Front Matter

Chapter 12 Disorders of the Canine Thoracic Limb: Diagnosis and Treatment 315

such as CT, MRI, and arthroscopy are often used
to evaluate dogs for concurrent FCP and to eval­
uate the articular cartilage (Cook & Cook, 2009a).

Treatment

Surgical removal of the osteochondrosis/OCD
fragment is recommended (Trostel et al., 2002;
Fitzpatrick & Yeadon, 2009; Fitzpatrick et al.,
2009b). After fragment removal, curettage and
osteostixis of the subchondral bone is per­
formed to encourage ingrowth of fibrocartilage
(Fitzpatrick & Yeadon, 2009). Long‐term osteo­
arthritis is expected. Osteochondral autographs
and allographs have been used to replace the
osteochondrosis defect with hyaline cartilage
(Fitzpatrick et al., 2009b). Fitzpatrick et  al.
(2009b) showed promising short‐term results
using the osteochondral autograph transfer
system. Sliding humeral osteotomy, total elbow
joint replacement, and CUE® may also be used
in the long‐term management of medial com­
partment disease secondary to osteochondro­
sis/OCD (Fitzpatrick & Yeadon, 2009; Cook,
2012b).

Long‐term management of elbow dysplasia
and osteoarthritis

Nonsurgical or complementary therapy for the
long‐term management of patients with elbow
dysplasia and osteoarthritis involves a multimodal
approach including weight management, activity
modification, chondroprotectants, pain manage­
ment, omega‐3 fatty acids, therapeutic modalities
(such as laser therapy, shock wave therapy, pulsed
electromagnetic field therapy), therapeutic exer­
cises, acupuncture, manual therapy, and intra‐
articular injections (biological therapies, hyaluronic
acid, cortisone, etc.) (Canapp et al., 2009).
Intra‐articular injections of biologics should
be considered as a treatment option for elbow
dysplasia. Biological therapies for managing
significant osteoarthritis may be done in con­
junction, in lieu of, or after arthroscopic treat­
ment. Products such as hyaluronic acid, PRP,
and stem cell therapies have been reported to
be used successfully for osteoarthritis in
humans, horses, and dogs (Guercio et al., 2012;
Vilar et al., 2013; Zhu et al., 2013; Beitzel et al.,
2015; Kilincoglu et al., 2015; Meheux et al., 2016).
Patients with persistent postop intra‐articular

symptoms (e.g., effusion, discomfort, or lame­

ness) and those who are intolerant or nonre­

sponsive to NSAIDs may also benefit from

intra‐articular therapy (Figure 12.22).

Ununited medial epicondyle

An ununited medial epicondyle is not consid­

ered to be a component of elbow dysplasia but

is a developmental condition of the canine

elbow. The etiology of UME is thought to be

either failed fusion of the ossification center of

the medial humeral condyle or osseous meta­

plasia of the flexor tendon origins (Paster et al.,

2009). The condition occurs in Labradors, with

a prevalence of 15% (Paster et al., 2009). German

Shepherds and English Setters are also fre­

quently affected. UME is generally unilateral;

however, histological studies suggest that the

underlying pathological changes affect both

elbows (Paster et al., 2009). Patients present

with a history of lameness and pain localized to

the elbow, however, UME may be an incidental

finding. Craniocaudal radiographs demon­

strate the lesion although the condition may not

be evident until dogs reach middle age (Paster

et  al., 2009). Surgical resection of the ossified

bodies has been recommended; however, little

evidence exists regarding long‐term results of

surgical intervention. Importantly, it has been

shown that UME is not associated with the

development of radiographic signs of osteoar­

thritis (Paster et al., 2009). Rather, it is an extra‐

articular condition and carries a better

prognosis than other disorders of the elbow.

Incomplete ossification of the humeral

condyle

Incomplete ossification of the humeral condyle

is a developmental condition that primarily

affects Spaniel breeds, with a reported poly­

genic recessive mode of inheritance (de Bakker

et al., 2011; Hattersley et al., 2011). Labrador

Retrievers and Rottweilers are also overrepre­

sented. The underlying pathophysiology is a

failure of the two ossification centers of the

humeral condyle to fuse (de Bakker et al., 2011;

Hattersley et al., 2011). Normally, complete

fusion should occur by 70 ± 14 days of age