Thoracic Limb Lameness. Jason Eisele, DVM, CCRP, DACVS

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Hilary Gray
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1 Thoracic Limb Lameness Jason Eisele, DVM, CCRP, DACVS

Difficulties with Thoracic Limb Lameness Can be difficult to know which limb is affected Owners often do not know which limb Patient is rarely non-weight bearing in the limb Often no pain on

2 Difficulties with Thoracic Limb Lameness Can be difficult to know which limb is affected Owners often do not know which limb Patient is rarely non-weight bearing in the limb Often no pain on palpation of the limb Seen less frequently than pelvic limb lameness Less experience with diagnosing cause of lameness Complex joints Elbow > shoulder Soft tissue, bone and cartilage are all possible sources of lameness Many different causes for lameness which can be very different as the patient ages

3 Signalment Large breeds most common But all dog sizes can be affected Ages Skeletally Immature Skeletally mature Older/ Geriatric Signalment

4 Gait analysis Head bob Down on sound External rotation and/or lateral limb placement during stance Palpation Digits to neck All joints, bones, soft tissue Effusion Pain Crepitus/ Decreased ROM Heat Fever? Physical Exam

5 Fractures Elbow dysplasia Shoulder Osteochondrosis Panosteitis Septic Arthritis Flexural carpal deformity Young Dogs

6 Fractures

7 Flexural Carpal Deformity Less than 6 months of age Rescued dogs that may not have received proper nutrition or activity Treatment = proper nutrition and activity Do Not Splint

8 Panosteitis

9 Septic Arthritis

10 Elbow Dysplasia A complex of developmental abnormalities of the elbow, including UAP, FMCP, OC, and elbow incongruity. Proposed causes: - genetics - nutritional excesses or deficiencies - growth disturbances - trauma

11 Elbow Incongruity Normal Abnormal (Incongruent)

- lack of visualization/abnormal contour MCP - subtrochlear

12 Fragmented Medial Coronoid Process (FMCP) Clinical signs: 4-7 months Bilateral 50-90% Radiography for diagnosis? - lack of visualization/abnormal contour MCP - subtrochlear sclerosis proximal ulna - periarticular osteophytes - subluxation or joint incongruity

13 FMCP - Radiographs

14 FMCP - Radiographs

15 Other Imaging/Diagnostics Arthroscopy allows visualization and treatment CT

16 Arthroscopy

17 FMCP - Radiographs

18 Arthroscopy

Ununited Anconeal Process (UAP Separate ossification center in large breeds Bone union between 15-20 weeks

19 Ununited Anconeal Process (UAP Separate ossification center in large breeds Bone union between weeks Definition: failure of fusion beyond 20 weeks Pathophysiology? - form of OCD - joint incongruity - genetics (G.Shep)

20 Ununited Anconeal Process (UAP) Clinical signs between 4-12 months Progressive lameness Bilateral reports 11-47% Flexed mediolateral rads Surgical options - Excision - Lag screw fixation - Ulnar ostectomy - Lag screw + ulnar ostectomy

21 UAP arthroscopy

22 UAP surgical treatment

Prognoisis Good Clinical presentation Age of onset: 5-6 months

23 Shoulder Osteochondrosis Site Caudal Humeral Head Diagnosis Radiography Arthroscopy Treatment Arthroscopy Arthrotomy Prognoisis Good Clinical presentation Age of onset: 5-6 months Mild to moderate lameness Predominantly large breed dogs Pain on extension of shoulder

24 OC v OCD Normal Abnormal OC OCD

25 Shoulder OC

26 Normal Shoulder Scope

27 Shoulder Osteochondrosis

28 Skeletally Mature dogs Elbow dysplasia Medial Shoulder Instability Biceps Tenosynovitis Supraspinatus tendionopathy/ mineralization Immune-Mediated Arthropathy

29 Medial Shoulder Instability

30 Abduction Angle

31 Shoulder MRI

32 Shoulder Restraint

33 Medial Shoulder Instability

34 Biceps Tenosynovitis Supraspinatus Tendonitis (inflammation) Tendon strains Mild (grade 1) Moderate (grade 2) Complete (grade 3) Supraspinatus involvement

35 Tendon Mineralization

36 Biceps Tendon Release

37 Immune-Mediated Polyarthropathy

Older Dogs Osteoarthritis Rarely primary OA in dogs Secondary to elbow dysplasia Secondary to shoulder instability Biceps tenosynovitis Previous trauma

38 Older Dogs Osteoarthritis Rarely primary OA in dogs Secondary to elbow dysplasia Secondary to shoulder instability Biceps tenosynovitis Previous trauma Neoplasia Bone Nerve sheath tumor Soft tissue Immune-mediated polyarthropathy Luxation of the femoral head during adduction of the femur Medial Shoulder instability

39 Elbow Osteoarthritis

40 Sever Elbow Osteoarthritis

41 Treatment Non-surgical treatment recommended NSAIDs Weight loss Joint Diets Intraarticular injections PRP Hyaluronic acid (HA) Steroids Activity/ PT INTERLEUKIN-1 RECEPTOR ANTAGONIST PROTEIN (IRAP)

42 OA treatment

43 Physical Rehabilitation

44 Neoplasia

45 Neoplasia

46 Other Possibilities

47 Summary Thoracic limb lameness can be mild The source of the lameness can be difficult to determine Shoulder v elbow Lameness may be bilateral and shifting in side Prognosis varies Shoulder OCD good Elbow dysplasia - fair

48 Questions/ Comments?

Diagnosing Forelimb Lameness in Canine Patients

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