Canine Elbow Displasia
The term Elbow Dysplasia
covers a group of developmental defects of the elbow joint that can
occur in any area of the joint. These include Fragmented Coronoid
Process or Fractured Coronoid Process, Degenerative Joint Disease,
Ununited Anconeal Process or Non-union of the Anconeal Process, and
It is a complex
condition as several genes combine to produce it. Diet, activity
and trauma may also contribute to elbow dysplasia. Joint pain and
usually result. The BVA and Kennel Club run a scheme to asses
is elbow dysplasia?
related terms: OCD, osteochondrosis of humeral condyle, fragmented
medial coronoid process, ununited anconeal process, incongruent elbow
elbow dysplasia refers to several conditions that affect the elbow
joint: osteochondrosis of the medial humeral condyle, fragmented medial
coronoid process, ununited anconeal process, and incongruent elbow.
More than one of these conditions may be present, and this disease
often affects both front legs. An affected dog shows forelimb lameness
pain. These conditions may actually be different manifestations of
a single disease process, osteochondritis dissecans (OCD) . OCD is
maturation of cartilage (the specialized connective tissue from which
bone develops). While this in an inherited defect, environmental
such as diet, activity, and trauma also have a role in the development
and progression of the disease.
Osteochondritis dissecans (OCD): A fragment of cartilage peels
away from the bone, within the joint.
Osteochondrosis of medial humeral condyle: OCD develops on
the elbow end of the humerus (the long bone in the front leg above the
Fragmented medial coronoid process and ununited anconeal process:
The coronoid and anconeal processes are small bones which fuse with the
main part of the ulna as the animal matures. (The ulna and the radius
are the two bones which make up the front leg between wrist and elbow).
These terms describe the condition where those processes either break
off from the ulna, or fail to fuse normally.
Incongruent elbow: The bones which form the elbow
joint grow at different rates and do not fit together properly.
How is elbow dysplasia inherited?
This is a polygenic condition (more than one gene is necessary to cause
the disease), although it is not currently known how many
or which genes are responsible. Environmental factors such as
over-feeding, which causes fast weight-gain and growth, can also affect
the development of this condition in dogs that are genetically
predisposed to it.
What breeds are affected by elbow dysplasia?
Many large breed dogs are affected, and elbow dysplasia is more common
in males than females. Affected breeds include the basset hound,
Bernese mountain dog, bloodhound, Bouvier des Flandres, chow-chow,
German shepherd, golden retriever, Great Pyrenees, Irish wolfhound,
Labrador retriever, mastiff, Newfoundland, rottweiler, St.
Bernard, and weimaraner. Other large breed dogs may be affected as well.
For many breeds and many disorders, the studies to determine the mode
of inheritance or the frequency in the breed have not been carried out,
or are inconclusive. We have listed breeds for which there is a
consensus among those investigating in this field and among veterinary
practitioners, that the condition is significant in this breed.
What does elbow dysplasia mean to your dog & you?
Lameness usually starts insidiously at 7 to 10 months of
age. It is present every day, and may be most obvious when you dog
first gets up, or starts to walk or run. The prognosis (the likely
depends on how far the disease has progressed when treatment begins.
Good clinical results (ie. your dog will not be painful) are usually
seen if treatment starts early, before osteoarthritis (degenerative
in the joint) has developed. If left untreated, your dog’s pain and
will gradually get worse.
How is elbow dysplasia diagnosed?
The initial lameness may be very subtle with this condition, and it may
be some time before it can be documented or diagnosed.
Your veterinarian will suspect elbow dysplasia if you have a young,
fast-growing, large breed dog (especially those breeds listed above),
with forelimb lameness and elbow pain. S/he will perform a physical
and watch your dog walk or run to confirm which limb, and which joint,
is painful. X-rays are necessary to diagnose elbow dysplasia. Your
will probably x-ray both elbows, because this disease is often present
in both sides even if your dog is only lame on one side. If possible,
s/he may do a CT scan; this technique will show certain bone fragments
better than plain x-ray films.
How is elbow dysplasia treated?
Surgery is usually recommended to remove a bone or cartilage fragment.
If unequal bone growth is the problem, surgery may help
to relieve the pressure at the joint.
Medical management recommendations include monitoring the diet (to
avoid excess weight gain and fast growth), and controlling exercise.
