Elbow Dysplasia

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Elbow dysplasia is a syndrome characterized by degenerative joint disease that results from one or more pathologies of the elbow joint structures:

The elbow is a complex joint whose normal function relies on the smooth articulation of the cartilage-covered surfaces within the joint space and on the uniform growth of the humerus, radius and ulna (the bones of the canine foreleg).  Unequal growth of any of these three bones can cause abnormal stresses to be placed on joint structures, leading to FCMP, OCD, and/or UAP. Trauma and dietary factors may also play a role in elbow dysplasia.

Affected dogs may have dysplasia in one elbow or both, and may have more than one type of pathology in the same elbow joint.  Elbow dysplasia is primarily a disease of large breed dogs, especially Retrievers, Bernese Mountain Dogs, Rottweilers, Basset Hounds and German Shepherds.

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What is FMCP?

FMCP is the most common pathology present in cases of elbow dysplasia.  It is characterized by fissures or complete separation of the medial coronoid process from the ulna.  This may result from abnormal stresses placed on the coronoid process during development.

Signs & Diagnosis

Common clinical signs of FMCP begin between 5-8 months of age and include acute or chronic intermittent lameness, stiffness, and stilted gait.  Lameness is usually intensified by exercise, and is prominent after resting. In some cases, lameness is not apparent until later in life.  Palpation by the vet may show joint swelling, and pain upon extension and flexion of the leg.  Older dogs may have crepitus (crackling) within the joint. The clinical signs of FMCP are very similar to those of OCD, and it is likely that the two coexist in a third of cases.  The majority of cases are bilateral, but clinical signs may be unilateral.  Radiographs may show degenerative changes in  the elbow, including osteophyte (bony spur) formation.  It is difficult to visualize the coronoid process on radiographs, and FMCPs are rarely diagnosed on radiographs alone.  Definitive diagnosis requires either arthroscopic joint exploration or CT scans.

Treatments

Dogs that are diagnosed early, with mild dysplasia and minimal existing degenerative changes to the cartilage, can typically be expected to have a relatively good prognosis with arthroscopic removal of the FMCP.

Unfortunately, many dogs we evaluate arthroscopically have more severe dysplasia with full thickness cartilage loss in area of the joint called the medial compartment.  This syndrome is currently being termed Medial Compartment Disease (MCD).  This can be seen in both young dogs with severe dysplasia and older dogs with end-stage osteoarthritis.  Historically, there have not been many treatment options available for dogs with MCD.  Dogs with MCD may show some improvement with arthroscopic removal of the FMCP, but as the cartilage destruction progresses and the medial elbow joint collapses, these dogs will continue to have some degree of lameness and pain requiring continued medical management of osteoarthritis.

In the future, total elbow replacement may become a viable option, but none of the replacements designed thus far have proven to be safe and effective enough for routine use.

What is OCD?

Osteochondrosis is a defect in bone growth that results in soft lesions in the cartilage.

As lesions progressively worsen with activity, cracks and fissures form, and eventually the cartilage may partially split away, forming a cartilage flap which causes pain when it moves in the joint space. This condition is termed osteochondritis dessicans. Once formed, this cartilage flap cannot heal back down to the underlying lesion bed. Instead, it will either continue to degenerate in place, or may break free and migrate to another area of the joint (these free pieces are known as “joint mice”). In either case, the presence of the flap will cause pain and inflammation within the joint. OCD not only occurs in the elbow, but can be seen in any joint.

Signs and Diagnosis

What are the clinical signs and how is OCD diagnosed?

Common clinical signs of OCD begin between 5-8 months of age and include acute or chronic intermittent lameness, stiffness, and stilted gait. Lameness is usually intensified by exercise, and is prominent after resting. In some cases, lameness is not apparent until later in life. Palpation by the vet may show joint swelling, and pain upon extension and flexion of the leg. Older dogs may have crepitus (crackling) within the joint. Diagnosis is confirmed by visualizing the OCD lesion, flap or joint mice on Radiographs and/or during joint exploration.

