Arthroscopic features of primary and concomitant flexor enthesopathy in the canine elbow.

OBJECTIVES: To investigate the possibilities and limitations of arthroscopy to detect flexor enthesopathy in dogs and to distinguish the primary from the concomitant form. MATERIALS AND METHODS: Fifty dogs (n = 94 elbow joints) were prospectively studied: dogs with primary flexor enthesopathy (n = 29), concomitant flexor enthesopathy (n = 36), elbow dysplasia (n = 18), and normal elbow joints (n = 11). All dogs underwent an arthroscopic examination of one or both elbow joints. Presence or absence of arthroscopic characteristics of flexor enthesopathy and of other elbow disorders were recorded. RESULTS: With arthroscopy, several pathological changes of the enthesis were observed in 100% of the joints of both flexor enthesopathy groups, but also in 72% of the joints with elbow dysplasia and 25% of the normal joints. No clear differences were seen between both flexor enthesopathy groups. CLINICAL SIGNIFICANCE: Arthroscopy allows a sensitive detection of flexor enthesopathy characteristics, although it is not very specific as these characteristics may also be found in joints without flexor enthesopathy. The similar aspect of both forms of flexor enthesopathy and the presence of mild irregularities at the medial coronoid process in joints with primary flexor enthesopathy impedes the arthroscopic differentiation between primary and concomitant forms, requiring additional diagnostic techniques to ensure a correct diagnosis.

Anaesthetic arthrography of the shoulder joint in dogs.

OBJECTIVE: To evaluate the use of intra-articular anaesthesia combined with positive contrast arthrography (collectively called 'anaesthetic arthrography' [AA]) in the shoulder in order to identify and confirm the source of pain in lame dogs. METHODS: Anaesthetic arthrography was performed in 30 dogs with shoulder joint lameness with a mixture of contrast medium (iohexol: 240 mg I/ml) and a local anaesthetic (mepivacaine 2%: 20 mg/ml). The effect of intra-articular anaesthesia was evaluated by an objectified visual scoring system and the arthrograms were evaluated for their diagnostic value. RESULTS: This study showed that AA was positive in 28 out of 30 dogs. Dilution of the contrast medium with a local anaesthetic produced an arthrogram of good quality for each shoulder joint. In 16 out of 18 cases of osteochondritis dissecans, a cartilage flap could be identified following arthrography. In all cases the flap was not identified from plain radiographs. Biceps brachii tendon pathology was diagnosed on arthrography in seven dogs but was missed in two dogs. Calcification at the caudal rim of the glenoid cavity was diagnosed in three dogs, but was of clinical importance in only two dogs. In addition one infection was diagnosed during synovial aspiration. CONCLUSION: Anaesthetic arthrography of the shoulder is a simple, safe, and reliable diagnostic test to confirm shoulder joint pain and simultaneously identify a lesion. This procedure may be of particular importance in cases of occult shoulder joint lameness when clinical findings and plain radiographs are inconclusive.

Arthroscopic treatment of fragmented coronoid process with severe elbow incongruity. Long-term follow-up in eight Bernese Mountain Dogs.

The purpose of this study was to investigate the long-term treatment results of fragmented coronoid process (FCP) in joints with a radio-ulnar step greater than 3 mm. Treatment of these patients only consisted of fragment removal, without correction of the incongruity. The eight Bernese Mountain Dogs (11 joints) included in this study showed obvious clinical signs of elbow disease and were diagnosed with severe elbow incongruity and concomitant FCP in the time period from 1999-2003. At that time, elbow radiography, computed tomography, and arthroscopy were performed. The mean follow-up period was 5.6 years. The follow-up consisted of a telephone questionnaire combined with a clinical and radiographic re-evaluation at our clinic. The questionnaire revealed that all dogs were either free of lameness or only lame following heavy exercise. One dog sporadically required medication after heavy exercise. The owner satisfaction rate was 100%. The clinical re-evaluation did not reveal any signs of pain or lameness in all cases. Range-of- motion was decreased in nine of the 11 elbows. Radiographs revealed an increase in severity of osteoarthritis in every case.In this case series, arthroscopic fragment removal without treatment of incongruity was demonstrated to be a valuable treatment option and may provide a satisfactory long-term outcome.

