PHYSIOTHERAPY | REHABILITATION | HYDROTHERAPY

ELBOW DYSPLASIA IN DOGS

In memories of all immobile dogs that were not given a second chance

What is Elbow Dysplasia in Pets?

Canine elbow dysplasia (ED) is a disease of the elbows of dogs caused by growth disturbances in the elbow joint. There are a number of theories as to the exact cause of the disease that include defects in cartilage growth, trauma, genetics, exercise, diet and so on. It is likely that a combination of these factors leads to a mismatch of growth between the two bones in the fore leg located between the elbow and the wrist (radius and ulna). If the radius grows more slowly than the ulna it becomes shorter leading to increased pressure on the medial coronoid process of the ulna (Figure 1). This in turn can cause damage to the cartilage in joint and even fracture of the tip of the coronoid process, which damages the medial compartment (side closest to the body) of the joint. Less commonly, if the ulna grows too slowly then the radius pushes the upper arm bone (humerus) against the anconeal process, which can then lead to failure of the anconeal process to attach to the ulna at maturity. It is believed that the mismatch in growth between the radius and ulna may sometimes only occur during a puppy’s growth, but it may also persist when the pup has finished growing.

hese abnormalities, known as ‘primary lesions’, give rise to osteoarthritic processes. Elbow dysplasia is a common condition of certain breeds of dogs.Most primary lesions are related to osteochondrosis, which is a disease of the joint cartilage and specifically Osteochondritis dissecans (OCD or OD), the separation of a flap of cartilage on the joint surface. Other common causes of elbow dysplasia included ununited anconeal process (UAP) and fragmented or ununited medial coronoid process (FCP or FMCP).

References

Darryl L. Millis, MS, DVM, DACVS, DACVSMR, CCRP
Professor of Orthopedic Surgery & Director of Surgical Service

Robin Downing, DVM, MS, DAAPM, DACVSMR, CVPP, CCRP
Diplomate of the American Academy of Pain Management, is a a founder and past-president of the International Veterinary Academy of Pain Management.

Janet B. Van Dyke, DVM
Diplomate American College of Veterinary Sports Medicine and Rehabilitation, CCRT, CEO

Ludovica Dragone, DVM, CCRP
Vice President of VEPRA, Veterinary European of Physical Therapy and Rehabilitation Association.

Andrea L. Henderson, DVM, CCRT, CCRP
Resident, Canine Sports Medicine and Rehabilitation

Steven M.Fox, MS, DVM, MBA, PhD
President Securos. Inc

What causes Elbow Dysplasia in Dogs and are there certain breeds at risk?

The most common cause is osteochondrosis, which is a disease of the joint cartilage, and specifically Osteochondritis dissecans (OCD or OD), the separation of a flap of cartilage from the joint surface as a result of avascular necrosis, which in turn arises from failed blood flow in the subchondral bone. Other common causes of elbow dysplasia included ununited anconeal process (UAP) and fractured or ununited medial coronoid process (FCP or FMCP). Another theory is that this condition is primarily of genetic cause, although environmental factors such as obesity during puppyhood may influence whether an animal with the genes coding for Elbow Dysplasia will develop a clinical problem. Current estimates state that more than one hundred genes code for Elbow Dysplasia. It is common in some large breeds such as the Bernese Mountain Dog, German Shepherd, Golden Retriever, Labrador, Newfoundland, Rottweiler and others. ED can start in puppy hood and affect the dog for the rest of its life.

Elbow Dysplasia – The importance of a proper diagnosis process

Diagnosis of elbow dysplasia is usually performed with a combination of clinical examination and x-rays. Usually the dog has pain on fully bending or extending the elbow and often your veterinarian will want to watch your dog walk or trot to detect any lameness. X-rays will typically shows signs of arthritis but may also show the presence of small bone fragments in the joint or an ununited anconeal process . Your veterinarian may also choose to refer you to a specialist veterinary surgeon for more advanced diagnostic procedures to be performed. This may include CT scans, MRI scans, or arthroscopy, which is preferred as a more accurate diagnostic procedure.