Medications such as non-steroidal anti-inflammatory drugs may help with
pain relief. "Chondroprotective agents" such as glucosamine may also be
Do not breed affected dogs, or dogs which produce offspring with elbow
dysplasia. The Orthopedic Foundation of America (OFA - www.offa.org)
maintains an elbow registry screening programme, as do European
organizations. The Institute for Genetic Disease Control in Animals
(GDC - www.vetmed.ucdavis.edu/gdc/gdc.html) provides evaluation of
elbows as recommended by the International
Elbow Working Group.
INFORMATION ABOUT THIS DISORDER, PLEASE SEE YOUR VETERINARIAN.
Abstracts of the 7th Annual Meeting of the International
Elbow Working Group. 1996. Veterinary Comparative Orthopaedics and
Bennett D, May C. 1995. Joint diseases of dogs and cats.
In EJ Ettinger and EC Feldman(eds). Textbook of Veterinary Internal
Medicine, pp. 2032-2077.WB Saunders Co., Toronto.
Schrader SC. 1995 Differential diagnosis of nontraumatic
causes of lameness in young growing dogs In JD Bonagura (ed.) Kirk's
Current Veterinary Therapy XII, pp. 1171-1180. WB Saunders Co., Toronto
© 1998 Canine Inherited Disorders Database. All rights reserved. Revised: April 23, 2002.
This database is a joint
initiative of the Sir James Dunn Animal Welfare Centre at
the Atlantic Veterinary College, University of Prince Edward Island,
and the Canadian Veterinary Medical Association.
with kind permission from:-
Crook, DVM,Coordinator, Sir James Dunn Animal Welfare Centre, Atlantic
Veterinary College,University of Prince Edward Island, 550 University
Ave.Charlottetown, PEI C1A 4P3
Look at Elbows
by Fred Lanting
In the Second Quarter 2000, the SENNtinel, official publication of the
Greater Swiss Mountain Dog Club of America, carried a reprint on
Elbow Dysplasia by Dr. Henry DeBoer, a prolific magazine writer,
schutzhund enthusiast, and all-around “working dog guy”. His topic
should have been of great interest to Swiss people because ED is at a
high incidence in the breed. Unfortunately, there were a couple of
minor errors in his
piece. Besides clearing up those, I would like to give some additional
information on the disorder's) in the elbow. Please look at the
first, so you have “map and dictionary” to guide you through the text.
The word “process” in this work means a bony “bump or protrusion”.
1 through 3 are main positions used for radiographic views of the elbow.
The most obvious of the
errors was when Dr. DeBoer said that the coronoid process (like the
anconeus) starts as a separate bone centre with a growth plate, and
that it unites with the rest of the ulna in the same manner. This was
an initial assumption `way back in the beginning, when the most
authoritative orthopedics researcher and surgeon Sten-Erik Olsson first
saw (in adult dogs) that there was a fragment in the coronoid-radius
area of the elbow, not visible of nearly any radiograph. Finding that
piece upon necropsy,
and knowing that the anconeal started as a separate bone centre in the
embryo and growing puppy, it was natural for him to think that the
coronoid process did, too. He first reported the disease as “ununited
medial coronoid process”. However, he quickly found it not to be the
case. Rather, the coronoid
ossifies (changes into bone tissue) from the embryo’s cartilaginous
of the main ulnar shaft itself. See Figure 4. Since the first
got into print, and was misunderstood by lay readers as an infallible
statement, it persisted for a long time in the popular press even
the editors should have picked up Olsson’s repudiation shortly
Two of today’s prominent researchers are Dr. Paul W. Poulos Jr. and Dr.
Alida Wind. Poulos is president of the IEWG (International Elbow
Working Group), found at
and Dr. Wind is a renowned orthopaedic surgeon at the Univ. of
Calif. at Davis and one of the founders of GDC, the Institute for
Disease Control, which you can see at
When Poulos was in Sweden working on his Ph.D., and with
Professor Olsson, the medial coronoid process was one of their areas
of interest. He reports that when Olsson “went to unaffected dogs, we
could not find any evidence of a separate center of ossification for
medial coronoid. At that time he changed the terminology to ‘fragmented
medial coronoid process’, although the terminology ‘fractured medial
coronoid’ has also been used. I know of no evidence to support a
centre of ossification for the medial coronoid process.”
