Imagine walking on your arms like a pet does. If you have elbow dysplasia the simple act of walking can be painful. We can help create a plan to help get your pet walking comfortably again and prevent elbow dysplasia from progressing into arthritis!
Elbow dysplasia is a congenital condition that starts in puppies and progresses into elbow arthritis as the dog ages. The elbow is a very complicated joint that is comprised of 3 bones that must grow together at the correct rate. If one bone grows quicker or shorter than the other bones, then it can lead to an malalignment called elbow dysplasia. This can lead to boney protuberances that hit the neighboring bones leading to cartilage defects, fragments, and osteophyte formations.
Components of elbow dysplasia includes fragmented medial coronoid process (FCP), ununited anconeal process (UAP), incongruity, and osteochondritis dissecans (OCD). Typically dogs will only have one of these three conditions. Elbow dysplasia can also include elbow incongruity, which is where the radius and ulna grow at different speeds and can lead to FCP or UAP. Poor nutrition (high energy and high calcium diets), genetics and trauma are factors leading to elbow dysplasia, and it commonly affects large and giant breed dogs. Elbow dysplasia is bilateral, but one elbow may be affected more severely.
Osteochondritis dissecans is a disease affecting medium and large breed dogs. It is a developmental disease affecting joint cartilage and growth plates, where the articular cartilage is thickened. These thickened areas are prone to injury even with normal activity, and can lead to a cartilage flap. The lesions tend to affect both limbs, but can be more severe in one. Rapid growth of young dogs, high calorie diets and/or diets with excess calcium can predispose dogs to this condition. Dogs with OCD typically present between 4 and 9 months old with a mild to moderate weight bearing forelimb lameness. Physical exam shows triceps and biceps muscle atrophy, elbow joint effusion and/or heat, decreased range of motion, crepitus, thickening of the surrounding soft tissue structures, and pain on full extension or flexion of the joint. You can also pick up on OCD lesions by pain exhibited when compressing and grinding the joint. Diagnosis is difficult to make with elbow radiographs. CT or elbow arthroscopy is best and will shows a defect in the bone below the cartilage flap, which is typically on the medial humeral condyle. Treatment is through various surgical procedures to remove the damaged cartilage flap and debride the lesion. Prognosis is better if surgery is performed early.
Sometimes surgery is not a curative option for pets with elbow dysplasia and even more so with pets that have progressed into elbow arthritis. The further progression into the disease the less likely surgery will be curative, but rather palliative. At Walking Paws Rehab we see patients pursue many routes. We rehab patients coming out of surgery. We rehab patients where surgery was not recommended by orthopedic specialists and instead physical therapy recommended. We even rehab patients that pursue regenerative therapies instead. At our first evaluation we can talk to you about the many options ahead and help guide you on a route that fits your pet’s needs, family, and finances.
Our goals of physical therapy are to reduce and manage elbow joint pain foremost. We focus on reducing compensation in surrounding joints and muscles. Often patients with elbow disease have taut biceps, triceps, lats, teres majors, and reduced range of motion in their shoulder. They compensate in their wrists due to changing forces when weight bearing while trying to off load the inside of their elbow. Often these pets stand with their elbows bowed out, putting excessive weight on the inside of their wrists and medial digits. So they may have some laxity and pain in their wrists. Their elbows are held in a more flexed position leading to the taut biceps. Compensation occurs all the way down to the toes and all the way up the back.
After pain is addressed we then focus on improving flexibility of the muscles surrounding the elbow and compensatory muscles from change in posture and gait. We work on improving range of motion of the joint safely being cautious of any bone chips.
Following improvements in comfort, flexibility, and range of motion we progress into improving weight bearing. Walking in the underwater treadmill is very beneficial for dogs with elbow disease since it allows us to build up muscle while off loading. The elbows don’t have a lot of cartilage and cushion so walking on land can be painful for these patients. Non weight bearing exercises allows us to strength building in a more pain free manner.
Our ultimate goal is to rebuild muscles so whenever your pet takes a step and bears weight through their limb, the muscles are absorbing the shock from the ground and less is going through the bones. Furthermore, improving muscle mass will provide stability to the joint. Maintaining a lean body mass is also important for patients with elbow disease.
If your pet has elbow disease, feel free to reach out to us for any further questions. We can help slow down the onset of arthritis and improve your pet’s quality of life.
