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Elbow Dysplasia in the Dog: Pathophysiology, Diagnosis and Control

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Elbow Dysplasia in the Dog: Pathophysiology, Diagnosis and Control Review article — Oorsigartikel Elbow dysplasia in the dog: pathophysiology, diagnosis and control R M Kirbergera and S L Fouriea elbow incongruity, probably as result of ABSTRACT small growth abnormalities of the long Elbow dysplasia is a non-specific term denoting abnormal development of the elbow. Elbow bones making up the elbow joint32. The dysplasia encompasses the clinical and radiographic manifestation of ununited anconeal cartilaginous growth disturbance is likely process, fragmented medial coronoid process, osteochondritis dissecans, erosive cartilage to have genetic and environmental, lesions and elbow incongruity. The net result is elbow arthrosis, which may be clinically mainly traumatic, and nutritional inapparent or result in marked lameness. These conditions may be diagnosed by means of causes31. The most important nutritional routine or special radiographic views and other imaging modalities, or the precise cause of factors are an excess supply of energy and the arthrosis or lameness may remain undetermined. Breeds most commonly affected are 31 the rottweiler, Bernese mountain dog, Labrador and golden retriever and the German relative over-nutrition with calcium . shepherd dog. Certain breeds are more susceptible to a particular form of elbow dysplasia Trauma is usually minimal and associated and more than 1 component may occur simultaneously. The various conditions are thought with hyperactivity or excessive body 31 to result from osteochondrosis of the articular or physeal cartilage that results in disparate weight . Figure 1 denotes the relationship growth of the radius and ulna. Heritability has been proven for this polygenic condition of factors involved in elbow dysplasia and and screening programmes to select suitable breeding stock have been initiated in several the development of arthrosis. Severe countries and have decreased the incidence of elbow dysplasia. trauma resulting in premature closure of Key words: elbow dysplasia, elbow incongruity, fragmented medial coronoid process, a physis is a separate clinical entity osteochondritis dissecans, ununited anconeal process, screening programmes. causing severe growth disturbance of the affected long bone that may markedly Kirberger R M, Fourie S L Elbow dysplasia in the dog. Journal of the South African Veterinary Association (1998) 69(2): 43–54 (En.). Department of Surgery, Faculty of Veterinary Science, influence joints adjacent to the trauma- University of Pretoria, Private Bag X04, Onderstepoort, 0110 South Africa. tised physis, and is excluded from the elbow dysplasia syndrome. Elbow dysplasia is a worldwide problem in intermediate and heavy-set INTRODUCTION resulting in mild arthrosis may be present breeds and is commonly seen in South Elbow dysplasia is the abnormal with no clinical evidence and breeders are Africa in the rottweiler, Labrador and development of the elbow joint. The term unaware of the problem in their breeding golden retriever, and German shepherd dysplasia is derived from the Greek words stock36. In a study of rottweilers, 57 % of dog. Other breeds commonly affected dys meaning abnormal and plasia mean- dogs had radiographic signs of elbow worldwide are the Bernese mountain ing development. Elbow dysplasia is an dysplasia but only 15 % were lame36. dog, Saint Bernard, Newfoundland, all-encompassing term comprehensible to Developmental elbow abnormalities and bull mastiff. The condition is seen the dog-breeding fraternity and has included in the term elbow dysplasia are sporadically in many other breeds. Breeds gained popular recognition, particularly fragmented medial coronoid process may be predisposed to a particular form in communicating scientific information (FMCP), osteochondrosis and osteochon- of elbow dysplasia, e.g. the German to the public2,10,40. In scientific publica- dritis dissecans (OCD) of the medial shepherd dog suffers more from UAP16, tions, however, specific aetiologies should humeral condyle, ununited anconeal the rottweiler rarely has OCD11,17 and be referred to where possible10 or, if only process (UAP), humero-ulnar, humero- the Labrador retriever is most likely to secondary arthritic changes are seen on radial and radio-ulnar incongruity and have combined OCD and FMCP17. The routine radiographic views with no articular cartilage erosion. These condi- condition is more likely to occur in males, evidence of the primary cause, the term tions, singly or in combination, result in probably owing to their faster rate of elbow arthrosis should be used40. As irreversible elbow arthrosis with resultant growth or a sex-linked factor5,11,17,20. Elbow elbow dysplasia is a developmental pain and lameness. Osteochondrosis, the