The same writer (DeBoer) also relates UAP to the disparity in growth
rates of ulna and radius, and says that taking a slice out of the ulna
(effectively raising the relative height of the radius for better
support of the humerus) “allows the anconeal process to unite”. He
a “decrease in tension”. I know about that experimental procedure, but
fail to see the connection, or the effect of better weight-bearing by
the radius on the anconeal process. It is unlikely that there would be
any biomechanical stress changes on that portion, which is “above and
beyond” the gravitational support vectors from humerus to radius to
Perhaps a re-wording would help us understand this seemingly puzzling
concept. Unfortunately, the article was not annotated.
The elbow is called a synovial (lubricated) hinge joint, although it
has some minor similarity to a ball-and-socket joint. There is not that
sort of rotation that we find in the hip; the twisting of the lower arm
is possible because of the design of the radius. Mainly, flexion and
extension are the movements in the elbow itself. The ulna acts to add
and restrict motion, and the radius bears most, perhaps up to 80%, of
the weight of the forequarters. At the top (proximal) end of the ulna,
there are three main processes that concern us (See Fig. 5). The
process on the back (posterior) side is easily felt and seen and is
called the “point of the elbow” by dog fanciers. On the front
are the anconeal and coronoid processes. The first is seen on
while the other is very hard to find because its shadow is covered by
of other structures such as the condyles (knobs) on the bottom of the
The separate anconeal process shown in Fig. 4 ossifies at the expense
the growth plate between it and the olecranon. If it doesn’t do this by
age five months, you have the dysplasia known as UAP, ununited anconeal
The coronoid process
develops differently, having always been part of the ulnar bone center.
However, if the other lower-arm bone (radius) does not grow at a
compatible rate with the ulna, it might be too short to effectively
the weight of the dog’s front end. This puts much extra stress on the
coronoid process, which simply is not strong enough to bear the load.
Sooner or later it develops fissures (stress cracks) and starts to
like a rock ledge crumbling away (See Fig. 6). Of course, the presence
of loose bony pieces such as these (they are often called joint mice)
to inflammation and pain. Some dogs feel it greatly; others are more
or tough in regard to pain threshold. Although both anconeal
and coronoid (secondarily) dysphasia's are related to defects in
growth and ossification, the different routes and origins make me want
to keep the manifestations of elbow osteochondrosis separated in
and discussion. On the other hand, Dr. Wind theorizes, “This disease
is an abnormal development of the elbow joint due to underdevelopment
the ulnar trochlear notch. This causes incongruity within the joint,
which leads to osteoarthrosis but may also cause fragmentation of the
medial coronoid process, osteochondrosis of the humeral condyle,
ununited anconeal process, or combinations thereof.” So you can think
of ED as one disease or syndrome, or more than one very closely related
Even from before birth, the
development of these parts is by endochondral ossification with bone
replacing cartilage at hopefully a normal rate and manner. Go back to
Figure 4 now. Using the typical medium-size dog as an example, the
following “secondary” (other than the main shaft) bone or ossification
centres are seen by about 10 weeks:
|Fragmented Coronoid Process with
tell-tale osteophytes at some distance from the lesion
|a. 3 year old Old English
Sheepdog with joint mouse moving in and irritating soft tissues.
b. 9 year old Bulldog; joint mouse has been
resorted or lost and another break is starting.
1. The lateral and medial humeral condyles (the two rounded “bumps” on
the distal end of the humerus (upper arm) that fit into the
half-moon-shaped groove in the lower arm’s ulna),
2. The epicondyle of the humerus,
3. The epiphysis of the radius (that’s the shorter of the two bones in
the lower arm),
4. The olecranon (the “point” of the elbow) at the proximal (top) end
of this longer bone in the lower arm.
During the first 10 weeks, the anconeal process is not visible
on radiographs, but in the next couple of weeks, ossification begins,
with gradual growth and increased opacity until, somewhere in the 16-24
week time frame, the centre not only turns “completely” to bone, but
fuses with the ulna. The result is a stronger joint with more
weight-bearing ability than cartilage could offer. With the normal
anconeal process in place (riding or inserting into the notch between
the condyles of the humerus, there is stability in motion. Without it,
there is a side-to-side action, with the olecranon (topmost point of
elbow) rolling around in what is referred to as an “out at the elbows”
gait. There are also some breeds in which individuals have been
described as “double-jointed” because they have less restriction on
extreme extension and flexion than is made by the anconeus and coronoid
in most dogs.
