Forelimb Lameness in SA

Question 1

What is the usually the only cause of shoulder lameness in YOUNG dogs?

Answer 1

Osteochondritis dissecans (OCD)

Question 2

What causes shoulder lameness in a dog that isn’t young?

Answer 2

Osteoarthritis, Soft tissue injuries e.g. rotator cuff, Trauma

Question 3

Why does OCD occur?

Answer 3

problem with the vasculature in the cartilage meaning the cartilage doesn’t form bone and it necrosis and/or causes fissure/ flap formation

Question 4

Which breeds and sex commonly get OCD in the shoulder?

Answer 4

Giant breeds e.g. great Danes, wolfhounds, Bernese mountain dogs
Males usually

Question 5

What age does OCD present and what signs will show on the physical exam?

Answer 5

4-8 months old
Forelimb lameness with muscle atrophy and pain on flexion/ extension

Question 6

How do we diagnose OCD? (3)

Answer 6

Radiographs
Can perform a contrast arthrogram for less obvious lesions- inject contrast into joint
Arthroscopy

Question 7

How is OCD treated? (2)

Answer 7

Surgical removal of the flap
Conservative pain management- but flap can break off and tear bicep so best to remove it surgically ourselves

Question 8

Young, toy breeds commonly suffer from…

How is this treated?

Answer 8

Shoulder luxations
Treat surgically by transposing the biceps tendon or putting artificial ligaments in to stabilise the joint

Question 9

What is the most common type of elbow dysplasia presented in practice?

Answer 9

Medial Coronoid process disease (95%)

[the bone in front of the ulna which articulates with the humerus and radius)

Question 10

What causes Medial Coronoid Process disease?

Answer 10

Radial-ulna incongruity- growth mismatch causes overloading on the coronoid

Question 11

What conservative management can we recommend for Medial Coronoid Disease? (4)

Answer 11

Weight restriction
Hydrotherapy to build more muscle to support joint
NSAIDs
Omega 3 fatty acid supplementation

Question 12

Apart from medial coronoid process disease, what other structure can radial-ulna incongruity affect?

Answer 12

Excessively long radius can put pressure on the Anconeal process

Question 13

What is Trochlea notch dysplasia in the elbow?

Answer 13

type of growth disturbance that causes broad humero bulb that ‘pinches’ the bone

Question 14

What clinical signs can we expect to see with Elbow Dysplasia?

Answer 14

Forelimb lameness that is worse post exercise and would possibly shift sides but frequently bilateral
Effusion

Question 15

What radiographic views is it standard practice to take to diagnose Elbow Dysplasia?

Answer 15

Cranio-caudal
Mediolateral neutral
Mediolateral flexed

Question 16

Why is it standard to take 3 radiographic views to diagnose elbow dysplasia?

Answer 16

Common for the medial epicondyle to superimpose the anconyl process and block the full view

Question 17

Which breeds are predisposed to Ununited anconeal process?

Answer 17

GSD, Basset Hounds, American Bulldogs

Question 18

How do we diagnose Ununited anconeal process?
BUT what’s the catch?

Answer 18

Radiographic diagnosis
BUT have to wait until dog is older than 20 weeks as there is a separate fusion centre before 5 months

Question 19

Would we perform a CT/ Arthroscopy in an animal with a ununited anconeal process?

Answer 19

Yes we can if planning surgery as it allows accurate measurements for dissection BUT fairly useless otherwise as it is very easy to diagnose via radiographs

Question 20

What options do we have for treating ununited anconeal process? (2)

Answer 20

Removal of excess- short term treatment as leads to Osteoarthritis
Osteotomy if patient is young enough

Question 21

Apart from the shoulder, where else may we find OCD and how common is this?

Answer 21

in the humerus but fairly uncommon (found in labs, retrivers and newfoundlands)

Question 22

What is the general prognosis for animals with elbow dysplasia?

Answer 22

It’s a lifelong disease process that usually progresses to osteoarthritis

Question 23

How can breeders prevent elbow dysplasia?

Answer 23

Has a high heritability so can radiographic screen their dogs under the Kennel Club scheme and register them as healthy if they pass and not breed ones that do not pass

Question 24

What is a common disease process to see in a Spaniels forelimb?

Answer 24

Humeral Intracondylar fissures (HIF)- its a partial/ complete gap found in the humeral condyle