Elbow - Duerr

Question 1

Joint with WB fxn

Answer 1

Humeroradial

Question 2

Joint that restricts motion to sagittal plane

Answer 2

Humeroulnar

Question 3

Joint responsible for transverse plane pronation/rotation

Answer 3

Proximal radioulnar

Question 4

This articulates with the radial head

Answer 4

Capitulum (Lateral)

Question 5

This articulates with the medial portion of ulnar coronoid process

Answer 5

Trachlead (medial)

Question 6

Coronoid disease

Answer 6

FCP or MCD - this is the most common in dogs! 99% of dogs that we see with severe OA of elbow is due to MCD

Question 7

Ununited Anconeal Process

Answer 7

UAP

Question 8

Osteochondrosis dissecans

Answer 8

OCD

Question 9

FCP - how do we dx?

Answer 9

Rads, CT, scope

Question 10

UAP - how do we dx?

Answer 10

Rads

Question 11

Incongruity - how do we dx?

Answer 11

CT, scope

Question 12

OCD - how do we dx?

Answer 12

CT

Question 13

What can we do on PE to test elbow instability?

Answer 13

Full flexion, hyperextension, Campbell Test (carpus and elbow held at 90 degrees and then you sup/pronate)

Question 14

Incongruity plays an important role in ___/___.

Answer 14

FCP/UAP

Question 15

What is incongruity? What 3 places does it occur?

Answer 15

The joint surfaces “don’t match”

1. Humeroulnar –> Notch incongruity
2. Proximal radioulnar –> Step
3. Humeroradial

Question 16

What does a short radius do?

Answer 16

Puts pressure on coronoid process

FCP

Radioulnar incongruency

Question 17

What does a short ulna do?

Answer 17

Puts pressure on anconeal process

UAP

Radioulnar incongruency

Question 18

What kind of incongruity would cause FCP and UAP?

Answer 18

Trochlear notch incongruity (small notch)

Pressure on both coronoid and anconeal process

Question 19

How do we correct UAP?

Answer 19

Ulna OsteOtomy - triceps pull restores elbow congruity by pulling the ulna proximally

Cut bone

Question 20

How do we correct FCP?

Answer 20

Ulna OsteCtomy - allows shortening of ulna

Remove bone

Question 21

What is MCD?

Answer 21

Medial compartment dz - aka FCP (old name)

Question 22

Whats the pathogenesis of Coronoid Disease?

Answer 22

Unknown

There is a genetic component that has been proven

Incongruity can be a factor

Very diverse disease

Question 23

Signalment: large breed dogs (labs, GSD, Rotties, Goldens, etc). Usually 6-18 months

Hx: variable lameness that is worse after exercise, stiff gait after rising, “lazy” but will still play, often bilateral so its hard to notice

PE:

• abnormal stance
• pain on palpation (hyperflexion, extension and medial compartment pressure/palpation)
• crepitus, reduced ROM & swelling in older, arthritic patients

Answer 23

Coronoid Dz!

Question 24

What do you look for on rads of pt with suspected MCD?

Answer 24

• discontinuity of the coronoid process
• osteophytes on anconeal process and cranial aspect of the proximal portion of the radial head
• ulnar sclerosis
• A/P view –> can see fragment sometimes

Question 25

Tx of MCD - Arthroscopy

Answer 25

- arthroscopic debridement | - ulnar ostectomy for incongruity

Question 26

Are we "fixing" the problem of MCD with Arthroscopy?

Answer 26

NO! We are just slowing the progression... O's need to know this and understand there is long-term OA management ahead of them

Question 27

Prognosis of congenital FCP (MCD) in young dog?

Answer 27

Depends on severity of DJD - Sx rec to slow down arthritis progression and dec lameness - this is NOT a cure!

Question 28

How does the congenital form and adult-onset form of Coronoid dz differ?

Answer 28

Congenital: (Common!) - puppy with severe ED but little DJD -> may need CT for dx - adult dog with moderate ED but severe DJD -> rads are adequate for dx Adult-Onset form - rare! - any mid-older aged dog with minimal rad changes - traumatic in origin? - congenital but not clinically? * need CT or arthroscopy for dx

Question 29

FCP - Summary You need to ID early! 'Normal' rads ___ ___ R/O ED. Good PE and ideally CT esp for adult-onset. _____ ____ needed regardless of tx! Tx options vary but include fragment excision. Advise O about the severity of dz and lack of ______ procedures

Answer 29

do NOT Medical Management Salvage

Question 30

How do we Tx Humeral OCD? Whats the prognosis?

Answer 30

Tx: - excision of cartilage flap - curettage and microfracture/-picking of the subchondral bone - OATS Prognosis: - DJD is inevitable - Medical OA management longterm

Question 31

Define UAP

Answer 31

Anconeal process that doesn't unite by week 20

Question 32

Signalment of UAP pts:

Answer 32

Young, large/giant breed dogs (GSD< berners) Males:Females 2:1 20-35% are bilateral

Question 33

Pathogenesis of UAP?

Answer 33

Nutrition, genetic, trauma, OCD? Incongruity (ED) - short ulna Incongruity (traumatic) - premature closure of distal ulnar physis Concomitant dz --> FCP 15%

Question 34

UAP - PE and Dx

Answer 34

PE: - mild-moderate lameness - pain on hyperextension - joint effusion Rads: - do a flexed view --> this eliminates superimposition of the humerus CT/Arthroscopy: - evaluate for FCP and incongruity

Question 35

All dogs with ED will become ___

Answer 35

Arthritic! Do everything to preserve the joint!

Question 36

Elbow injuries are best diagnosed with ____ particularly in young animals, however, when the animal is older ____ are usually sufficient since you should see _____. That is unless you are dealing with ______. The prognosis for ED is ____ and hence the vet should focus on _____ OA management. ____ is easily diagnosed with ____ after _____, however, it can occur together with ____ which is why a _____ is preferred

Answer 36

CT Rads OA Adult-onset Poor Long-term UAP Rads 20wks FCP CT

Question 37

You have a dog with severe elbow OA --> on rads you do not see UAP (lucent line) --> what would you think they have?

Answer 37

MCD!! Most common *OCD is rare