CURRENT AVAILABLE MEDICAL TREATMENT IN SINGAPORE

Treatment depends on the severity of the disease in the elbow. In many cases surgery is recommended, but your veterinarian may recommend medical management if the problem is very mild or so severe that the joint is not likely to benefit from routine surgery. Treatment can be divided into the correction of a joint step between the radius and ulna if present, and treatment of any other joint damage. Often surgery is best performed arthroscopically, but conventional open surgery can also be done. Depending on the individual dog’s elbow problem surgery may involve:

Correction of joint step; is usually done by cutting the ulna to re-establish elbow congruence.
Surgical alteration of the elbow joint to shift weight away from damaged areas
Reattachment or removal of an united anconeal process of the medial joint compartmentJoint replacement if the elbow is severely diseased.
Removal of any coronoid fragments and removal of loose cartilage

Signs and Symptoms of Elbow Dysplasia in Dogs

Dogs with elbow dysplasia are often lame or they have an abnormal gait (they ‘paddle’ or ‘flip’ their front feet when they walk). Sometimes elbow dysplasia causes dogs to hold their elbows out or tightly into their bodies, and often a dog’s feet will rotate outwards. Sometimes dogs with this condition will choose to spend much of their time sitting or lying down, and when they play it’s usually not for long periods of time. Dogs with elbow dysplasia tend to tire easily, and their owners may assume they’re just lazy or quiet when really their elbows hurt. You might also notice your dog is stiff when he attempts to stand, and exercise frequently makes the situation worse, not better. If your dog has dysplasia in both elbows, his lameness may shift from one leg to the other. When both legs hurt equally, dogs with this condition don’t limp. They alter the way they stand and walk in order to shift their weight back and forth. If one elbow hurts more than the other, you’ll notice an obvious limp.

Front limb lameness
Gait is not asymmetric
When both elbows are involved the dog usually becomes unwilling to exercise for long periods or may even refuse to complete a walk
Very painful elbows
Tired Easily

The importance of Rehabilitation and Physiotherapy for Dogs with Elbow Dysplasia

Elbow dysplasia is the term used to describe a developmental abnormality in the elbow joint which involves a complex structure of three bones. If the three bones do not fit together (articulate) absolutely perfectly the consequence is abnormal concentration of forces on a specific region of the elbow joint causing lameness. There are multiple management options for elbow dysplasia; conservative and surgical however rehabilitation in either case can facilitate mobility. And abnormalities are the primary cause of ED which then induce a secondary osteoarthritic process, hence it is important to get your pet to us as soon as you can.

Physiotherapy can help to alleviate the symptoms of elbow dysplasia and enhance your dogs general well being

Rehabilitation Aims

Reduce pain and swelling
Maintain and/or increase joint mobility with a specific stretching programme which will be tailored to your dog
Maintain and/or increase muscle mass

Rehabilitation Options

Water based therapy is a perfect environment for a dog with elbow dysplasia. The warm, supportive medium provides pain relief and allows mobilisation of joints in a buoyant / semi-buoyant environment, maintenance and strengthening of specific muscle groups and enhancement of general cardiovascular fitness which on land might not be so easy.Hydrotherapy can be provided in a 100% buoyant environment such as our pool or in a variable buoyancy environment such as our underwater treadmill. Our therapists will advise you which is best for your dog depending on the severity of clinical signs and whether your dog is having conservative or post-operative rehabilitation.

Timeline	Physiotherapy Aims	Rehabilitation Therapy options
Week 0 to 2	Reduce swelling and pain	Cryotherapy Cold Laser Soft tissue massage
	Reduce muscular guarding and maintain soft tissue flexibility	Cold Laser Soft Tissue Massage Careful joint range of motion exercises
	Allow limb loading as able	Active exercises Underwater treadmill
Week 2 to 4	Progress limb loading and gait re education	Home exercise program Neuromuscular electrical stimulation Underwater treadmill
	Increase muscle mass	Low level exercise program Electromusclar stimulation
	Maintain soft tissue length and flexibility	Passive movements and stretches
	Management at home	Exercise restriction Advice regarding flooring Advice regarding the importance of avoiding jumping and climbing on and off furniture
Week 4 to 6	Continue as above	Progression of home exercise program to challenge balance and strength eg cavaletti poles, alternating gradients and surfaces Low level agility equipment use
		Advice on maintaining controlled exercise when dog feeling better
Week 6 to 12	Increase exercise tolerance	Increase exercise level, considering land and water based options.
	Continue to increase core stability	Home exercise program considering land and water based exercises
Week 12 onwards	Return to full function or establish deficits and advise regarding long term management.	Progress to off lead exercise and previous exercise level if appropriate.

URGENT CARE FOR PETS

Proven steps to pain free mobility.

REHABVET CLINIC is Singapore’s first full-fledged animal rehabilitation clinic. With our team of well-trained and experienced veterinarians and therapists.

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