Gross differences in growth rates between ulna and radius can put great
pressure on the coronoid process, leading to FCP, and in many dogs the
lower forelimb is bowed. If lameness does not develop, there may still
be very variable amounts of ulnar growth retardation; many
fiddle-fronted dogs are seen in the show rings, especially Toys and
Shar Pei, but also many other breeds. If the coronoid process of the
ulna bears a disproportionate amount of the weight from the humerus,
and that upper arm is not as much supported by the (shorter) radius,
eventual fracture is almost assured, especially in the larger, heavier
dogs and those that do a good amount of jumping and running. The
wide-top radius is designed to support most of the dog’s
In the development of the normal elbow, there is good congruity (which
is to say tight fit) between humeral condyles and the trochlear notch
that runs from the ulna’s anconeal and coronoid processes, and between
humerus and radius. Likewise, there is a tight fit between the radius
and the ulna, with the curve of the coronoid process continuing in an
unbroken arc forming the articular top surface of the radius. In some
elbows, the coronoid process is situated a bit higher than normal (or
you could say the top of the radius isn’t high enough because it has
in growth). This “step” is often accompanied by a crack in the coronoid
process, or a fragmentation. In some elbows with or without FCP, UAP,
OCD, there can be increased joint space between humerus and radius,
and ulna, or both. Studies at Davis showed that joint incongruity
clinically observable FCP and since it is seen in conjunction with UAP
and OCD also, the implication is strong that incongruity precedes these
lesions as well.
Breeding for Better Elbows — What is “Normal”?
In Scandinavia, there is a closer working relationship between
scientists, government, and breeders than is found in the Americas.
Dr. Lennart Swenson, geneticist at the Swedish University of
Sciences, calls our attention to the fact that it is relatively easy to
define “normal” and segregate them from “affected” (dysplastic elbows),
and select our breeding stock from the former class. But within the
we identify as normal, how should we further separate them by genetic
We can give grades of dysplasia to the affected dogs, but should we not
further identify the best of the unaffected? That is a harder task
of more minor differences and lower accuracy in designating our
Professor Swenson gives this table, based on a study of the incidence
of elbow dysplasias in Rottweiler progeny (The word “normal” here
probably should be in quotation marks, since the dogs obviously are not
normal in genotype.):
Parents Offspring Affected, %
normal X normal 31
normal X mild ED 43
normal X mod/severe ED 48
ED X ED 56
Elbow dysplasias, whatever type, are polygenic, and as you know that
means environmental forces such as nutrition might affect individual
differences in severity of the dog, but do not change what it passes
on to the next generation.
We lump together in a category called “normal” all those that we
subjectively decide do not have characteristics worthy of putting them
over the line or threshold into the affected categories. It is harder
to create grades of normality than to segregate other dogs into grades
of abnormality. The somewhat threshold nature plus the polygenic basis
makes us treat all such dogs as equal, even though some may be, in the
words of George Orwell, “more equal than others”.
Covert Elbow Dysplasia
Not only can we not tell how one normal-elbow dog differs from
the next, but also we can be fooled by actual affected dogs that show
no arthrosis or dysplasia. Therefore, we should consider that, on
breeding a phenotypically normal dog only means that we are using the
or mean “normal” from a range of genetic (and perhaps phenotypic)
in the population from which it was selected. The only thing we can
and accurately say about the ones classified as “normal” is that we
see any signs, not that we can be positive there is not the same number
of bad genes as in some of the less-obvious cases. In the affected
we can give a grade, but in the normals, we can only estimate the
value as being the average of that segment of the colony. We as
breeders must find some middle ground where we are neither too
(discarding most of the dogs in a breed) nor too lax (calling too many
If we were to improve diagnostic techniques in the study of ED
as we have with the use of the PennHIP Distraction Index for hip
joints, we could differentiate between dogs in the “normal” category,
and improve our selection immensely. We could avoid more of the
carriers than we
have in the past. If we could assign a numerical, objective value, or
even an improved subjective one, to each normal dog, they could have
individual phenotypic values and thus a closer estimate of each dog’s
genetic value. Better techniques of ascertaining these differences
would be extremely helpful. However, in the meantime, we might get more
mileage out of data on close relatives, especially if the population of
the “normals” were
a small percentage such as in the previous paragraph. That means we
need all exam results to be added to the database; in other words, an
mandatory, and complete registry. Information on siblings, parents,
and other close relatives would make for better differentiation of
as much as improved diagnostic techniques would. As knowledge of breed
value increases, so does efficiency of breeding programs. The only open
registry in North America (at the time of this writing) was GDC, and
operated such registries for both hips and elbows. They have since
with OFA and consequently the openness of their data is a thing of the
Depending on breed, elbow dysplasias can range from inconsequential to
a very serious problem. In one review it was reported that one dog in
300 seen at 14 university veterinary teaching hospitals had some elbow
disease. That all-breed estimate fails to convey the serious economic
and emotional costs of ED incidence in the more popular breeds.
