The Elbow Room is Your Place for Canine
Osteoarthritis (OA) Information and
Canine elbow OA is an extremely common and debilitating disorder.
• Analgesics are often needed as early as 2 years of age1
• Fewer than 50% of all treated dogs have satisfactory long-term recovery1
Elbow dysplasia is commonly diagnosed in the most popular breeds, such as Golden Retrievers, Labrador Retrievers,
German Shepherds and Rottweilers. Elbow dysplasia can lead to OA even in young, active dogs.1,2
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Canine Elbow OA Facts
A brief overview of the 4 steps to diagnosing canine elbow OA include the following:1,2
Step 1: Gait/mobility assessment. The dog is observed at the walk and trot and on various surfaces and inclines to determine gait abnormalities. These include a shortened stride, toe-in/toe-out, stumbling, audible click, leg crisscrossing, dragging toenails, limb circumduction, ataxia, head bob, asymmetric pelvic motion, weakness, hypermetria, and vocalization.
Step 2: Standing exam. The dog’s body confirmation is assessed, evaluating for symmetry and alignment. Any decrease in weight-bearing or altered-limb motion should be noted, as well as trembling or off-loading while standing. A sit-test and a down-test are also recommended.
Step 3: Recumbent exam. Working from distal to proximal, looking for asymmetry from trauma, degenerative changes, inflammation, congenital defects, and neoplasia. Note the presence of painful response, particularly in full extension, such as body shifts and change of facial expression. The joint should be palpated, looking for swelling, heat, malalignment, crepitus, and muscle atrophy, and valgus and varus stresses should be used to assess joint capsule and ligaments/tendons.
Step 4: Diagnostic imaging. It is important to obtain multiple views on conventional radiograph, with orthogonal views of each limb looking for signs of osteophytosis, subchondral bone sclerosis, remodeling, and joint space narrowing. Referral for CT/MRI/MSK ultrasound should be made based on findings.
References: 1. Fox SM. Multimodal management of canine osteoarthritis. 2nd ed. Boca Raton: CBC Press; 2017. 2. Brunke M. 4 steps to addressing canine osteoarthritis (OA). March 2020. Available from Exubrion Therapeutics.
The early signs of elbow osteoarthritis (OA) are subtle and typically marked by gradual or intermittent changes in gait and/or demeanor. Some of the more common early signs include:1
- Stiffness after a walk that tends to improve throughout the day
- Stumbling on a walk
- Reduced walking speed, which may be accompanied by increased panting
- Reluctance to exercise, get out of bed to go for a walk, or to play
- Reduced ability to jump into a car
- Difficulty posturing to toilet
- Owner description of the dog as being “sad” or “withdrawn”
Some dogs may show signs that can be associated with pain, such as non-weight bearing lameness during or immediately after exercise, vocalizing when moving, and licking or biting a joint repeatedly.1
Reference: 1. Belshaw Z, Dean R, Asher L. Could it be osteoarthritis? How dog owners and veterinary surgeons describe identifying canine osteoarthritis in a general practice setting. Prev Vet Med. 2020;185:1-23.
Current therapies can fall short in effectively treating chronic elbow OA.1
- Certain treatments can be associated with systemic side effects (GI, renal, chondrotoxic)
- Daily administration or multiple injections can be inconvenient and can lead to pet parent noncompliance
- Many treatments are short-acting and only designed to address acute pain and inflammation, not the ongoing pain of elbow OA
- Treatments may only target specific pathway receptors, but don’t suppress the transduction phase of the pain pathway
- There is uncertain efficacy with some approaches, especially supplements and unapproved products, which have limited or no evidence-based data
Reference: 1. Bland SD. Canine osteoarthritis and treatments: a review. Veterinary Science Development. 2015;5(2):84-89. DOI: 10.4081/vsd.2015.5931.