Treatment

What is the recommended treatment for OCD?

Treatment for OCD consists of surgical removal of the flap and any other loose cartilage or joint mice, and smoothing out the area of the lesion to stimulate the filling-in of the lesion area with fibrocartilage (scar-tissue-type cartilage). This may be accomplished arthroscopically or through traditional open surgery.

What is UAP?

UAP is characterized by the failure of the growth center of the anconeal process to fuse properly with the olecranon. This leads to instability or detachment of the process and osteoarthritis of the elbow. It is most commonly diagnosed in German Shepherds.

Signs & Diagnosis

Clinical signs are usually not seen before 5-8 months of age. Occasionally, lameness is not observed until the dog is several years old. In the earliest stages, the only clinical signs may be a slight limp and standing or walking with the paw turned out. Palpation of the joint in older dogs may reveal swelling and crepitus (crackling) within the joint. A preliminary diagnosis may be made by clinical signs, age and breed. The diagnosis will be confirmed by Radiographs showing the partially or fully detached anconeal process, as well as possible osteophytes (bony spurs) throughout the joint.

Treatments

Treatment for UAP consists of traditional open surgery to remove the anconeal process, which is generally too big to remove arthroscopically.

For OCD, UAP and FCMP, the best prognosis is expected with early treatment performed prior to extensive degenerative osteoarthritic changes. In this case, return to good function is expected, although some degenerative changes may still occur later in life. If extensive osteoarthritis is already apparent in the joint prior to treatment, the prognosis is poorer, but treatment may slow further degeneration of the elbow.

After arthroscopic surgery, the dog will generally stay one night for observation and then will require two weeks of confinement and rest at home.  After that, the dog will have a four-week rehabilitation period with gradually increasing exercise, but no running, jumping or playing with other dogs.  Pain medications and anti-inflammatories will be prescribed for the first weeks at home and possibly longer depending on the existing osteoarthritis in the elbow.  Lifetime supplementation with chondroprotective agents such as glucosamine/chondroitin may be recommended.

As with any surgery, there is risk of infection, as well as anesthetic risk. Anesthetic complications are rare, however, and risk is minimized by our use of best practices in anesthesia choice and extensive monitoring of your pet by our surgeons, licensed veterinary technicians and advanced monitoring equipment.For many patients with FCMP and OCD, surgical treatment can be accomplished through the use of an arthroscope. Advantages of arthroscopy include:

  • Better visualization of the entire joint and cartilage surface
  • Less trauma to the joint capsule and tissues
  • Smaller skin incisions
  • Faster recovery
  • Less post-operative pain

Arthroscopy is minimally invasive and considered the gold-standard in human joint surgery.

For many patients with FCMP and OCD, surgical treatment can be accomplished through the use of an arthroscope.Advantages of arthroscopy include:

  • Better visualization of the entire joint and cartilage surface
  • Less trauma to the joint capsule and tissues
  • Smaller skin incisions
  • Faster recovery
  • Less post-operative pain

Arthroscopy is minimally invasive and considered the gold-standard in human joint surgery.

Sliding Humeral Osteotomy (SHO) is a relatively new procedure that was developed specifically as a treatment for dogs with severe cases of Fragmented Medial Coronoid Process that have resulted in Medial Compartment Disease and severe cartilage loss in the medial aspect of the elbow joint.  The SHO was developed in the Orthopedic Research Laboratory of the University of California by Dr. Kurt Schulz, DVM, MS, DACVS.

We are excited to report that Dr. Allen Johnson and the Animal Surgical Clinic of Seattle are currently involved in a multi-center clinical study to further evaluate the clinical efficacy of the SHO.  These cases will have elbow arthroscopy to fully evaluate the articular cartilage and, if severe cartilage erosion of the medial compartment is confirmed, then a SHO will be performed.  These cases will be followed closely postoperatively with radiographs and owner and veterinarian evaluations, and the owners must be committed to follow through with the postoperative evaluations.