Most body types are represented in the early lists of breeds affected
by one or another of the elbow dysplasias, including Akita, Bouvier,
Dobe, Fila Brasileiro, Springer, Irish Wolfhound, Shar Pei, and others.
the early 1999 OFA elbow data, approximately 30% of the Bernese
Mountain Dogs were dysplastic, 12% of the Golden Retrievers, over 20%
of the German Shepherd Dogs, 13% of the Labs, and 42% of the
Rottweilers. Border Collies appear to be almost free of ED, while the
incidence in the Chow Chow is about 50%!
The 1998 OFA data shows the average of all breeds in the database to be
about 11%, [incidentally, that means Swissies are worse off than the
average], males are more affected than females, and that it is
bilateral in as many as 35% of affected dogs. Now that statistic seems
to me, so it leads me back to the concept of covert ED. No explanation
was proffered as to why the OFA’s ED percentages in Rotties and Berners
were lower than those seen in Scandinavia. I might offer one possible
idea: during the time the Norwegians and Swedes were emphasizing
dogs with normal elbows (and seeing progress in that joint) as well as
hips, we in America were concentrating on promoting the preferential
of dogs with OFA numbers for hips only. If, as Dr. Olsson has said,
osteochondrosis is the description of a general disorder in which HD is
one manifestation, and elbow problems are others, then perhaps by
selecting for normal hips, our better American breeders were
unwittingly and unintentionally selecting dogs with fewer genes for
osteochondrosis of any sort, including in elbows. Or maybe not.
In the mid 1990s, the large and sometimes ponderous SV (Germany-HQ club
for GSDs) at last admitted that elbow dysplasia was a serious enough
problem in the GSD that it was worth their attention. While finding
that HD was more prevalent and of greater concern, they now
that ED existed and should be addressed. They started with a voluntary
program with 450 dogs participating and in that initial study found
had more than 10 % incidence of UAP, FCP, and OCD. But some 30% of GSDs
had some sort of arthrosis. Similar numbers also had been reported in
and Australian studies, they noted. The SV suggested screening all dogs
6 and 12 months of age.
Working the Affected Dog
Often, the dog that is diagnosed with mild ED of one sort or another
belongs to someone active in the sport end of the dog game, having no
plans to breed but wanting to do obedience work. Caution must be
advised here, but it is possible for many dogs to live a happy life and
compete in such events. AKC-CKC-type obedience is easier, as the jump
have been lowered, the rings are small, and no really fast running for
considerable distances is required. Let your dog and your common sense
guide you in how much you ask or encourage your dog to do. These
or suspected dogs especially should be prevented from becoming heavy.
of the Grade 1 dogs will not develop any lameness. As is recommended
any other sort of osteochondrosis, keep the nutritional volume and
level (and hence the weight) down, and do not supplement with calcium.
In 1981, Dr. Wind began studying elbow laxity in Berners, basically the
“same breed” as the Swissy. By 1986, Dr. George Padgett, pathologist at
Michigan State, with a special interest in genetics, sent a
questionnaire to national breed clubs re the status of and needs for
genetic disorder control schemes. He proposed a disease registry which
would contain information on genetic risks of individuals, based on
their own phenotype plus those of their progeny, siblings, and
half-siblings. Physicist Dr. Martin Packard developed a computer
program about that time. Bernese (and other breed) fanciers,
radiologists, geneticists, and vets soon were working hand-in-glove
with like-minded individuals and groups in Sweden, Canada, Switzerland,
the US, Canada, and the U.K. Almost all were also coming to realize
that elbow dysplasias and other problems were very much genetic in
nature, and that registry and control measures were needed. Some first
approached the OFA because of that foundation’s wide recognition in the
field of HD control and registry. After she found OFA initially to be
less than enthusiastic, Dr. Wind found other funding to organize the
inaugural International Elbow Working Group meeting in Davis, CA in
1989. In that year these three brought together a group of about eight
people who collectively gave birth on the same day to twins: the IEWG
(Int’l Elbow Working Group) and the GDC (America’s first open
The OFA published a table for several years, showing the current
progress, called “Trends in Elbow Dysplasia”. One such year’s report,
given to several clubs and available on the Internet, is shown here,
though the amount of change seems minor.
