Pet health

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October 2014 Case of the Month

October’s case of the month is an interesting one. Lucky is a young chihuahua mix that came to us with SEVERE injuries. He was attacked by a neighborhood dog about 7 days before presenting to us and was in very bad shape. His initial wounds were managed, but unfortunately infection still set in and the majority of his cervical (neck) skin started to die and needed to be removed. Not only was the infection causing a problem locally, but we had signs of it being spread systemically (through his blood stream). He needed both surgical care and care by a criticalist(board certified in Emergency and Critical Care) in order for him to have a fighting chance. Below is a picture of what he looked like when he was admitted into the hospital.

This was Lucky as he was admitted to the hospital.

This was Lucky as he was admitted to the hospital.

You can make out the extensive injuries on the photo above. He was fortunate to be alive! Whenever we get a case like this (unfortunately it happens more frequently than we like), we am always realistic with the owners, because there is a chance that their pet will not survive. Also, these cases are not quick cases, Lucky was hospitalized for 2-3 weeks and wasn’t fully healed for about 6 weeks. Our first objective is to get the systemic infection under control and get him strong enough to be able to handle surgery. While the criticalist was working on the systemic infection, we were concentrating on the neck wound.

The first phase wounds go through is the debridement phase, which is where the body gets rid of necrotic (dead) tissue and the size of the wound is established. The next phase to follow is the granulation phase. The granulation phase is very important in a large wound like this, this is when the body begins to infiltrate the wound with healthy tissue and more importantly capillary vessels, which bring blood flow. For this wound, I choose to use a wound dressing called BurnStat (Ubuntu) which is a dressing that can be used through multiple phases. It is an organic clay substrate that does an excellent job of removing toxins and necrotic tissue while promoting granulation tissue formation.

Debridement phase

Debridement phase

Applying BurnStat as the primary wound dressing

Applying BurnStat as the primary wound dressing

Following this type of bandaging, the diseased tissue begins to be replaced with more healthy, red granulation tissue. The final product, before being able to close the wound, needs to be completely covered with granulation tissue in order to increase the chance of the new skin being accepted.

Complete coverage by granulation tissue.

Complete coverage by granulation tissue.

You can see how the surface is covered with healthy looking tissue and no presence of dying tissue visible. By this time Lucky amazingly over came his battle with the widespread infection and overall was doing very well. He was making a remarkable recovery.

Our next dilemma was “how do we cover the exposed tissue”? In cases like this, we have a few options, which is beyond the scope of this post. I choose to use an advancement flap (skin freed up from a nearby location that is moved over the wound), which made the most sense due to the elasticity of the skin in this area. Below is his wound following surgery.

Advancement flap

Advancement flap

Following surgery we also utilized laser therapy to help promote uptake of the skin flap. This is Lucky in his referee uniform (it is close to Halloween) receiving his laser therapy.

Post-advancement flap therapy

Post-advancement flap therapy

Here is the finished product for Lucky!!! He overcame a lot of obstacles along the way!!

This is about 6 weeks after Lucky presented.

This is about 6 weeks after Lucky presented.

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Osteochondritis Dissecans (OCD) – Shoulder

Sometimes it can be very hard to determine which leg your pet (or patient) is limping on, let alone which joint is causing the problem. I want to take a little time to discuss a problem that we see from time to time that typically affects the juvenile (6-18 month), medium and large breed dog and is typically thought of as a congenital/hereditary issue. The most note worthy joints affected are the shoulder (proximal humerus), the elbow (distal humerus), stifle (distal femur), and hock (talus).

The underlying etiology is similar in all the joints, however this article will focus on the shoulder with subsequent articles dealing with the other joints. I think this approach is reasonable because the treatment may be different for other joints,as well as, the prognosis can vary. Again, this disease affects primarily young dogs; in the older patients we usually see the consequence of this issue, resulting in osteoarthritis of the joint.

