Dysplasia Advice Sheet About Elbow Dysplasia joint cartilage, which cannot be seen on Elbow dysplasia is a complex disease which x-ray or CT. results from a group of genetic conditions which cause parts of the elbow joint to Surgical treatment of cartilage develop abnormally, resulting in abnormal abnormalities can be performed as part of articulation of the “hinge” elbow joint this procedure if required. between the (upper arm ) and the radius and (lower arm ). The severity of the signs of elbow Over time, the cartilage becomes damaged, dysplasia on and develops. diagnostic imaging and does Clinical Signs not always correlate Elbow dysplasia commonly affects large to the severity of breed dogs, such as Labradors, German clinical signs. Fragmented Shepherds, Bernese Mountain Dogs, Rottweilers and Golden Retrievers. coronoid process

Clinical signs include; • Forelimb lameness and stiffness after rising or strenuous exercise • Reduced range of motion • Pain on manipulation of the elbow joint may be found on orthopaedic examination, on one or both

Investigation X-rays of the elbows are used to demonstrate the degree to which the elbow formation is abnormal, some of the types of abnormalities present and the presence and severity of secondary osteoarthritis. In some dogs the x-rays may be normal. CT reconstruction of elbow with severe A computed tomography (CT) scan may osteoarthritis secondary to elbow dysplasia be suggested to further Treatment assess joint congruency (how well the joint Conservative Treatment “fits” together) and to identify small bone Non-surgical treatment of elbow fragments. dysplasia cannot address the underlying developmental abnormalities of the Arthroscopy of the joint (keyhole ) affected joints, but focusses on managing may be recommended to evaluate the the associated osteoarthritis. Elbow Dysplasia Advice Sheet Surgical Treatment unload the inside of the elbow joint and Arthroscopy improve how the elbow joint fits together. Arthroscopy is a “keyhole surgery” procedure that involves placing a camera PAUL into the affected joint in order to view An alternative osteotomy procedure is the cartilage lesions and potentially remove or proximal abducting ulnar osteotomy (PAUL). treat damaged areas of cartilage. This is reserved for patients with severe cartilage damage of the inside of the elbow The removal of damaged cartilage and (medial part). The ulnar bone fragments during arthroscopic is cut and a specially treatment of the affected joints appears to designed stepped variably improve patient comfort. plate is used to unload the medial part of the However, further development of elbow joint. Although osteoarthritis is unfortunately inevitable, there is little objective resulting in progressive lameness. published data, studies report an improvement Following arthroscopy, your pet’s lameness in lameness over a may initially be a little worse on the period of around 6 affected leg, but should improve fairly months. quickly. X-rays of the stepped plates Your pet will need to have two weeks of strict rest to allow the joint capsule to heal Total Elbow Replacement again before starting a gradual exercise Some dogs with severe osteoarthritis may programme. not be a candidate for a DUPO or PAUL. A total elbow replacement is a salvage (“last Complications following arthroscopy resort”) procedure for dogs with long term include seroma formation (accumulation of elbow pain who have not responded to fluid under the skin) and infection (less than conservative treatment, such as pain relief 0.1% of cases). and exercise modification.

Osteotomy Procedures The aim of the procedure is to allow dogs Dynamic proximal ulnar osteotomy (DUPO) with severely compromised mobility and is a procedure that may be considered in elbow pain to return to exercise. A recent some dogs where the elbow joint does fit multi-centre study showed the major together properly. This ‘imperfect jigsaw’ complication rate of this procedure is very may mean that the medial (inside) part of high. At the current time we are not offering the joint has excessive load placed through total elbow replacements at Langford Vets. it when walking, eventually leading to A new generation of improved implants are inflammation and osteoarthritis. By cutting being developed so we hope to be able to the ulnar at a specific location we aim to offer this as an option again in the future.

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