Breed % Dys. through 1990 % Dys. 1993-94
Bernese Mtn. Dog 30.6 29.7
Golden Retriever 11.8 10.7
German Shepherd Dog 21.6 18.2
Labrador Retriever 14.2 11.3
Rottweiler 46.1 36.0
Newfoundland 24.3 19.6
GDC used to update news periodically on their two websites. The
following comes from their December 2000 memorandum. Access to the
searchable GDC registry was available through the GDC website, and
people could then use that search to:
• Find out if a dog is registered with GDC;
• Find how many of its close relatives, parents, siblings, and
offspring are also registered;
• See how many close relatives will be listed in a Kin Report;
• Find the number of evaluations and the sites evaluated for each dog;
• Track your dog's new registration. Pending registrations are
marked with an asterisk (*).
• Updated weekly with all newly registered dogs;
These reports provided information on the following:
• The dog in question;
• Siblings, half-siblings and progeny (offspring) of dog;
• Siblings, half-siblings and progeny of sire;
• Siblings, half-siblings and progeny of dam;
• List of additional related dogs (useful for creating a genetic
GDC was a public-benefit non-profit organization that worked for the
health of companion animals, and tax-deductible gifts were solicited
until they decided to merge with OFA in 2002. GDC accepted and
registered dogs with:
• OFA and other registries’ elbow evaluations if two views are
• OFA evaluations of affected and unaffected hips;
• PennHIP evaluations of hips.
Control Through Peer Pressure
Better progress can be expected when leaders of various major breed
clubs take their blinders off and encourage selection for control of
these disorders of the elbow. The GSD Club of America at the time of
this writing is still not requiring its Select dogs (officially
highly-recommended for breeding) to have “normal” elbows, in spite of
the notorious problem with UAP in many American show lines. The SV’s
top radiograph expert, Dr. Brass, until very recently if at all, still
considered elbow dysplasias not to be a serious problem despite many of
the winners today being line bred on dogs who “threw” much UAP.
However, an article in the SV Zeitung (magazine) covered the topic for
the first time in the late 1990s, so acknowledgment of the problem is
in the works. Very little has been done so far in the
United Kingdom. Australia’s GSD community, which follows the SV lead in
some respects, has had the same head-in-sand attitude, although
are a little different. Genetic problems don’t go away without help.
modified slightly spring, 2002.
TREATMENTS FOR ELBOW DISORDERS
By Fred Lanting and S-E
(Permission to reprint must be obtained.)
WORKING THE AFFECTED DOG
Often, the dog that is diagnosed with mild ED of one sort or another
belongs to someone active in the sport end of the dog game, having no
plans to breed but wanting to do obedience or
schutzhund work. Caution must be advised here, but it is possible
for many dogs to live a happy life and compete in such events.
Schutzhund is more demanding, as the dog has to clear a one-meter-high
jump, run fast, and struggle with a “bad guy”, all of which can put
sufficient stress on mildly dysplastic elbows as to cause trauma.
AKC-CKC-type obedience is easier, as the jump heights have been
lowered, the rings are small, and no really fast running for
considerable distances is required. The retrieves are to be performed
briskly, but that is nothing compared with the work demanded in
schutzhund. Let your dog and your common sense
guide you in how much you ask or encourage your dog to do. These dogs
especially should be prevented from becoming heavy. Many of the Grade
1 dogs will not develop any lameness. As is recommended for any other
sort of osteochondrosis, keep the nutritional volume and energy level
(and hence the weight) down, and do not supplement with calcium. DeBoer
recommends a diet with less than 17% fat, and lower than 4 kilocalories
per gram energy density.
TREATMENT OF UAP
Even as late as the early 1980s, controversial forms of treatment were
being promoted and practiced. Some advised rest, painkillers, and
patience; others were experimenting with fixation with wires, screws,
and the like; a fourth type of treatment proposed was surgical fusion
of the elbow. All these have fallen out of favour as a result of
comparisons, and removal of the offending particles is now generally
agreed upon as the only reasonable treatment.
