Elbow dysplasia in dogs I.

Elbow dysplasia is one of the most common orthopedic problems in dogs, specially affecting medium to large breeds. It is a developmental disorder involving abnormal growth and formation of the elbow joint, leading to joint incongruence, cartilage damage, and eventual osteoarthritis. Incongruence within the elbow joint can predispose dogs to secondary complications, including fragmented coronoid process (FCP), ununited anconeal process (UAP), and osteochondritis dissecans (OCD). About these conditions (FCP, UAP, OCD)  we will discuss in the further blog posts. Understanding the anatomical structures involved is crucial for recognizing early signs and managing this progressive disorder effectively.

Anatomy of the Canine Elbow Joint

The elbow is a complex, synovial hinge joint consisting of three primary bones:

1. Humerus – The upper arm bone, which articulates with the radius and ulna to form the elbow joint. The humeral condyles play a crucial role in distributing weight and stabilizing joint motion.

2. Radius – The main weight-bearing bone of the forelimb, positioned laterally in the distal portion of the forearm.

3. Ulna – The medial, stabilizing bone of the forearm, consisting of the olecranon, anconeal process, coronoid processes (medial and lateral), and trochlear notch, which contributes to articulation with the humerus.

The trochlear notch of the ulna and the humeral condyles must align perfectly for smooth, friction-free movement. Any disparity in growth rates or shape discrepancies results in joint incongruence, leading to abnormal stress distribution and cartilage erosion.

What is (elbow) incongruence?

(Elbow) incongruence occurs when the (three) bones forming the (elbow) joint (humerus, radius, and ulna) fail to align properly, leading to uneven load distribution and abnormal wear patterns. This misalignment creates excessive pressure on specific joint structures, increasing the risk of cartilage damage, inflammation, and pain.

Types of Elbow Incongruence

1. Radius-Ulna Length Disparity

• A short radius (radius hypoplasia) results in excessive weight-bearing stress on the ulna, particularly the medial coronoid process, predisposing the joint to fragmented coronoid process (FCP).

• A short ulna (ulnar hypoplasia) leads to increased pressure on the anconeal process, increasing the risk of ununited anconeal process (UAP).

2. Humeral-Ulnar Malalignment

• Malpositioning of the humeral condyles relative to the ulnar trochlear notch creates shearing forces that accelerate cartilage degradation.

3. Trochlear Notch Mismatch

• If the ulnar trochlear notch is too shallow or deformed, it results in joint instability and uneven cartilage loading, contributing to osteoarthritis.

Commonly Affected Breeds

• Labrador Retrievers

• Golden Retrievers

• German Shepherds

• Rottweilers

• Bernese Mountain Dogs

• Newfoundlands

Genetic predisposition plays a significant role in the development of elbow incongruence, but other factors, including nutrition, rapid growth, and exercise during puppyhood, also contribute.

Signs of elbow dysplasia

Early detection is essential for managing elbow dysplasia and preventing long-term joint deterioration and pain. Dog owners should watch for the following signs:

✔️ Intermittent or persistent lameness (especially after exercise)
✔️ Difficulty rising or getting up from rest
✔️ Stiffness or reduced range of motion in the elbow
✔️ Preference for non-weight-bearing positions
✔️ Reduced willingness to play, run, or jump
✔️ Abnormal gait, including a “paddling” motion of the front legs
✔️ Pain or discomfort upon palpation of the elbow joint, try to flex and extend the elbow, push the medial (inner part, the side which is "inwards") part of the elbow

+1: changed behaviour: dogs with chronic pain might show anxiety, agression or depressed mood, but not all dogs with pain show discomfort, since their heart is huge and they love adventures, many dogs act completely normal and an X ray would reveal an ugly elbow dysplasia.

Dogs with elbow dysplasia often display compensatory gait patterns, shifting their weight to the opposite limb or overloading their shoulders to relieve elbow pain. It’s very common to see, that they rotate their shoulders inwards so it bears more weight, and elbows are rotated outwards bearing less weight.

Diagnosis of elbow dysplasia & incongruence

Accurate diagnosis requires a combination of clinical assessment, imaging techniques, and orthopedic evaluation.

✔️ Radiographs (X-rays): Can detect bony abnormalities, joint incongruence, or secondary osteoarthritis.
🔬 Computed Tomography (CT): Provides a detailed 3D image of bone structures, making it the gold standard for diagnosing subtle joint incongruence.
🔎 Arthroscopy: A minimally invasive procedure that allows direct visualization of cartilage and joint surfaces, detecting early lesions.

Treatment approaches

Surgical Interventions

• Proximal Ulnar Osteotomy (PUO): Corrects ulnar length disparity, reducing stress on the coronoid process.

• Distal Ulnar Osteotomy (DUO): Used to relieve pressure in cases of trochlear notch incongruence.

• Subtotal Coronoid Ostectomy (SCO): Removal of damaged coronoid fragments to relieve pain.

It’s extremely important that you only let your dog to be operated by an orthopedic vet and ofc, you must have before the operation the heart ultrasound, a complete blood analysis and prepare your home for your post-op dog: non slippery flooring everywhere where the dog can access and elevated water + food bowls.

Physiotherapy & Conservative Management

For mild cases or post-surgical rehabilitation, physiotherapy plays a crucial role in joint stabilization, pain relief, and muscle conditioning. We always aim to restore function and within the given spectrum achieve the best quality of life and painless movement.

Manual Therapy & Fascia Release

• Myofascial techniques improve mobility and reduce pain by addressing muscle compensations and fascial restrictions.

Strength Training & Muscle Activation

• Focus on the triceps brachii, biceps brachii, and flexor carpi, the pronator and supinator muscles to provide support and stability to the joint. You need to build strength to the muscles if you want a pain free dog living a joyful life. No massage or hydrotherapy or whatsoever can substitute strength training.

Low-Impact Weight-Bearing Exercises

• Cavaletti poles and controlled incline walking strengthen stabilizing muscles.

🔦 Laser Therapy & Hydrotherapy

• Helps reduce inflammation and pain, promoting cartilage health.

Long-term management & prevention

Since elbow dysplasia is progressive, even when operated, long-term management strategies are essential.

✔️ Weight Management: Excess weight worsens joint stress. Keep dogs slim, lean and fit.
✔️ Omega-3 Supplements: Helps reduce inflammatory cytokines in the joint.
✔️ Controlled Exercise Regimens: Avoid excessive running or jumping.
✔️ Joint Supplements: Glucosamine, chondroitin sulfate, MSM, Boswellia serrata, collagen, vitamin C, hyaluronic acid.

Scientific References

📖 Books:

• Canine Rehabilitation and Physical Therapy – Darryl L. Millis, David Levine

• Diagnosis and Management of Elbow Dysplasia – Rory J. Todhunter

📄 Studies:

1. Lavrijsen IC et al. (2014). “Prevalence and Heritability of Elbow Dysplasia in Dogs.” Journal of Veterinary Research.

2. Fitzpatrick N, Smith TJ. (2017). “Advances in Canine Elbow Surgery: A Review.” Veterinary Surgery Journal.

3. Meyer-Lindenberg A et al. (2021). “Radiographic and CT Evaluation of Elbow Incongruence.” Veterinary Radiology & Ultrasound.

4. Samoy Y et al. (2016). “Correlation Between Weight-Bearing and Elbow Dysplasia Progression.” Veterinary Journal.

5. Wind A. P.(1986): Elbow incongruity and developmental elbow diseases in the dog

 

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