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Medial Humeral Epicondylar Lesions and Discreet Calcified Structures in the Canine Elbow

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Medial Humeral Epicondylar Lesions and Discreet Calcified Structures in the Canine Elbow Rørvik et al. Acta Vet Scand (2020) 62:58 https://doi.org/10.1186/s13028-020-00556-w Acta Veterinaria Scandinavica RESEARCH Open Access Medial humeral epicondylar lesions and discreet calcifed structures in the canine elbow: radiographic description of 183 cases Arne Magnus Rørvik, Cathrine Trangerud* and Jorunn Grondalen^ Abstract Background: In this 4-year prospective observational study, all elbows in a dysplasia screening program including 14,073 dogs were studied using radiographs in two projections. Elbows were evaluated for the presence of medial humeral epicondylar lesions or discreet calcifed structures and were described as they appeared. The age, breed, and sex of afected dogs were recorded. The prevalence for each lesion was calculated exclusively on breeds where the number of radiographed dogs exceeded 500. Results: Medial humeral epicondylar lesions or medial discreet calcifed structures were diagnosed in 183 dogs and 211 elbows. The prevalence of true Flexor enthesopathy (FE) in this Norwegian population of mainly young, large breed dogs was calculated to be approximately 1.4 per 1000 dogs and varied by breed. Also, the prevalence of the other lesions varied considerably by breed. The most common fnding was discreet calcifed structures, termed medial ossifed structures (MOS) (0.7%). In elbows afected with fragmented medial epicondyles (FME) (0.07%) and especially FE (0.14%), the degree of periarticular new bone formation (PNBF) was increased when compared to unafected elbows. In joints afected with MOSs or medial lucent lesions MLLs (0.25%), there was no diference in the presence or degree of PNBF compared to unafected joints, even in older dogs. Conclusions: The prevalence of medial humeral epicondylar lesions and MOSs difers considerably among dog breeds. Elbow joints with FMEs and particularly FE had a highly increased presence and degree of PNBF compared to joints without these lesions. Elbow joints with MOSs or MLLs did not have an increased presence or degree of PNBF compared to joints without these lesions. Keywords: Dog, Elbow, Flexor enthesopathy, Medial humeral epicondyle Background which were poorly described in the literature at that While scrutinizing canine elbows in the Norwegian time. Te ED screening program was intended to change elbow dysplasia (ED) screening program for several the method of screening using only fexed mediolateral years, we came across various forms of lesions of the (M-L) views in grading instead of two projections. It medial epicondyle or medial discreet calcifed structures, was decided to initiate a prospective observational study on the observed lesions before the craniocaudal (Cr- Cd) projection was no longer available in the screening *Correspondence: [email protected] program. ^ Jorunn Grondalen is deceased. Early studies on these lesions were reports of a Department of Companion Animal Clinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, P.O. Box 369, few lame dogs where a calcifed object was surgically N-0102 Centrum, Oslo, Norway removed [1–7]. In a study, the authors described a lesion © The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creat iveco mmons .org/licen ses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creat iveco mmons .org/publi cdoma in/ zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Rørvik et al. Acta Vet Scand (2020) 62:58 Page 2 of 12 on a radiograph as a ‘partial ununited epicondyle’, but elbows were called ‘concomitant fexor enthesopathy’. called the lesion ‘ununited medial epicondyle’ (UME) and Te authors made a very distinct separation between presented it as a developmental lesion and a new form of elbows with specifc changes in the enthesis of the medial ED [5]. It was opposed in another report, stating that nei- epicondyle itself (medial epicondylar lesions) and elbows ther three similar cases presented, nor the one previously with normal medial epicondyles. All elbows with medial presented, were UME [6]. It was postulated that UMEs epicondylar lesions (80 elbows with FE, primary or con- do not actually occur and that the lesion was rather a comitant) had irregular bone structure on the distal edge fragmentation of the medial epicondyle. May and Ben- of the medial epicondyle and/or ‘bony spurs’ distal-cau- net [7] reported four cases of fexor enthesopathy (FE) dally, except for two elbows that only had an irregular and were the frst to describe the clinical and radiological bone structure [10]. fndings of these lesions. In another study, 13 elbows (8 dogs) were diagnosed In later studies, the number of cases increased [8– with primary FE. Tese elbows had low-grade or no oste- 13]. Forty cases of what was called ‘medial epicondylar oarthritis and no calcifcation in the soft tissue. Clinical lesions’ were separated into two groups of 20; one group examination, radiography, ultrasound, CT, MRI, arthros- with evidence of FE and one with discreet mineralised copy, and open surgery were used. Specifc pathologi- fragments [9]. Few reports have described the histology cal changes in the soft tissue and bone were described. of these structures. Meyer-Lindenberg et al. [8] described All elbows had bony spurs and irregular bone structure the histology of 13 structures that had been surgically distally in the epicondyle on radiography except in one removed from the joints when they reported the fnd- dog. Tis dog had bilateral FE, but the only radiographic ings of 23 cases of ‘metaplasia’, and they reported that fve fnding in the elbows except from low grade osteoarthri- structures contained pure bone. tis was dense sclerosis around a distinct radiolucent area What was called ‘ununited medial epicondyles’ was centrally in the medial epicondyle in both elbows [11]. found in 15% of the puppies in a follow-up study of seven Previous studies have predominantly included lame litters of Labrador Retrievers (46 dogs). Te degree of dogs collected during clinical examination and/or treat- osteoarthritis and clinical signs were equally expressed ment. Te aim of our study was to use a Norwegian in the afected and non-efected elbows during the whole population of dogs radiographed for ED, which is a large observation time, ending at the age of 6–8 years. Te and defned population not signifcantly biased by clini- authors stated that the term ‘UME’ was not appropri- cal symptoms, and to describe radiographic variations ate for the described lesions and that the lesions in these of medial humeral epicondylar lesions and medial calci- elbows had no clinical impact. Tey also suggested that fed structures and fnd the prevalence of these lesions in these lesions were more frequently present in dogs than the population. Tis population seemed to represent the previously described [14]. true population of young dogs, at least for some specifc In a review on medial humeral epicondylar lesions, the breeds in Norway. Our hypothesis was that there was no authors frequently found that calcifed bodies near the diference in prevalence between breeds. medial epicondyle were described using several terms, Another aim was to evaluate the association between including ‘UME’. Tey concluded that this expression was the lesions and periarticular new bone formation (PNBF) unsuited and proposed that the term ‘fexor enthesopa- on a large scale. Te presence of PNBF might indicate thy’ should be used instead to describe the presence of whether these lesions have a harmful impact on the joint, pathological changes within the fexor muscles and their which is difcult to evaluate in individual joints when attachment to the medial epicondyle, whatever the cause infammation is present. Our hypothesis was that there of the actual problem [15]. was more PNBF in elbows with lesions. In a study of 117 dogs with elbow lameness, radio- Such a study is unique, but for various reasons the graphic fndings in the medial humeral epicondyle were study was not published. When the interest for these studied. Diagnosis was confrmed either by computed lesions increased, we found that the results of this study tomography, magnetic resonance imaging, or arthros- might provide additional and important knowledge if the copy depending on the type of elbow problem. Eighty radiographs were re-interpreted considering the results elbows were recorded with lesions in the medial humeral of new knowledge. epicondyle. In 12 of these radiographic changes of the medial epicondyle were the only fndings and these were Methods diagnosed with ‘primary fexor enthesopathy’. Te 68 Tis was a prospective observational study. Elbow radi- other elbows with medial epicondylar lesions had other ographs from the Norwegian ED screening program major lesions present, mostly medial coronoid disease were studied during a four-year period. Tey were eval- (MCD), and the medial epicondylar lesions in these uated for the presence of medial humeral epicondylar Rørvik et al. Acta Vet Scand (2020) 62:58 Page 3 of 12 lesions and discreet mineralised bodies in the soft the radial head. Te grade of PNBF, not the ED score, was tissue as they arrived. Te radiographs were of both used to compare secondary changes in the joints.
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