Osteochondrosis (OC) precedes osteochondritis dissecans (OCD) and is characterized by a problem between the metaphyseal growth plates of the affected bone and the cartilage. In essence, the cartilage surface does not adhere to the underlying subchondral bone surface. When a cleft or break develops in this “soft” cartilage, this fulfills the term OCD. Once the area progresses to an OCD lesion (a break in the cartilage develops), then the patient becomes clinically lame and will exhibit a degree of lameness/limping. Once a flap/break develops there is no known healing that occurs and the abnormal area will continue to incite inflammation within the joint.

There are multiple suspected causes of this issue in the dog, with the most reasonable explanation being that of a congenital/hereditary cause. There is some support of other predisposing factors that may enhance the genetic expression of this disease such as juvenile obesity and imbalances in calcium intake.

Patients with this type of condition will usually be within 6-18 months of age and have a varying level of lameness on one or both front legs. An owner may also see more limping/lameness after strenuous activity or rising from rest.

Physical examination of the suspected patient usually will direct us in the right direction. A thorough gait evaluation is needed to identify which leg or if both front legs are affected. There are certain techniques that can be used to detect which leg is the culprit even with a mild lameness. If your dog is “off and on” lame, it is always helpful to the veterinarian for the owner to bring in video of the patient when he is limping, to help improve our chances of diagnosing your pet correctly. The next step in the evaluation is direct palpation of the leg starting from the digits, working up to the neck. It is very important that care is taken at each joint and long bone on evaluation, since shoulder OCD is not the only cause for limping in the young dog. Typically, discomfort will be elicited on manipulation of the affected shoulder(s) and especially on hyperflexion and hyperextension of the joint. The next step is diagnostic tests.

Radiographs (X-rays)

Shoulder_OCD0001 Shoulder_OCD0002

Above are x-rays of a left and right shoulder affected with OCD lesions. These are on the same patient. The images labeled with the left (L) marker has a flattened region noted by the arrow which is characteristic of OCD. The image on the right has the area highlighted in blue. While the lesion doesn’t look big, it can definitely cause a lot of pain and discomfort.

Another way to diagnostically evaluate the joint is with a computed tomography (CT) scan. This will give more detail into the region of interest. Generally this is not needed, however indications for it may be to evaluate the elbows as well.

Treatment:

For the best possible outcome do not delay treatment! At this time, the gold standard approach is arthroscopic debridement (removal) of the fragmented cartilage and the surrounding diseased cartilage and subchondral bone. Curettage may allow the now vacant cartilage bed to fill in more quickly with what is called fibrocartilage. I likened the removal of the fragment to old wallpaper removal (very much oversimplified). Once the old wallpaper bubbles and tears, you need to remove all the damaged wallpaper in the periphery or else the wallpaper will continue to peel.

If the cartilage is an osteochondrosis (OC) lesion and has not fragmented (OCD) non-surgical treatments (activity restriction, dietary restriction, etc) may be attempted and successful. Unfortunately, if OCD has not occurred then the patient will not be limping and most of these dogs go undiagnosed. It is my belief that any dog exhibiting pain/lameness with the presence of a radiographic (x-ray) OCD lesion ,should have surgery. Surgery will benefit them both in the short term and the long term.

There are older techniques of opening the joint to get access to the cartilage flap, however the recovery time on this type of procedure is significantly longer than with arthroscopy. Also, potential complications are increased with an “open” technique than with arthroscopic techniques. Arthroscopy is a minimally invasive tool that allows us to both diagnose and treat this condition. Generally speaking the patient can walk on the surgery leg (even if both legs have surgery at the same time!) following an arthroscopic procedure. Generally 2-3 small ports are placed over the shoulder (2-4mm in length) and this allows us access to the joint and work within the joint.

