Elbow lameness: In a young dog, a deformed elbow may be the problem
The term dysplasia refers to a developmental defect, where abnormal cells appear in a particular type of tissue or organ. And while hip dysplasia tends to get the headlines for canine orthopedic health, elbow dysplasia can be equally debilitating. Elbow dysplasia is the second-most common cause of elbow lameness in dogs. The first is osteoarthritis, which can be associated with elbow dysplasia.
While elbow dysplasia cannot be cured, it can be well-managed. With surgery and the appropriate medical management, many dogs have a good long-term prognosis.
Generally, dogs with elbow dysplasia will be lame after exercise and won’t recover fully with just rest. Some dogs will start refusing to exercise, with a noticeable decrease in their overall activity level. Dogs with this defect often move by turning their paw inward, noticeably holding their elbow out from the body
in an attempt to shift weight off the sore part of the joint.
If your dog has elbow dysplasia only on one side of their body, you or your veterinarian may notice their lameness earlier. Favoring the defective limb will often be evident by a “head bob,” which means that your dog’s head goes higher on the bad footfall to take weight off that leg, bobbing down when the “good leg” lands.
That is the clinical picture if both elbows are affected but one side hurts more than the other. If both elbows are equally affected, then it can be more difficult to pick up on lameness. Most dogs will try to compensate with a shortened stride, and the range of motion in their joints is generally reduced. Another clue is if you see your dog manipulating their leg by extending and flexing the elbow joint — an action that is often associated with pain. Even with a more stoic dog, owners may notice some swelling of affected elbow joints along with abnormal warmth in the area.
“In my experience, almost all dogs with elbow dysplasia show both pain and lameness. Pain on palpation or on full extension/flexion is often noticed with careful examination,” says Kei Hayashi, professor of small animal surgery in the Department of Clinical Sciences.
What is dysplasia
Dysplasia is a term that refers to a developmental abnormality in the body’s tissues.
In dogs, the elbow joint involves three bones: the humerus, ulna and radius. These bones must all work together perfectly to give your dog pain-free movement in their elbow joint.
True elbow dysplasia will not be diagnosed before 4 to 6 months of age, when the growth plates in joints are still closing. Most dogs are a couple of months older before a clear-cut diagnosis is made.
Most dogs are diagnosed with elbow dysplasia by physical examination and by doing a thorough lameness evaluation at 4 to 12 months of age. In mild cases, however, affected dogs may not show lameness until 7 or 8 years of age, when arthritis kicks in.
Diagnosing an elbow problem requires a thorough lameness exam with radiographs. Flexed views of both elbows can show defective areas and identify early arthritic changes. A CT scan and arthroscopic surgery to look into the joint are used to guide diagnosis and therapy.
As with so many health problems, early intervention is best. Surgery may reduce your dog’s pain dramatically.
“I personally recommend a CT scan and arthroscopic surgery to all symptomatic dogs as soon as they show pain or lameness,” Hayashi says.
For mild cases of elbow dysplasia, the goal of surgery is to remove any damaged tissues, which will often help to relieve pain, at least temporarily. Dogs with moderate-to-severe elbow deformities may need extensive surgery to realign the malformed elbow joint.
According to the American College of Veterinary Surgeons, on average, about 85% of cases will show some degree of improvement in lameness and comfort despite progression of arthritis on X-rays after surgical treatment. The goal of treatment is to slow the progression of arthritis and prolong the patients’ use of the elbow.
A new option for dogs is surgical elbow replacement, a very difficult, expensive option. Hayashi has performed elbow replacements, but he says, “our technology and experience are not there yet as compared to say, hip replacements in dogs. There are several elbow replacement systems available, but they all come with very serious complications. We are still diligently working on improving surgical approach and implant designs to reduce complications.”
If you’re considering elbow replacement for your dog, you need to be sure their weight is ideal and that their other joints are in great shape. Follow-up rehabilitation will be critical.
For any puppy, but especially ones with a greater risk for any orthopedic defect, keeping the puppy trim as they grow is important. You don’t want to scrimp on essential nutrients, but you don’t want a chubby puppy either. Your veterinarian may recommend some joint supplements right from a young age, even for normal pups, and they will encourage moderate exercise.