dysplasia is a polygenic and multifactorial condition, clinical signs are usually seen disturbed endochondral ossification of condition, the incidence of which can from 4–8 months and are followed by articular or physeal cartilage, is most likely be reduced by selective breeding15,20,40. elbow arthrosis. Long-standing elbow the underlying cause for all the conditions Affected dogs are more likely to have arthrosis due to undetected elbow included in elbow dysplasia31-33. Under- offspring with dysplastic elbows than dysplasia may only be diagnosed later in development of the trochlear notch with normal dogs. The greater the degree of life. In particular, lameness in both secondary incongruity is postulated by arthrosis in the parents, the greater elbows may result in a peculiar gait that others to be the primary cause45,47,50. In percentage of puppies are likely to suffer the owner may not have realised was osteochondrosis, normal cartilaginous from the condition. abnormal. Often minor elbow dysplasia development and maturation fails in the Recognition of the condition by veteri- hypertrophic zone, resulting in thickened narians and breeders and the institution cartilage31. In the elbow joint, articular of screening and breeding programmes aRadiology Section, Department of Surgery, Faculty of Veterinary Science, University of Pretoria, Private Bag cartilage involvement results in OCD are required to decrease the incidence of X04, Onderstepoort, 0110 South Africa. while non-articular cartilage alterations this often crippling disease. Elbow Received: January 1998. Accepted: March 1998. are assumed to result in FMCP, UAP and dysplasia is a progressive disease and 0038-2809 Jl S.Afr.vet.Ass. (1998) 69(2): 43–54 43 Fig. 1: Flow diagram of interrelationship between elbow dysplasia and elbow arthrosis. owners must be made aware that medical shoulder and elbow32. In the rottweiler, allows for the most accurate evaluation of or surgical treatment may result in the palmar metacarpal region should be joint incongruity but true lateral improvement but not normality48. The evaluated to exclude palmar metacarpal positioning is vital. Humeral condyles can objective of this article is to review the sesamoid pathology36. Radiographs of the be evaluated for OCD but minor changes pathophysiology and diagnosis of the rest of the limb may be required to exclude may not be detected. The medial coronoid various conditions involved in elbow other conditions such as panosteitis. process is seen superimposed on the dysplasia, briefly consider therapy and proximal radius with its cranial tip at the discuss measures to prevent and control Radiography level of the radial physis. Osteophyte the condition. Optimal radiographic detail is essential reactions on the cranial aspect of the joint to accurately evaluate elbow pathology. are seen more readily than in the flexed This is obtained by using table-top ML view. Early osteophyte formation DIAGNOSTIC IMAGING TECHNIQUES techniques, non-grid exposures, dorsally on the anconeal process may be Good quality, well-positioned radio- collimating to the elbow joint, centring obscured by the medial humeral condyle, graphs remain the most cost-effective the primary beam on the medial particularly on suboptimal radiographs. method of diagnosing elbow dysplasia. epicondyle of the humerus, using detail- Radiographs, however, do not show all intensifying screens and short-scale Lateral recumbency – mediolateral view abnormalities or are often only suggestive contrast (low kVp and high mAs exposure with the joint maximally flexed (flexed of an abnormality. This is often the case technique). Sedation or anaesthesia may ML) (Fig. 2b) in the growing dog when arthrosis has be indicated for accurate positioning. The angle between the humerus and not yet developed. Three-dimensional Standard craniocaudal and mediolateral radius and ulna is about 45°. This view imaging techniques such as computed views have been supplemented by maximally exposes the anconeal process tomography (CT) and magnetic resonance numerous additional views in an attempt and thus optimises visibility of UAP and imaging (MRI) are the most reliable to highlight certain anatomical locations early osteophyte formation within the methods, as they allow slices of the or pathological conditions. Minor lesions dorsal hollow of the anconeal process. affected joint to be evaluated. Linear such as erosion of the medial humeral This view does not contribute much to the tomography has also proven to be of condyle cartilage will not be visible in any demonstration of OCD and FMCP com- benefit9,44. Positive contrast arthrography, of these views. Microfocal radiography pared to the other views44. although technically fairly easy to per- of the elbow has been described and form, does not contribute to evaluating yielded more information
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