Recovery and Rehabilitation: 

Recovery for the arthroscopic procedure is generally 4-6 weeks. Every surgeon has a different protocol for after surgery and I am very respectful of that. I prefer controlled movement for my patients. In the first two weeks, passive range of motion is very important, followed by active icing of the joint(s). Short leash based walks are started shortly after surgery and incrementally increased as we proceed through the recovery phase. Introduction into a formal rehabilitation program is recommended, however there are times when this is not possible and rehabilitation must be performed at home. Below is a patient that had a single shoulder arthroscopy, you can see how well they can walk following surgery (this is the following day)!

Prognosis:

When diagnosed and treated early, the dog affected with OCD can have a good prognosis and resume a normal or near normal activity level and quality of life. The longer the lesion is present, the more inflammation and arthritis will develop decreasing our success with surgery. Of the OCD lesions (shoulder, versus the other sites affected) this region has the best prognosis. I do encourage all my patients to continue on joint supplementation for life and to be removed from any breeding program.

 

 

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September 2014 Case of the Month – Meet Tido!!!

Tido two weeks after surgery!!! You can't keep him down!!!

Tido two weeks after surgery!!! You can’t keep him down!!!

Meet Tido!!! Tido is a 6 1/2 year old West Highland White Terrier that came to us (Affiliated Veterinary Specialists – Orange Park) for a lower esophageal foreign body. He started showing signs of intermittent vomiting and regurgitation after swallowing his rawhide bone. Unfortunately, it became lodged in the portion of the esophagus that goes through his chest, just past his heart. Usually we can use a scope camera and remove the object without any incisions. The piece of rawhide was wedged in this area and was unable to be moved, so surgery was his only option.

This was the piece of rawhide that was lodged in Tido's esophagus. It was nearly 5cm in length!!

This was the piece of rawhide that was lodged in Tido’s esophagus. It was nearly 4cm in length!!

An incision was made in the chest and the large piece of rawhide was found in the esophagus just past the heart. An incision was made into the esophagus and the rawhide was removed. Surgery on the esophagus is a very delicate surgery. In this area we have big vessels (aorta) above the esophagus and the vena cava below. Just in front of the esophagus is the heart. Nearby, there are very important nerves (vagus) that course over the esophagus. Also, the esophagus has a harder time healing versus other areas of the gastrointestinal tract with a higher chance of stricture (narrowing due to scar tissue) formation.

View of the esophagus just past the heart.

View of the esophagus just past the heart.

After the rawhide was removed, the esophagus was closed in two layers and then a Vetrix Extracellular Matrix (ECM) sheet was placed. This will aid in healing by providing a scaffold for the tissue to heal and incorporate the bodies own stem cells to infiltrate the area. After the esophagus was closed, Tido’s chest was closed in a standard fashion.

Vetrix Extracellular Matrix placement over the esophageal incision.

Vetrix Extracellular Matrix placement over the esophageal incision.

Tido made an excellent recovery!!! He has been on a soft diet and no rawhides for him!!! In four weeks he should be able to resume his normal activity. At his two week recheck, you could never tell he had surgery. Way to go Tido!!!

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Frankie’s Journey: Part 2

Frankie relaxing before surgery.

After the diagnostics were performed (reviewed in the previous segment), a decision needed to be made as to which issue was to be addressed first. This is often a tough decision and must be made with the experience of your trusted veterinarian. My criteria consisted of which leg was most affected and the fact that I had already decided to address his hips with a total hip replacement. In my opinion (and supported clinically), a total hip replacement was a better option than other procedures available for canine hip dysplasia. Certain growth plates (centers of bone growth) need to be closed prior to performing a total hip replacement making the minimum age being around 10 months of age. This made our decision easier and the decision to address the elbows was made.