Upon diagnosis of UAP, the patient should be scheduled for surgery to
remove the “loose” piece. While it might not be
bouncing around like a ping-pong ball, there is enough movement
in relation to other structures in the joint to cause irritation
and promote worsening degenerative changes. If not diagnosed until
gross changes in appearance and gait have become obvious, there may
only be a 50/50 chance of improvement in gait and the rate of
osteoarthritis development. Early correction is far better, and routine
of your young stock is cost effective in the long run, as well as
to your breed and your public image. In past years, attempts were made
to screw the ununited piece onto the ulna, but for the most part, these
were very disappointing. As late as 1989, some few practitioners in
were still advocating it as a treatment for 6 to 10 month old dogs. No
matter what surgical or other treatment is chosen, joint incongruity is
Olsson’s work referred to in the 1990 Proceedings of veterinary
meetings regarding Orthopaedics, trauma, and surgery
also carried a reference to a new surgical technique he called “high
osteotomy of the ulna”. While he didn’t elaborate on the procedure,
it appeared that there was the idea of some promise to creating bony
union between the ossifying anconeal process and the ulna by relieving
the pressure and surgically replacing the cartilage and allowing callus
or bone to grow in the gap. Wind attributes it mostly to the decrease
in space and movement.
Here is what Olsson said about treatment as early as the mid 1970s: The
most common procedure is to remove the ununited process via a lateral
incision between the lateral epicondyle and the olecranon.
There seems to be a time factor to consider when one decides to do
surgery. It is the experience of the present author that surgery should
not be done until the dog has reached an age of 9-12 months. If it is
done earlier, during the period of very fast growth (four to eight
months), secondary changes (remodelling and osteoarthrosis) seem more
likely to develop after surgery than if the ununited anconeal process
is left in place until a time when growth is almost
TREATMENT OF FCP
In cases of FCP and OCD of the medial condyle of the humerus, surgery
preferably should be done as soon as diagnosis
is made. Only the medial approach to the elbow joint can be used.
In early cases of OCD of the medial condyle of the humerus there is
a defect in the weight bearing surface, covered by a flap of cartilage.
The flap should be removed and the edges trimmed. In later cases there
is usually no flap. Instead it may have been
turned into a large cartilaginous body that may be found adhering
to the joint capsule. It may even have been resorbed. In a joint with
only a defect and no flap, only the edges of the defect should be
Whatever the findings, the coronoid process should
be carefully inspected, as OCD of the medial condyle is frequently
combined with FCP.
The most common finding in FCP is an elongated, cartilage covered
ossicle, which lies between the
coronoid process and the head of the radius. Sometimes the coronoid
process is fragmented in several small pieces. On
the opposing joint surface there always is considerable erosion
caused by the loose fragments. All fragments should
be removed. After surgery the dog is caged for about 10 days and kept
on restricted exercise for a period of four to six weeks. If the only
finding at early surgery is FCP and the fragments can be completely
removed, prognosis is good. If surgery is done late (after the
appearance of large osteophytes), prognosis is guarded. The joint
become pain free but range of motion will remain limited. In cases
of OCD of the humeral condyle or in cases with combination of these
two lesions, prognosis is always guarded even if surgery is done early.
However, surgery should always be tried, as an untreated case
of either of the two lesions or a case with the two lesions combined
usually develops into a case of very severe osteoarthrosis. It should
be remembered, however, that in many dogs with FCP the lesion can
undetected for years. This usually happens in dogs with bilateral
and with owners who are not very observant. These dogs often are first
to a veterinarian when there is acute lameness due to trauma to one of
severely osteoarthritic elbow joints.
Olsson also has said, “...early removal of loose cartilage and
ossicles, although not a panacea, seems to be the only rational
treatment of FCP and OCD.” Since early removal is needed, the
veterinarian must become familiar with the signs and diagnosis of each
as well as follow the procedures in his surgery textbooks. By the early
1980s surgical techniques were developed which will be sufficient
the coronoid process becomes attached to the corresponding part of the
medial humeral condyle, other times it lodges in the joint between the
radius and ulna. Dr. Flo of Michigan State has reported on a 10-year
Lab with little or no DJD but with fragments of the coronoid.
there was no earlier diagnosis; in fact, radiographs at a much younger
age revealed normal anconeal process and no DJD or osteophytes. But
was this old dog that was slowing down because of pain, even though the
owner for a while thought it was “just age”. Arthrotomy revealed the
coronoid fragments, and indicated that some were “in the way” of
articulation so much that they actually caused pieces of the anconeal
process to fracture and contribute more bone fragments to the joint,
with more inflammation a natural consequence.