“Jump down” injuries can lead to a variety of front leg problems for dogs. This is when your dog repetitively jumps down off the bed, off the couch, out of your car and other similar movements. Going down long flights of stairs frequently can also add trauma. Many breeders recommend that puppies avoid more than 2 or 3 stairs until 6 months of age or older since the potential for damage is worse for puppies than for adult dogs.
Rigorous use of screenings for breeding animals (with full public information) is currently the best bet for decreasing cases of elbow dysplasia. Normal parents may produce elbow problems, but the incidence is much lower than if one or both parents have bad elbows themselves.
“A registry system to reduce the number of dysplastic puppies produced would be the most important strategy to effectively decrease the number of cases of elbow dysplasia. There are many treatment options proposed (often commercially) but nothing has been scientifically proven to be effective,” says Hayashi.
He personally recommends taking action as soon as possible to detect pain and lameness early, perform an arthroscopic coronoidectomy, followed by intensive non-surgical supportive care.
"We are currently developing more effective surgical options for elbow arthritis, but I have studied the canine elbow for almost 30 years, and now I know we know next to nothing. It has been a humbling experience," he says. "Canine elbow disease is a developmental problem with significant dynamic components contributing to pain and disability. I believe it is arrogant to think we can fix it once the problem develops.”
Fragmented medial coronoid process
There are three other processes that describe specific types of bony defects in the elbow: fragmented medial coronoid process (FCP), osteochondrosis of the humeral condyle and ununited anconeal process. These all fall under the umbrella of elbow dysplasia umbrella, and they all lead to secondary arthritis.
Some dogs will be affected on just one side, but many dogs will have problems with both elbows. Fragmented coronoid process is the most common.
“For mild FCP cases, I offer (but don’t necessarily push) surgery. The reason for this is that we don’t know for sure that we will make these dogs better with surgery. There is the potential to make them worse, and surgery is expensive. At the same time, if owners want to pursue surgery, it’s better to do it when their dog is first diagnosed rather than waiting,” says Selena Tinga, assistant professor of small animal surgery.
“For moderate to severe FCP cases, I will push surgery more strongly but never guarantee a cure," she says. "Surgery is only part of these dogs’ lifelong treatment.”
Unfortunately, there’s no way around it: Surgery is your best choice for helping a dog with elbow dysplasia. The elbow cannot correct itself.
That said, if surgery is impossible for other reasons, then medical-management strategies designed to help with severe arthritis are your next-best choice. While they can’t fix the problem, they may make your dog more comfortable.
- Weight management: Simply getting your dog to their normal weight may decrease their pain dramatically.
- Exercise: Moderate exercise moves the joint and builds cushion. Be sure to use proper warm-up and cool-down periods. For example, if your dog loves to play ball, a 10-minute walk will help loosen their joints so that they can move more freely.
- Physical therapy: Massage and hydrotherapy, like underwater treadmills and swimming, are typically done after elbow dysplasia surgery, but they also can be used to help the joint in cases where surgery isn’t possible. Laser treatments, TENs (transcutaneous electrical nerve stimulation), ice therapy and acupuncture may be worth trying.
- Pain medications: Your veterinarian may recommend a non-steroidal anti-inflammatory drug (NSAID), such as carprofen, to help keep your dog comfortable.
- Joint supplements: Ingredients like glucosamine, hyaluronic acid and chondroitin encourage healthy cartilage and increased joint fluid, which help act as cushions. The choices on the market are plentiful, but they aren’t all effective. Work with your veterinarian to choose the best supplement for your dog.
- Injectables: Adequan is another injectable drug that could help with the accompanying osteoarthritis and pain. While it can help alleviate some pain, it won’t help the elbow dysplasia itself. Injecting platelet-rich plasma (PRP) into the joint has also been used with some success in canine elbow dysplasia. Synovetin OA is a new, injectable medication that uses electron therapy to target macrophages and synoviocytes in the painful elbow. It must be injected directly into the affected joint.
- Braces: Although you’ll find braces for elbow dysplasia on the market, they’re more suited for luxations (dislocations), hygromas (fluid buildup around joints) and ligament tears — not loose pieces of cartilage or bone. If you’re going to try a brace, proper fit is critical to it being effective, so be sure to involve your veterinarian or a veterinary rehab specialist in your decision-making process.
This article has been reprinted with permission from Cornell University College of Veterinary Medicine’s DOGWatch Newsletter, published by Belvoir Media Group. Subscribe online to DOGWatch Newsletter here.