Surgery for his elbows was staged; the left elbow surgery performed on December 6, 2013 and the right elbow addressed on February 14, 2014 (Happy Valentine’s Day!). The time period in between was used for physical therapy and maximizing the results of the surgeries. Identical surgeries were performed on both elbows due to the similarity of the disease process occurring. An elbow arthroscopy was performed, which revealed the cartilage flap (osteochondritis dissecans (OCD)) and a fragmented coronoid process (FCP) The OCD flap was removed and the FCP segment was removed. The damaged bone under the OCD flap was removed with a shaver until healthy bone was present. Since the diseased area of the elbow was on the inside (medial) aspect a specialized procedure to displace weight to the central and outside (lateral) aspects was performed. This procedure is called a sliding humeral osteotomy (SHO). This procedure is fairly aggressive and involves a bone cut in the middle of the humerus bone and a plate/screws placed.

Below are images of the elbow arthroscopy showing both the OCD lesion and the FCP segment.

 

Noted the line in the cartilage outline a fragmented coronoid Process (FCP).

Noted the line in the cartilage outline a fragmented coronoid Process (FCP).

Note the underlying bone (pink). This is usually covered by cartilage, however the cartilage has become a flap.

Note the underlying bone (pink). This is usually covered by cartilage, however the cartilage has become a flap.

 

Following the elbow arthroscopy, the SHO procedure was performed. Below is a radiograph of the procedure.

Note the cut in the middle of the humerus and the shifting of the bone.

Note the cut in the middle of the humerus and the shifting of the bone.

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February 2014 Case of the Month – Meet Smokey!!!

Two week recheck

Smokey at his two week recheck!

Smokey was transferred to the surgery department from the overnight emergency service after being attacked by a larger dog the night before. His injuries were multiple and severe. He sustained multiple bite wounds over his thoracic and abdominal body cavities. Thoracic radiographs revealed multiple left sided rib fractures and multiple defects (tears) into the chest wall. The bite wounds over the abdomen were superficial with no evidence of penetration in the abdomen.

Note the multiple rib fractures and the multiple thoracic wall defects.

Note the multiple rib fractures and the multiple thoracic wall defects.

Smokey was stabilized by the emergency service and prepared for surgery once transferred in the morning. Based on the injuries, Smokey had a thoracic exploratory to evaluate the thoracic wall wounds and subsequent internal injuries. Surgery revealed a large thoracic wall defect and multiple fragmented ribs, some of which needed to be removed. Interestingly, the left caudal (posterior) lung lobe had a large laceration caused by one of the rib fragments, necessitating removal of the lung lobe. The remaining thoracic wall defect was too large to close primarily.

The white arrow denotes the diaphragm, the red arrow is showing the muscle of the thoracic wall and the caudal edge of the heart and the black arrow denotes the great vessels (caudal vena cava and caudal aorta).

The white arrow denotes the diaphragm, the red arrow is showing the muscle of the thoracic wall and the caudal edge of the heart and the black arrow denotes the great vessels (caudal vena cava and caudal aorta).

The thoracic wall defect was repaired using porcine small intestinal submucosa extracellular matrix sheets (Vetrix ECM). Note the placement of the ECM in the defect. The overlying muscle was freed and placed as a muscular flap over the ECM. Following the repair a thoracic tube was placed to maintain negative pressure in the chest following surgery. Smokey recovered well from surgery and was released 48 hours following surgery. Two weeks later at his suture removal and he is doing great!

This is demonstrating the placement of the Vetrix ECM sheet for repair of the thoracic wall.

This is demonstrating the placement of the Vetrix ECM sheet for repair of the thoracic wall.

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Frankie’s Journey: Part 1

Frankie and Vinnie relaxing.

Frankie and Vinnie relaxing.

Here are some of the diagnostics  that were performed on Frankie. As mentioned before, during his first visit a thorough examination was performed, which revealed congenital issues on all limbs. Also, when he presented he was overweight (for a 6 month old puppy). We do know that too rapid growth and obesity at a young age can preferentially express the genes responsible for these issues and exacerbate signs.