Diagnostic intra-articular anaesthesia of the elbow in dogs with medial coronoid disease.

OBJECTIVE: Assessment of the effect of intra-articular anaesthesia on lameness caused by medial coronoid disease. METHODS: This study included 90 dogs that were evaluated for the complaint of unilateral forelimb lameness. All dogs were suspected of having an elbow problem for which orthopaedic examination and radiographs showed inconclusive findings. Following a short sedation, mepivacaine was injected intra-articularly to determine whether lameness was caused by a suspected elbow problem. This effect was compared with the final diagnosis based on computed tomography and arthroscopy. RESULTS: Out of 90 dogs, 78 (87%) dogs had an improvement of lameness after injection of the local anaesthetic, which confirmed the elbow joint as the primary source of lameness. A positive response was seen in all types of medial coronoid lesions. A false negative result was observed in 12 dogs (13%). CLINICAL RELEVANCE: Medial coronoid disease is represented by different types of pathologic lesions including chondromalacia, fissures, fragments, and medial compartment disease. Diagnosis may be difficult because of limited clinical or radiographic signs or a combination of both. Intra-articular anaesthesia can be a helpful diagnostic tool to localize the problem by eliminating pain and reducing lameness to a great extent in all types of coronoid lesions.

Primary flexor enthesopathy of the canine elbow: imaging and arthroscopic findings in eight dogs with discrete radiographic changes.

OBJECTIVE: To describe the radiographic, ultrasonographic, computed tomography (CT), magnetic resonance imaging (MRI), and arthroscopic findings in eight dogs with elbow lameness caused by primary flexor enthesopathy. STUDY DESIGN: Clinical study. ANIMALS: Eight client-owned dogs. METHODS: In all dogs, lameness was localized to the elbow by clinical examination. Radiographic examination, ultrasound, CT and MRI were performed prior to arthroscopy. In seven dogs, surgical treatment and subsequent histopathology were performed. RESULTS: Primary enthesopathy of the medial epicondyle was diagnosed in eight dogs (13 joints) by combining the minimal radiographic changes with specific ultrasonographic, CT, MRI and arthroscopic findings at the medial epicondyle. In all joints, any other pathology could be excluded. Histopathology of the affected tissue revealed degeneration and metaplasia in the flexor muscles. CONCLUSIONS: Primary flexor enthesopathy at the medial epicondyle is an unrecognized condition and is a possible cause of elbow lameness in the dog. Diagnosis is based on specific imaging and arthroscopic findings. CLINICAL RELEVANCE: The most important cause of elbow lameness in dogs is medial coronoid disease. Often this condition presents with minimal radiographic and arthroscopic changes. In these cases, primary enthesopathy of the medial epicondyle should be considered as a differential diagnosis, in order to make the correct treatment decision.

Evaluation of two sedation protocols for use before diagnostic intra-articular anaesthesia in lame dogs.

OBJECTIVES: To assess the influence of two sedation protocols on the degree of lameness in dogs. METHODS: Fifty lame dogs were allocated to one of two sedation protocols. Group ACPM (acepromazine + methadone; n=25) was sedated with acepromazine and methadone. Group MED (medetomidine antagonised with atipamezole; n=25) was sedated with medetomidine and reversed with atipamezole. Each dog was evaluated for lameness before and after sedation using videotapes. Four experienced clinicians allocated global lameness scores before and after sedation to each dog using a numerical rating scale. RESULTS: In 80% of the dogs in group ACPM and in 72% in group MED lameness was not affected by the sedation. In 12% of the dogs in group ACPM and 20% of the dogs in group MED the observers noticed an increase of lameness of 1 or 2 degrees on a scale of 0 to 10. In 8% of the dogs in both groups lameness decreased with 1 degree. CLINICAL RELEVANCE: A possible diagnostic test for investigation of obscure lameness is intra-articular anaesthesia. Sedation is necessary to allow intra-articular injection. This study provided evidence that the effect of sedation with the proposed protocols on the degree of lameness is negligible.

