UAP: Treatment – Fragment Removal
- prognosis?
- Prognosis fair but better than FCP/OCD
- Osteoarthrosis will progress
- Medical management as required
Elbow Luxation
- are they usually medial or lateral? why?
- mostly congenital or traumatic?
Because of the presence of a large medial trochlea, almost all luxations are lateral.
* Traumatic (most frequent)
* Congenital (rare) > Significant deformities
Traumatic elbow Luxation
- how does it arise? how painful?
- what do we see?
- rule outs?
- Violent trauma
- Very painful
- Non-weight bearing lameness
- Must rule out Fx
- Neurologic Examination!!
Elbow Luxation: Closed Reduction
- when can we do this? when should we not?
- easy?
- Acute traumatic luxations
- Do not attempt in congenital
- Do not attempt if fractured
<><><> - Perform as soon as possible
- General anesthesia
- Hard!
Elbow Luxation: Treatment
- what should we do if we reduce and it is stable?
- what if not stable or large dog?
- prognosis?
If stable post reduction:
* Splint in extension (spica) 1-2 wks
* Restricted activity 4-8 weeks
<><><>
If significant instability or large active dog:
* Surgically repair the ligaments
* Splint for 2 weeks
* Restricted activity for 4-8 weeks
<><><>
Prognosis: Good but some OA and mild lameness expected
Elbow Luxation: Treatment - arthrodesis
- when should we do this?
- outcomes?
Arthrodesis:
* Non-reducible fractures
* Extensive damage to articular cartilage
* Chronic luxation
<><><>
Outcome:
* Possible but difficult
* +/- Mechanical lameness
Incomplete Ossification of the Humeral Condyle
- common in what breed?
- assoc risk?
> issues?
- Cocker spaniels
(Springer spaniels, Labradors, Cavalier King Charles, Rottweilers) - At risk for humeral condylar fracture
- Repair of fractures = 20% failure rate
Incomplete Ossification of the Humeral Condyle (Spaniels)
- etiology
- Humeral condyles > 2 distinct ossification centers
- No fusion occurs
- Inheritance is believed to be autosomal recessive
Incomplete Ossification of the Humeral Condyle (Spaniels) - repair
- efficacy?
- how do we do it?
- Large complications with repair
- preventive fixation of non-fractured elbow with lag screw – minimal success
- New technique – large core across condyles and pack with bone graft – lag screw
Elbow dysplasia summary
- cause
- who is affected
- subcategories
- prognosis
- Group of diseases caused by asynchronous growth
- Young, large breed dogs
- FCP, UAP, Incongruity, OCD
- Prognosis guarded, progression of DJD
Elbow Luxation summary
- types
- typical presentation, Tx, prognosis
- Traumatic
> Almost always Lateral
> Closed or open reduction - Congenital
> Severe deformities, poor prognosis
Incomplete Ossification of the Humeral Condyle summary
- who affected
- whats the problem
- are treatments successful?
- Spaniels, autosomal recessive
- Incomplete fusion of the humeral condyle
- 20% failure rate with fracture repair