Here are his physical exam findings: lameness noted in all limb, more pronounced on his left side. Pain on hyperextension and hyperflexion of both elbows and pain on palpation of the medial (inside) compartment of both elbows. Pain on hyperextension and hyperflexion of both hips. Positive Ortolani tests on both hips – this is were the femoral head portion of the hip can be pushed out of the acetabulum (socket) and then falls back in; I have downloaded a video displaying this on Frankie.

Our first steps in diagnosis was to perform radiographs (x-rays) and a CT scan of the elbows. The x-rays confirmed both elbow dysplasia and hip dysplasia. Interestingly, Frankie had bilateral Osteochondritis Dissecans lesions, which isn’t commonly seen, but can be a part of elbow dysplasia.

The CT scan demonstrates the same lesions as the x-rays, but gives a different view. A CT scan is a very sensitive diagnostic test for elbow pathology, especially in cases that have not developed normal x-rays changes yet.

Left Elbow: Osteochondritis Dissecans (OCD).

Left Elbow: Osteochondritis Dissecans (OCD).

Lateral view of the left elbow: elbow dysplasia
Lateral view of the left elbow: elbow dysplasia

Bilateral Hip Dysplasia
Bilateral Hip Dysplasia

OCD lesion seen on the humerus.
OCD lesion seen on the humerus.

Fragmented medial coronoid process.

Fragmented medial coronoid process (FCP).

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Frankie’s Journey

Image

I want to share this story of Frankie with everyone, as it will be an ongoing story for the next year or so as we continue to help him though this hard time. Frankie was seen by me about two months ago when he was six months old. He is a Golden Retriever that presented for lameness in all legs. He had been enrolled in a service dog program when his owners started to realize that he was having trouble walking. He was referred to me after being evaluated by a local neurologist, who couldn’t diagnose a neurologic issue.

On presentation, Frankie had lameness (limping) in all four limbs. He had pain on manipulation of both elbows, especially when pressure was placed on the inside of the elbows. He had a shortened stride to both hind limbs and was painful on hyperflexion and hyperextension of both hips. Another interesting finding, was that both hips could be felt subluxating on exam (positive ortolani test). This means that you could feel the femoral head rub and partially come out of joint.

Radiographs (x-rays) were taken of all joints and a diagnosis of bilateral elbow dysplasia (osteochondrosis dissecans (OCD) and fragmented coronoid process) and bilateral hip dysplasia was made. Unfortunately, Frankie’s career as a service dogs had to abruptly end. Because of the extensive orthopedic work that would be needed (both elbows and both hips) he was in need of a new home to care for his special needs. My wife and I may be a glutton for punishment, but we thought long and hard about this decision and decided to open our home and give this Golden puppy a second chance.

So my intention for this “Featured Article” segment is to follow the course of Frankie’s treatment including surgery, recovery, physical therapy, and final outcome. I feel that other owners may be in similar circumstances and this may help encourage some and educate others. This will also give a forum to discuss congenital issues such as elbow dysplasia and hip dysplasia. Going through these issues on our own pet, has been an eye-opening experience for us and me professionally. I can now relate to my patients and clients on a much more personal level.

In future segments (soon to follow) we will go through diagnosis, diagnostic test (radiographs and CT scan) and surgeries. So far, Frankie has had surgery on one elbow and is recovering well from that, we will go into more specifics as we go. The plan will be for the other elbow in the near future and then total hip replacements.

Also, please do not ask to donate financially to Frankie, I am not trying to raise money. I am just trying to educate others. There are so many generous people out there and there are many charitable animal organizations that can benefit from your generosity, as it is always appreciated!

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Pets and Decorations Don’t Mix

A timely discussion about some of the hazards that may be around the home during the holiday season.

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October 2013 Case of the Month

October Case of the Month

Scooter (left) enjoying the beach!!

Scooter (left) enjoying the beach!!

