Osteochondritis dissecans Flashcards
Who gets OCD?
- Skeletally immature dogs
- Not cats
- Larger breed juvenile dogs: labrador retrievers, golden retrievers, pointers, Great Dane, Saint Bernard, over-represented; M > F
Age of onset of OCD
- 5-7 months of age (7-9 months of age)
Risk factors for OCD
- Genetic inheritance (ethically they should not be breeding)
- Nutritional (supplement calcium volume relative to calcium-phosphorus)
- Activity? Overloading?
Is OCD usually unilateral or bilateral?
- Bilateral normally
What is the primary defect with OCD?
- Endochondral ossification defect
Which joints are most often affected with OCD?
- Shoulder (humeral head - most common form)
- Elbow: medial side of the humeral condyle
- Stifle: lateral aspect of the medial femoral condyle or medial aspect of the lateral femoral condyle
- Tarsus: Medial trochlear ridge of the talus (or lateral ridge in Rottweilers)
History of OCD
- Acute or insidious onset of lameness
- Weight bearing lameness
- Worsens with activity*
Physical examination findings for shoulder OCD
- Unilateral weight-bearing lameness
- mild muscle atrophy over the shoulder and scapular region
- Pain/discomfort on flexion or extension of the shoulder
- Bilateral findings
Elbow OCD findings
- Similar to Medial compartment disease and medial coronoid process disease
- Elbow pain - flexion with medial collateral ligament pressure
- Effusion/synovial popping
- Joint thickening/resistance to flexion/extension
- Externally rotated paw
Stifle OCD findings
- Stifle pain on flexion and extension
- Effusion
- Thickening
- Looks virtually identically to cranial cruciate rupture
Tarsal OCD findings
- Tarsal pain on flexion and extension
- Hyperextended when standing
- Marked effusion/thickening medial side of the joint
Shoulder OCD radiographs - which views?
- Mediolateral view (slight extension, slight traction)
- +/- craniocaudal view
Shoulder OCD radiographs - what findings?
- Osteophytes (caudal humeral head, caudal glenoid cavity)
- Focal, subchondral bone flattening - caudal humeral head
- +/- mineralized OCD flap
Elbow OCD radiograph views
- Craniocaudal
- Mediolateral
- Flexed mediolateral
Elbow OCD radiograph findings
- Osteophytes
- Focal subchondral defect on the medial side of the humeral condyle (weight bearing aspect)
Stifle OCD radiograph views
- Craniocaudal and mediolateral views
Stifle OCD radiographic findings
- Osteophytes
- Focal subchondral defect: lateral side of the medial femoral condyle or the medial side of the lateral femoral condyle
Hock OCD radiographic views
- Dorsoplantar
- Mediolateral
- DLPM
- 45 degree views that are skyline or flexed views
Hock OCD Radiographic findings
- Osteophytes
- Subchondral defect on the medial trochlear ridge of the talus (lateral in Rottweilers)
- It’s a huge osteochondral fragment
- Lots of joint effusion visible too, and a flattened area on the medial side of the trochlear ridge of the talus
Surgical for OCD
- Arthrotomy or arthroscopy to remove the OCD flap (allows for fibrocartilage to form)
- +/- curettage
Other treatment possible for OCD
- In the shoulder only: if no mineralization present and in a patient <6 months of age, you can do conservative management
- Non-weight bearing flexion bandage for 2 weeks and restrict activity for 4 weeks and spontaneously recover
- He’s only had this happen with Great Danes
Post-op treatment for OCD surgery (arthrotomy, arthroscopy)
- Restrict to leash walks only for 4 weeks
- NSAID analgesia for 5-7 days
- Ice incision for 2-3 days after surgery
- Likely would want to consider mult-modal OA
Prognosis for lame free function in shoulder OCD
- Very good to excellent
Prognosis for lame free function in elbow or stifle OCD
- Fair to good