After removal of the pieces, the dog’s attitude and activity
dramatically and immediately increased and lameness improved. It was
deduced that this dog had semi-healed or stable coronoid fissures for a
long time, but that continued use of the limbs
over those ten years of high activity finally loosened those fragments,
allowing them to move around in the joints.
In some minor cases, only cartilage damage rather than coronoid
fragmentation may exist, and in others, the fragment may reunite and
the process heals. Perhaps this is because the lagging growth rate of
the ulna’s trochlear notch catches up with the growth of the humeral
trochlea enough to recreate the greater measure of
congruity, if indeed it does. If the lag is very temporary, not enough
incongruity may appear on the radiograph although the lesion is seen
Another technique, based on the differential growth rate theory, is the
transverse (“horizontal”) slicing of the ulna with a saw, making it
shorter than before, and giving the humerus the broad head of the
radius to sit on as it is designed to do. At least one writer claims
that this operation also has some sort of effect on the anconeal
process, “allowing” it to unite.
TREATMENT OF ELBOW OCD
As in FCP, the only good way to handle OCD of the humeral condyle is by
going in and removing the culprit responsible for the damage, and
before much of that damage has been done. I can’t emphasize the word
“early” enough, especially in OCD, since in this lesion;
delay gives a worse prognosis than it does in the other two elbow
dysplasias. Get the minor cases treated early enough, and you might
slow the progression of arthritis and overcome lameness. If the flap
hasn’t come loose yet, the results are best, and the size of the flap
or mouse has a bearing on it, too. One approach is to saw through the
epicondyle so the muscles and tendons attached to it can be pulled out
of the way while the area of the fragment(s) can be scraped and washed
out. The epicondyle is put back and held in place with a lag screw, and
the joint closed.
Prognosis for surgical improvement of either FCP or OCD of the humerus
is usually “guarded”, with about 50% of those operated on being
relieved from lameness.
The extent of degenerative change may have much to
play in this scene, although some arthritis develops whether or
not surgery is performed. Many of those who do not limp may simply
not favour one bad elbow over the other, and decreased mobility
of the joint is hard to objectively assess, as is the case with FCP.
Fred Lanting, All rights reserved, but reprinting allowed after
permission. Please read his other articles on http://siriusdog.com/sphider/search.php?query=lanting&search=1
, for example, or e-mail him at: Mr.GSD@netscape.com
or Mr.GSD@Juno.com for specific
Editor’s Note: A
well-respected and frequent GSD specialty and
all-breed judge for many clubs around the world, with KC and
other-country credentials, Mr. Lanting since 1966 has lectured on
Gait-and-Structure, Canine Orthopedic Disorders, and other topics, and
has judged in about 30 countries. He has been described by a former OFA
director as the world’s leading non-veterinarian authority on hip
dysplasia. He has lectured at numerous veterinary schools in the USA
and abroad, and is the author of the following “must read” books for
the dog owner (E-mail for curriculum vitae). “Canine HD and Other
Orthopedics Disorders” : This expanded revision is a comprehensive
(nearly 600-page), amply illustrated, annotated, monumental work that
is suitable as a coffee-table book, a reference work for breeders and
veterinarians, and a study adjunct for veterinary students. It is
equally valuable for the owner of any breed. It covers every aspect of
HD and other orthopedic, bone, or spinal disorders, and includes
genetics, diagnostic methods, treatment options, and the role of
environment. Your autographed copy will be mailed from the USA as soon
as the appropriate amount is received and is processed. Pricing: US $68
in the U.S., or ask about mail overseas. Combine orders with “The Total
German Shepherd Dog” by the same author ($50 plus $4 postage). 17 of
the 20 chapters are suitable for owners of any breed. Order both at
once direct from the author, and the postage will be waived.
The above information is simply
informational. It's intent is not to replace the advice of a
veterinarian nor to assist you in making a diagnosis of your pet.
Please consult with your own veterinarian for confirmation of any
diagnosis. Your pets life may depend on it.