For October’s Case of the Month, I have selected a relatively common problem that we see in veterinary medicine – cranial cruciate ligament ruptures. Cranial cruciate ligament (CrCL) ruptures (more commonly referred to as an ACL tear after the human literature) are commonly seen in the practice of veterinary surgery, in fact they are our most common orthopedic case that we see. This disorder affects both the large and small dog, from the Great Dane to the Chihuahua and can affect dogs of any age most commonly the middle age dog. If you would like further details about this specific disorder, please see the previous posts regarding cranial cruciate ligament ruptures (click on the orthopedics tab in the menu bar).

Scooter is a  5  yr old Labrador Retriever that presented for lameness in both hind limbs. His history was such that he was lame in the left hind limb about a year ago and had a previous surgical procedure to address the CrCL performed, to which he responded well early on but became increasingly lame again in the leg and then developed a right hind limb lameness in addition. The procedure previously performed on the left stifle (knee) was not documented and no radiographic implants were used in or around the stifle. Also, Scooter has a chronic history of hip dysplasia and osteoarthritis in both hips to compound his issues.

Physical Exam:

Scooter could walk with assistance, however really struggled in both hind limbs to ambulate. Also, you could see Scooter shifting his weight to his front legs, which is a very classic feature for dogs with CrCL ruptures that affects both stifles. Our physical exam revealed that both (left and right) CrCL were ruptured and we highly suspected bilateral meniscal injuries/tears. While some discomfort could be elicited from manipulation of his hips, the majority of his discomfort and inability to walk was from his CrCL ruptures and meniscal tears.

Right knee - note the joint swelling, arthritic changes, and forward movement of the tibia in relation to the femur.

Right knee – note the joint swelling, arthritic changes, and forward movement of the tibia in relation to the femur.

Left knee - note the joint swelling, arthritic changes, and forward movement of the tibia in relation to the femur.

Left knee – note the joint swelling, arthritic changes, and forward movement of the tibia in relation to the femur.

VD pelvis x-ray - note the chronic signs associated with hip dysplasia.

VD pelvis x-ray – note the chronic signs associated with hip dysplasia.

Surgery:

Surgery was scheduled soon after his initial exam, all his pre-operative work-up was otherwise normal. Most of the time we try to stage each leg. The big reason for separating out surgery on each leg is to reduce the risk of complications such as infection and implant breakdown. Some cases, like Scooter, we chose to do both especially if they are severely affected on both legs like Scooter.

At surgery, bilateral cranial cruciate ligament ruptures were noted, along with bilateral medial meniscal tears. All those findings can be very painful for the patient. Both meniscal tears were debrided (removed) and bilateral tibial plateau leveling osteotomies (TPLOs) were performed. For more detailed information about ways we correct CrCL tears, please view that page on this website.

Right knee - following TPLO surgery.

Right knee – following TPLO surgery.

Left knee - Following TPLO surgery.

Left knee – Following TPLO surgery.

Post-operative care:

As you can image, we treat these patients very carefully. In human medicine, physical therapy and rehabilitation is started almost immediately following surgery. As soon as a patient leaves the operating room, we start icing of the surgical site. That is followed but passive range of motion exercises and short, assisted walks and frequent icing after sessions during the first two weeks. A fairly strict physical therapy program is given to owners and in some cases, organized physical therapy sessions are scheduled under the supervision of a certified canine rehabilitation therapist (CCRT). I generally tell the owners that their commitment to physical therapy is as important as the surgery performed. In Scooter’s case, his owners were very dedicated to the whole process and 16 weeks later he is back to doing his normal activity, which includes running, swimming, and of course lounging around from time to time.

Swimming at dusk.

Swimming at dusk.

Happy dog basking in the sun!!

Happy dog basking in the sun!!

Scooter and his buddy enjoying a swim!!

Scooter and his buddy enjoying a swim!!

Elbow Dysplasia
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Elbow Dysplasia

What is Elbow Dysplasia?