Medial humeral epicondylar lesions in the canine elbow. A review of the literature.

A calcified fragment near the medial epicondyle of the humerus was originally described as an ununited medial epicondyle in 1966. Since then several papers reported similar lesions as a cause of elbow lameness. The aetiology and clinical significance of those lesions is poorly known. This paper gives an overview of the veterinary and human literature in an attempt to explain the aetiology and to suggest a diagnostic protocol and treatment plan.

Recognition of anatomical predilection sites in canine elbow pathology on bone scans using micro-single photon emission tomography.

The limited resolution of planar bone scintigraphy precludes exact anatomical localisation within a joint. Micro-single photon emission tomography (µ-SPECT) has a much higher resolution, and in this study the use of µ-SPECT in the evaluation of the canine elbow joint and fusion with structural imaging data were tested. Twelve elbows of seven normal dogs were included. µ-SPECT was performed with a conventional triple head gamma camera adapted with three multi-pinhole collimators (HiSPECT). Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) were performed on all elbows and data from CT and MRI were fused to the HiSPECT data using dedicated software. Different important anatomical regions could be recognised on the HiSPECT images. The improved resolution of the HiSPECT system allowed better differentiation of the anatomical areas in the elbow joint. Two case studies were included to demonstrate the potential of this methodology. Fusion software facilitated the use of combined structural and functional information.

Single-phase bone scintigraphy in dogs with obscure lameness.

OBJECTIVES: To evaluate the diagnostic merits of scintigraphy in dogs with clinically obscure lameness origin. METHODS: In 43 dogs, the scintigraphic findings were compared with the results of subsequent radiological, computed tomography and/or arthroscopic findings and/or additional neurological examination. RESULTS: In all dogs, focal increased uptake was found in one or more joints or bones. The presence of associated pathology was confirmed by radiography, computed tomography and/or arthroscopy of the limb region of interest. Additional neurological examination was performed when indicated. In cases of elbow pathology, unilateral involvement of the elbow was confirmed with computed tomography/arthroscopy in 14 cases, while bilateral increased uptake could not be confirmed with radiography or computed tomography in three cases. Three dogs showed an increased activity in one joint on the bone scan, while computed tomography, arthroscopy or radiography revealed bilateral joint disease. Generalised mild increased radionuclide uptake in all joints and bones was observed in the lame limb in 15 forelimbs and five hindlimbs. Generalised prominent uptake of an entire limb was noted in three cases suffering from neurological disease. CLINICAL SIGNIFICANCE: Scintigraphy may provide information on areas of increased radionuclide uptake, thereby aiding in the localisation of obscure lameness. Generalised mild increased uptake of radionuclide in all joints and bones in the lame limb may occur in the older dog. The generalised prominent uptake, seen in three cases with neurological disease, may resemble reflex sympathetic dystrophy syndrome seen in human beings.

Review of the literature: elbow incongruity in the dog.

Elbow incongruity is the term to describe bad alignment of the joint surfaces of the elbow. Two features illustrate incongruity of the elbow: an abnormal shape of the ulnar trochlear notch and a step between the radius and ulna, caused by either a short radius or a short ulna. It has been suggested that both an elliptical notch, and a step, can cause increased local pressure within the joint, resulting in loose fragments at different locations: ununited anconeal process (UAP), fragmented coronoid process (FCP), osteochondritis dissecans of the humeral condyle (OCD). These lesions are grouped under the term 'elbow dysplasia' and are the most frequent causes of front leg lameness in the dog. Although several radiographic features to diagnose incongruity have been described, the 'scoring' of incongruity is subjective because there is currently no objective method to measure the degree of incongruity. Because superimposition is avoided, CT is suggested as a standard technique to measure incongruity. Arthroscopy on the other hand, allows the direct visualisation of the intra-articular structures and their abnormalities. Information on both techniques are still relatively new. Several surgical techniques have been proposed to restore joint congruity; the one most frequently used is an ulnar osteotomy. But because of possible complications, other techniques are being developed. Reports evaluating the results of the different techniques are not yet available.