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Elbow Dysplasia
Similar to hip dysplasia, elbow dysplasia (ED) is caused by the abnormal development of the elbow joint due to problems in the growth of the cartilage on the surface of the joint or the structures around it. These growth problems lead to secondary osteoarthritis, which is irreversible and will cause lameness and pain. The disease can begin in puppy hood and affect the dog for the rest if its life. Unfortunately, the elbow seems to be especially prone to this type of disease due to its construction similarity to a hinge and its propensity for high motion. It is also the joint which normal forelimb gait is most dependent on and so any small changes in any part of the joint will cause large changes in function.
Elbow dysplasia is a group of four slightly different diseases associated with abnormal development of this joint in dogs:
1) Fragmented medial coronoid process
Fragmented medial coronoid process is a condition in which a small piece of bone on the inner side of the joint has broken off of the ulna bone. This piece of bone irritates the lining of the joint and grinds off the cartilage of the adjacent humerus (similar to having a pebble in your shoe). In the photo below is a large fragmented coronoid process (labeled FCP) as seen at the time of arthroscopy.
2) OCD of the medial humeral condyle
OCD is a condition in which a piece of cartilage becomes partially or fully detached from the surface of the elbow joint. This results in inflammation of the lining of the joint and pain. Below in this photo an intra operative open approach shows the OCD flap (labelled OCD)
3) Ununited anconeal process
Ununited anconeal process is a condition in which a fragment of bone on the back side of the joint has failed to unite with the ulna bone during growth. Normally this bony process fuses with the ulna bone by 20 weeks of age. The breeds most commonly affected include German Shepherds, Bassets, Mastiffs, and St. Bernards. In the photo below the ununited anconeal process (labeled UAP) is clearly visible on the radiograph; the black line (labeled L) in the bone is the cardinal sign that an UAP is present.
4) Incongruity of the elbow joint
Elbow Incongruity is a condition in which the joint does not have perfect conformation, and the cartilage of the joint wears out rapidly. In simple terms the joint does not fit together well and the final result is progressive arthritis.
The cause of elbow dysplasia is not fully understood. Certainly there is a complex genetic basis and it is likely that several different genes are involved. It is also likely that environmental factors (exercise, growth rate, nutrition) play a role.
All types of elbow dysplasia can cause pain and lameness although in some dogs the disease may remain clinically silent for many months or years. Lameness may appear suddenly or insidiously. Often the condition occurs in both elbows and so signs may relate to joint stiffness in both forelimbs. Later in life, the osteoarthritis initiated by elbow dysplasia may progress to cause pain, stiffness and lameness.
ED usually causes pain on flexing or extension of the elbow and the dog may show a stilted forelimb gait but X-rays are needed for confirmation. Like hip dysplasia again, treatment depends on the severity of the disease.
Some cases can be managed with controlled exercise and weight management .This should be done in all cases, regardless of severity and hydrotherapy is the perfect type of exercise. It provides movement to help maintain muscle and mental stimulation often lacking in dogs with reduced mobility, and it also provides a form of pain relief with the heat and buoyancy the water provides. Some may also require drugs to relieve pain and inflammation. Severe cases may require surgery. Treatment should always be discussed with your vet and considered on an individual case basis. The irreversible changes mean that the dog’s ability to exercise will gradually be restricted through life but with correct management, especially in the early stages, the dog can lead a comfortable life.