Elbow dysplasia is a multifaceted disease that can affect both juvenile and mature dogs. The complex of elbow dysplasia can be divided into the following categories:

–        Fragmented coronoid process (FCP)

–        Medial compartment disease (MCD)

–        Osteocondrosis dissecans (OCD)

–        Ununited anconeal process (UAP)

–        Elbow incongruency (EI)

–        Ununited medial humeral epicondyle

One or more of these problems can be affecting your pet and can cause a varying amount of lameness. We generally believe that elbow dysplasia is a congenital issue and affects mostly larger breed dogs, but can affect small breed dogs, as well.

Diagram of the canine elbow.

Diagram of the canine elbow.

The “ins” and “outs” of Elbow Dysplasia

Clinical signs: The most common clinical sign that is reported in dogs is front leg lameness. This can vary in intensity and can come on slowly or acutely (all of a sudden). Some pets will develop swelling at the elbow. Typically, limping becomes worse with activity and can subside with rest. Unfortunately, clinical signs can vary from pet to pet.

Diagnosis:  A thorough exam is recommended to isolate the elbow as the problem. It is important to evaluate the whole front leg as well as the opposite leg for any abnormalities. Because elbow dysplasia is congenital, both elbows tend to be affected (>80%).

Radiographs – In juvenile dogs, changes can be very minimal. Classic radiographic signs include: osteoarthritis (anconeal ridge is an early sign), sclerosis            (thickening) of the ulna, joint swelling and fragmentation of the medial coronoid process (33-50% visible on x-rays). OCD and UAP lesions typically will be evident on x-rays. It is standard to take three views of each elbow.

Patient with elbow dysplasia. Note the osteoarthritis present.

Patient with elbow dysplasia. Note the osteoarthritis present.

Patient with an ununited coronoid process.

Patient with an ununited coronoid process.

CT scan – Computed tomography (CT scan) may be necessary in some cases to make a diagnosis. A CT scan is a different type of x-ray and requires that your pet be anesthetized. The advantage of a CT scan is that it gives us a greater detailed image of the joint allowing us to detect mild changes. Sensitivity of a CT scan is >90% in diagnosing elbow dysplasia.

3-D image reconstruction of an elbow CT scan.

3-D image reconstruction of an elbow CT scan.

Treatment: Successful treatment of elbow dysplasia can occur with early diagnosis and treatment. The more advanced the arthritic changes (which will occur with time), the less successful treatment becomes. The following is a brief overview of the current treatments that are performed, usually in combination. 

Arthroscopy – Considered to be the “gold standard”, arthroscopy allows us to obtain critical information about the joint by looking in the joint via a minimally invasive approach. A scope and camera are introduced into the joint and the joint surfaces are assessed for arthritis, cartilage wear, incongruency and fragments. If fragments exist, these can be removed with arthroscopy. If substantial cartilage wear is present other procedures may be recommended.

Conservative management – this includes non-steroidal anti-inflammatories drugs (NSAIDs), supplements, physical therapy, acupuncture, and regenerative stem cell therapy. Unless your pet is very severely affected this therapy is often used in conjunction with arthroscopy and surgical management.

Advanced surgical procedures – Depending on the assessment of the joint, other procedures may be recommended such as the following: sliding humeral osteotomy (SHO) or unicompartment elbow replacement (CUE) for medial compartment disease, biceps tendon release and elbow replacement surgeries.

Patient with a Sliding Humeral Osteotomy (SHO).

Patient with a Sliding Humeral Osteotomy (SHO).

“Will my dog get better?

Prognosis – With early diagnosis and aggressive treatment, the success rate of the treating elbow dysplasia is ~80%. This generally entails elbow arthroscopy and sometimes more advanced procedures. Also, if changes are detected on the opposite leg, arthroscopy of this leg is recommended as well. In about 20% of the cases we need to combine multiple treatments and sometimes arthritis and discomfort will still progress.

Elbow replacement surgeries are still up and coming and can be considered in pets with “end-stage” changes to the elbow.