314 Canine Sports Medicine and Rehabilitation
Osteochondrosis/osteochondritis dissecans
of the elbow
Pathophysiology
Osteochondrosis is defined as the failure of endo
chondral ossification resulting in a discrete lesion
of thickened and degenerative cartilage (Trostel
et al., 2002). Mild forces on the abnormal cartilage
can result in shearing of the cartilage flap from
the underlying bone, referred to as osteochondri
tis dissecans (OCD). The flap of cartilage can
remain attached to the defect or can become dis
lodged into the joint. Osteochondrosis/OCD can
occur in the shoulder, stifle, tarsus, and elbow.
Within the elbow, the most common location for
osteochondrosis to develop is the distal medial
humeral condyle (Trostel et al., 2002; Fitzpatrick
et al., 2009b).
The underlying cause of osteochondrosis has
not been firmly established, but may be related to
overnutrition, rapid growth, excess dietary cal
cium, ischemia, hormonal influences, or trauma.
A genetic component is also likely. The condition
is most commonly seen in large‐ and giant‐breed
male dogs such as Bernese Mountain Dogs and
Labrador Retrievers. Bilateral disease occurs in
20–50% of dogs and osteochondrosis and FCP
commonly occur within the same joint (Trostel
et al., 2002; Fitzpatrick et al., 2009b, 2009c).Diagnosis
The clinical history and physical exam findings
of dogs with osteochondrosis/OCD is similar to
that of FCP (Trostel et al., 2002; Fitzpatrick &
Yeadon, 2009). Four‐view radiographs of the
elbow are often sufficient to diagnose osteochon
drosis, where the lesion is seen as a lucency of
the distal medial humeral condyle (Cook &
Cook, 2009a). Advanced imaging techniquesLeft shoulder: Significant inflammation and tenosyno-
vitis of biceps tendon. Severe supraspinatus bulge. Severe
inflammation, fraying, and disruption along subscapula-
ris tendon, medial glenohumeral ligament, medial
labrum, and caudal glenoid labrum. Moderate inflamma-
tion and disruption of synovium. Mild craniomedial
laxity. Caudal glenoid slab fracture.
Right shoulder: Significant inflammation and teno-
synovitis of biceps tendon. Severe supraspinatus bulge.
Moderate inflammation, fraying, and disruption along
subscapularis tendon, MGL, medial labrum, and cau-
dal glenoid labrum. Mild to moderate inflammation
and disruption of synovium. Mild craniomedial laxity.Diagnosis: Bilateral supraspinatus tendinopathy (left >
right), bilateral medial shoulder syndrome (left >
right), left caudal glenoid slab fracture, severe medial
compartment disease (right elbow).Treatment: Bilateral radiofrequency treatment per-
formed to medial joint capsule, subscapular tendon,
medial glenohumeral ligament, and in the region of the
supraspinatus bulge. Excision of right caudal glenoid
slab fracture. Right elbow arthroscopic debridement
and fragment excision. Ultrasound‐guided injections of
bone marrow‐derived stem cell and platelet‐rich
plasma into both supraspinatus tendons, both shoul-
ders, right elbow, and right biceps. Hobbles applied.
Enrolled in rehabilitation program 7 days following
injections and application of hobbles. Diagnostic
ultrasound and physical examination rechecks per-
formed 6, 12, and 16 weeks postoperatively.6 weeks: Diagnostic ultrasound shows improved
homogenous fibers of bilateral supraspinatus tendinopa-
thy. Decreased inflammation, biceps impingement, and
fibrous tissue within shoulder joint. Joint capsule WNL.
Biceps insertionopathy remains consistent with hob-
bles use. Palpation shows improved comfort on
shoulder ROM. Moderate muscle atrophy due to
hobbles usage and lack of strength training. Mild
restriction in scapular thoracic region, elbow, and
carpi. Mild effusion in right elbow.
12 weeks: Hobbles removal. Diagnostic ultrasound
shows significantly decreased inflammation and
significantly improved homogenous fibers of bilateral
supraspinatus tendinopathy. Bilateral supraspinatus
WNL. No biceps impingement. Decreased fibrous
tissue within shoulder joint. Joint capsule WNL.
Biceps insertionopathy remains, but consistent with
use of hobbles. Palpation shows improved ROM in
shoulder, elbow, and carpus.
16 weeks: Diagnostic ultrasound shows resolution
of bilateral supraspinatus tendinopathies, no inflam-
mation present, and decreased fibrous changes in
both supraspinatus tendon insertions. Right biceps
insertionopathy at the point of origin resolved and
shows a significant improvement of fiber pattern.
Palpation reveals shoulder and elbow ROM WNL. No
discomfort noted.
Agility retraining initiated.Case follow‐up: 6 ‐, 12‐, and 18‐month follow‐up calls
with no reports of lameness or performance‐related
issues.