About Rata Resources Feature cases FAQ's Procedures
Elbow Dysplasia Overview
Elbow Pic
Ununited Anconeal
Elbow

Information on the condition and its management options.

The Elbow joint

The elbow is a complex joint as it is composed of three bones - the Humerus (bone from shoulder to elbow), the Radius and Ulna (bones from elbow joint to wrist). In young dogs, the radius helps support the weight of the animal as it is transmitted through the humerus, whilst the ulna’s primary function is to allow smooth flexion and extension (bending and straightening) of the forelimb (front leg). In adult dogs, the load bearing is more equal between the radius and the ulna.

In a normal dog, these bones grow at exactly the same rate and are congruent (well aligned) with the radial head lining up with the Medial Coronoid Process (MCP) which is part of the ulna. This means they can articulate smoothly with each other to function as the elbow joint. Any articular (joint) surface is covered in cartilage which aids in this movement by protecting the bone surfaces.

Elbow Dysplasia

‘Elbow dysplasia’ is a complex developmental problem, most commonly seen in large breed dogs, including Labradors, Retrievers and Rottweilers.

The word ‘dysplasia’ just means an ‘abnormal development’, whereas elbow dysplasia is a broad term for multiple problems as outlined below:

The underlying cause of elbow dysplasia is not fully understood, but the condition is related to the incorrect development of the humerus, ulna and radius. These progressively become abnormal as the animal grows and as a result become incongruent (mis-aligned). It is thought that this incongruency contributes to an abnormal distribution of weight within the elbow joint which results in rubbing and extra pressure, leading directly to cartilage erosion, fragmentation of bone and osteoarthritis. This may not be the complete story though and there are many studies being undertaken to determine what other factors may influence elbow dysplasia.

The disease itself includes four main components:

  • Medial Compartment Disease (MCD)
  • Ununited Anconeal Process (UAP)
  • Osteochondrosis Dessicans (OCD)
  • Joint incongruence

MCD occurs in around 95% of dogs with elbow dysplasia. This may be associated with cartilage being worn away from articulating surfaces (coronoid disease) of the ulna. As the cartilage wears away, underlying bone becomes exposed so that bone rubs on bone, causing friction, inflammation and pain. Disease changes to the medial coronoid process range from thickening, through to cracks/hairline fractures and free boney fragments in the joint. Conversely, some studies have shown that MCD can occur separately as puppies can have coronoid disease without any secondary changes to the joint (MCD).

UAP, OCD and joint incongruneyce occurs in just 3-5% of Elbow Dysplasia cases. It is important to be aware that some doghave more than one condition occurring in the same joint, which can complicate the condition further.

We see two distinct populations of dog with forelimb lameness associated with elbow dysplasia:

  • Juvenille dogs: Lameness is caused by one of the primary conditions (as mentioned above). Treating this problem directly can reduce pain and improve function.

However, the formation of arthritis is still very likely, and even if the response to the initial treatment is good, it is important to remember that there is a high chance of the affected joint becoming arthritic later in life.

  • Adult dogs: Lameness in adult dogs is caused by pain associated with arthritis that has developed as a result of the primary condition. Arthritis cannot be cured, and a management plan tailored to the individual dog is required.

Symptoms:

These most commonly present at 6-10 months of age in the juvenile dog and may include a reluctance to play, stiffness after laying down/sleeping, lameness (especially after exercise), difficulty going down stairs and early exhaustion.

Some dogs only develop symptoms of pain when they are adults. This is a result of the development of secondary arthritis.

Diagnosis:

An orthopaedic examination by your vet can help in the diagnosis of elbow dysplasia. It can be used to determine if the elbow joint is thickened, if there is any discomfort on full extension and flexion and if rubbing or crepitus (grating or popping sounds) are present within the joint.

Radiographs (x-rays) will be necessary to help in the diagnosis but frequently (in younger dogs), a CT scan will be required to provide further (more detailed information). Arthroscopy is another useful diagnostic tool as it enables the surgeon to examine the joint directly by inserting a camera through a keyhole incision.

Treatment:

This depends on the severity of the issue. Determining the best treatment for a dog with elbow dysplasia can be challenging.

Some dogs will benefit from surgery whilst others require conservative management. All dogs with elbow dysplasia (whether they have surgery or not) will develop arthritis as a result of the disease.

Surgical techniques include:

  • Arthroscopy for MCD (an arthroscope is used to examine the joint, and diseased bone and bone fragments are removed).
  • Ulna Osteotomy/Proximal Abducting Ulna Osteotomy (PAUL) procedure for MCP & incongruence (an ulna osteotomy (cut to the bone) is performed to relieve pressure on the medial compartment).
  • OCD flap removal (the associated cartilage flap is removed and the underlying bone bed is cleaned up).
  • Stem cell therapy.

Conservative management is aimed at reducing the symptoms of arthritis to allow an affected dog to have an active happy life without resorting to procedures that invade the elbow joint.

There are five main components:

  • Weight management (obesity adds to the loading forces and aggravates the problems).
  • Exercise moderation.
  • Hydrotherapy.
  • Medication such as anti-inflammatory drugs.
  • Joint supplements (Omega 3 fatty acids, such as in Hills J/D).

Part of an effective management plan for the arthritic dog is deciding what level of exercise is appropriate to give your pet a good quality of life. Despite using all these measures, some dogs will continue to suffer debilitating elbow pain, which restricts their daily activities.

Salvage Procedures:

For dogs where pain is uncontrolled due to progressive debilitating arthritis, alternative (more severe) salvage procedures may be necessary. These include:

  • Total Elbow Replacement (TER)
  • Elbow Arthrodesis (fusion of the joint)

Outlook

This can be variable depending on the disease process and development of arthritis. Some dogs can be treated successfully with conservative treatment whilst others require surgery. A degree of stiffness and lameness (especially after exercise) is to be expected from dogs suffering with elbow dysplasia.

Please view our information sheets on the different surgical techniques for more detailed information regarding expectations on recovery.

KEY POINTS

· Developmental condition.

· Most common in large breed dogs

· ‘Dysplasia’ means ‘abnormal development’.

· Presents at 6-10 months of age, or can develop later in life.

· Degeneration of the elbow joint.

· Progressive development of arthritis in the joint.

· Can have conservative or surgical treatment options.

· Life – long management is required.

· Obesity contributes to the problems.

· Control of this disease can be challenging.