elbow dysplasia

Re: elbow dysplasia

Malcolm Ness — Fri, 15 Jun 2012 19:10:54 GMT

I suggest a relatively consistent amount of activity from day to day - the amount will vary between dogs (granny's westie vs Gamekeepers Springer) but try and avoid 10 miles at the weekend then 100yds during the week.

The limp in most dogs doesn't get much worse after it appears so I tend to encourage owners to push the dog on a little bit rather than backing off once the limp appears. Obviously, if the dog is knackered the next day you are forced to back off. However, usually the fitness and endurance increases and dog plus owner are happy with the fact that the pet is no longer an invalid. I tell owners that while I would like to stop their dog limping , I probably won't be able to but if we can get a fully active and pain-controlled dog that still limps then I consider that a success.

Expect occasional acute flares of the chronic OA and during these the exercise should be moderated (I very, very rarely advise complete rest) with a view to a return to full activity as soon as possible.

Re: elbow dysplasia

HMC — Fri, 15 Jun 2012 18:13:12 GMT

Thank you Malcolm, that's really clarified things. What kind of exercise regime would you recommend? Would you recommend the owners continue each walk after she starts limping or turn around and go back (they are currently doing the latter).

Re: elbow dysplasia

Malcolm Ness — Fri, 15 Jun 2012 18:01:35 GMT

[quote user="Hannah Bose"]

What would people recommend as the next step after radiographs with a dog with osteoarthritis secondary to elbow dysplasia?

The patient in question is a 5 year old G. Retriever who has failed to respond to medical management (very restricted exercise; 1st metacam then previcox; tramadol; joint supplements; not in need of weight loss). Her xrays were sent off to an orthopaedic specialist who recommended arthroscopy or CT. But which to choose? I don't want to choose arthoscopy just because the specialist is near and can do that and CT is a longer journey away- I want the decision to be based on more than that!

I would have thought CT next...?

Insured up to £2,500.

Thanks.

[/quote]

Been away for a few days and just seen this.

Elbow OA in this breed is most often due to ED and provided you have two well positioned, good quality radiographic views then your assesment of the abnormality is probably correct and consequently further diagnostic imaging (CT and/or arthroscopy) will do little other than enrich the investigator.

Contrary to what has been said earlier, the utility of arthroscopy in these cases in minimal - the arthroscopist will have fun and get a nice view of parts of the joint surface. They might also poke about a bit with some fancy tools under the guise of arthroscopic surgery. Regrettably, there is no good evidence to show that any such procedure is beneficial and accumulating evidence to indicate that, at best arthroscopic elbow surgery in ED is harmless.

Unfortunately, there aren't any quick fixes for these cases. Appropriate conservatism involves weight normalisation; long NSAID courses (3 mths initially) and regular exercise (NOT rest). Competent physiotherapy can help; hydrotherapy = expensive swimming and is pointless. If things are bad enough that Tramadol. Gabapentin etc is being contemplated then salvage surgery isindicated. Elbow replacement is costly but very effective at pain control and good for restoration of acceptable function - we use the TATE cementless system. Other systems have been less useful and upcoming systems might turn out to be better.

Elbow arthrodesis is not an attractive option and other surgical interventions which might be of some use in immature dogs (none are proven convincingly in my opinion) would not be appropriate in a 5yo where the problem is effectively OA - the inciting cause is history.

Being a fairly frequent user of both MRI and arthroscopy, I am of the opinion that they are modalities most frequently used with little risk of benefit to the patient!!

Re: elbow dysplasia

Claire Fisher — Wed, 13 Jun 2012 18:27:09 GMT

We have a very similar case with a young Labrador - he had chronic changes on xray and initally responded well to management then relapsed - referral centre recommended joint tap in case any infection and then switching Tramadol for Gabapentin and considering paracetmol for additional pain relief.

Re: elbow dysplasia

HMC — Wed, 13 Jun 2012 17:39:10 GMT

P.S. what is a sliding humoral osteotomy? [or maybe I should just look it up in a text book and stop being lazy]

Re: elbow dysplasia

James Laidlaw — Wed, 13 Jun 2012 17:00:17 GMT

Surely there are things that both ct and scoping can each show that the other procedure may not show? I'd agree that if cost is an issue then scoping probably leaves more finances to treat with, but there's potentially things that could be missed without ct as well. (PS I'm orthopaedically ignorant so wait for input from the boffins!)

Re: elbow dysplasia

Rob Davis — Wed, 13 Jun 2012 16:30:07 GMT

[quote user="Mark Holmes"] If the dog really is crippled and not responding to analgesia would you be better using as much of the insurance as possible for an elbow replacement[/quote]

I was under the impression that elbow replacements are not particularly great yet. I spoke to our local orthopods a little while ago and they don't offer it as they feel the results aren't good enough yet. I'd be interested to hear Malcolm's thoughts if he's around...

Re: elbow dysplasia

Mark Holmes — Wed, 13 Jun 2012 16:22:25 GMT

[quote user="David Mills"]

[quote user="Mark Holmes"]

In which case I would suggest arthroscopy as diagnosis and some treatment is possible at the same time.

[/quote]

What treatment for OA can be done arthroscopically? I was under the impression that arthroscopy is only useful in the first 18m at most for "elbow dysplasia" (and all its guises) in terms of treatment - removal of bone or OCD lesions - so at most in a dog this old you'd only be reaching a more definitive diagnosis.

Although the clinical exam may not be that exciting the clinical picture is one of pain if limping within a few hundred yards.

[/quote]

Well yes, I would agree my impression was also that arthroscopy is better in younger dogs, but there is a flushing effect and I was under the impression that it was possible to generally tidy things up, debride and encourage fibrocartilage formation. But yes chonic OA was less responsive and treatable than thanin younger dogs. Hence my note earlier that any benefit was only short term and had little medium or long term results.

You could also argue that are any further diagnostics going to be best value for money and would hydrotherapy/physio be a better solution. Is the limp pain related or the mechanical effect of a restricted gait? The equivalent of having one leg shorter than the other, markedly limpy but not necessarily painful.

Re: elbow dysplasia

David Mills — Wed, 13 Jun 2012 16:03:48 GMT

[quote user="Mark Holmes"]

In which case I would suggest arthroscopy as diagnosis and some treatment is possible at the same time.

[/quote]

Although the clinical exam may not be that exciting the clinical picture is one of pain if limping within a few hundred yards.

Re: elbow dysplasia

Mark Holmes — Wed, 13 Jun 2012 15:46:40 GMT

[quote user="Hannah Bose"]

Thanks. She isn't completely crippled- examination of the elbow (in my hands) is largely NAD. However, she starts limping within a couple of hundred yards. So I think TER is a little premature.

[/quote]

In which case I would suggest arthroscopy as diagnosis and some treatment is possible at the same time.

Re: elbow dysplasia

HMC — Wed, 13 Jun 2012 15:26:08 GMT

Thanks. She isn't completely crippled- examination of the elbow (in my hands) is largely NAD. However, she starts limping within a couple of hundred yards. So I think TER is a little premature.

Re: elbow dysplasia

Mark Holmes — Wed, 13 Jun 2012 15:10:35 GMT

CT won't leave you much money to actually do anything witht he CT results, where as arthroscopy would possibly have a benefit. That said I wasn't aware that anything that could be done with arthroscopy had much benefit over medium and longer term and was best considered to be a short term solution to pain. If the dog really is crippled and not responding to analgesia would you be better using as much of the insurance as possible for an elbow replacement rather than on further diagnostics.