An exam for canine elbow osteoarthritis (OA) should start with the patient’s medical history, including a general health assessment (incidence of recent trauma, signs suggesting discomfort.) Following this, there are 4 key steps to examining a patient for OA:
- Gait/mobility assessment
- Standing exam
- Recumbent exam
- Diagnostic imaging
For more information about how to perform a thorough examination for elbow OA, watch this video by Matt Brunke, Diplomate ACVSMR, CCRP, CVPP, CVA, Sports Medicine & Rehabilitation Specialist, Medical Director for VSCR. Watch video
Synoviocytes are metabolically highly active cells directly involved in joint homeostasis as well as the pathophysiology of DJD.1 Although synovitis tends to be more severe in advanced OA, it is clearly present from the earliest stages of DJD progression.2
The clinical signs include joint swelling due to synovial hyperplasia or synovial fluid effusion, a sudden increase in pain, and transient morning stiffness.1 Recent studies have convincingly shown that diffuse synovitis precedes the development of radiographic OA, both in human and canine hosts.1-5
References: 1. Sellam J, Berenbaum F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat Rev Rheumatol. 2010;6:625-635. 2. Wenham CY, Conaghan PG. The role of synovitis in osteoarthritis. Ther Adv Musculoskel Dis. 2010;2:349-359. 3. Atukorala I, Kwoh CK, Guermazi A, et al. Synovitis in knee osteoarthritis: a precursor of disease? Ann Rheum Dis. 2016;75:390-395. 4. Griffon DJ. A review of the pathogenesis of canine cranial cruciate ligament disease as a basis for future preventive strategies. Vet Surg. 2010;39:399-409. 5. Roemer FW, Guermazi A, Felson DT, et al. Presence of MRI-detected joint effusion and synovitis increases the risk of cartilage loss in knees without osteoarthritis at 30-month follow-up: the MOST study. Ann Rheum Dis. 2011;70:1804-1809.
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1. Orthopedic Foundation for Animals. Examining elbow dysplasia. Available at: https://www.ofa.org/pdf/elbowarticle.pdf. Accessed March 15, 2021.
2. American College of Veterinary Surgeons. Canine Elbow Dysplasia. Available at: https://www.acvs.org/small-animal/canine-elbow-dysplasia. Accessed March 15, 2021.
3. American College of Veterinary Surgeons. Osteoarthritis in dogs. Available at: https://www.acvs.org/small-animal/osteoarthritis-in-dogs. Accessed July 22, 2021.
4. Benito MJ, Veale DJ, FitzGerald O, et al. Synovial tissue inflammation in early and late osteoarthritis. Ann Rheum Dis. 2005;64:1263-1267. doi: 10.1136/ard.2004.025270
5. Bondeson J, Blom AB, Wainwright S, et al. The role of synovial macrophages and macrophage-produced mediators in driving inflammatory and destructive responses in osteoarthritis. Arthritis & Rheumatism. 2010;62(3):647-657. Doi:10.1002/art.27290
6. Blom AB, van Lent PL, Libregts S, et al. Crucial role of macrophages in matrix metalloproteinase–mediated cartilage destruction during experimental osteoarthritis. Arthritis & Rheumatism. 2007;56(1):147-157. doi: 10.1002/art.22337
7. Goldring MB, Goldring SR. Osteoarthritis. J. Cell. Physiol. 2007;213:626–634. doi: 10.1002/jcp.21258.
8. Sellam J, Berenbaum F. The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis. Nat Rev Rheumatol. 2010;6:625-635. doi:10.1038/nrrheum.2010.159
9. Bleedorn JA, Greuel EN, Manley PA, et al. Synovitis in dogs with stable stifle joints and incipient cranial cruciate ligament rupture: a cross-sectional study. Vet Surg. 2011;40:531-543. DOI: 10.1111/j.1532-950X.2011.00841.x
10. Klocke NW, Snyder PW, Widmer WR, et al. Detection of synovial macrophages in the joint capsule of dogs with naturally occurring rupture of the cranial cruciate ligament. Am J Vet Res. 2005;66:493-499.
11. Doom M, de Bruin T, de Rooster H, et al. Immunopathological mechanisms in dogs with rupture of the cranial cruciate ligament. Vet Immunol Immunopathol. 2008;125:143-161. DOI:10.1016/j.vetimm.2008.05.023.