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gimpy elbow

Customer Question

what would be the possible cause and or
treatment, of my
dog having some swelling in her front elbow
joint (right
side only) causing her pain and limping? Two
weeks after
I adopted her she started limping, I took her to
a vet
who X-rayed her and said everything looked
fine, then
told me $485.00 for blood work. I felt like I was
being
taken advantage of because I asked him for
his opinion
based on his experience with this type of
scenario and
he would not give me a straight answer but
continued to
press the need for bloodwork as the only
course of
action. Please Help, Thank you for your
attention and
time. michael singer
Submitted: 11 years ago.
Category: Pet
Expert:  Tammy F. replied 11 years ago.
 Did the vet mention patella luxation to you?
Customer: replied 11 years ago.
Reply to Tammy Falkner's Post: no, the vet did not mention patella luxation. my
dog has been favoring her paw for about two
months. this condition has remained very
consistent. she loves to go for walks(1 to 3 per
day at 1/2 mile each) frequently and when
walking she seems to place her paw securely
but limps. on her bad days I have cut up
ibuprofen and glucosamine and given her a
little of each, it seems to help her but if there is
something more appropriate I would like to
help her further. thank you for your care
concern expertise & time. sincerely, michael
singer
Expert:  Tammy F. replied 11 years ago.

 Patella luxation, in layman's terms, means wiggly kneecaps.  When a dog has this condition, their kneecap will slip in and out of place.  The dog can usually flex the leg and pop it back in.  You might see her pick the leg up, flex it and then put it back down and be fine for a while.


I think that you should speak with your vet about this being a possibility. 


You should also have the vet check for a torn cranial cruciate.  This can be severely debilitating.


Let me know if you have more specific questions.

Customer: replied 11 years ago.
Reply to Tammy Falkner's Post: I'm not sure if the last 2 replies went through
because I recieved an error message. My
dogs condition is in the elbow joint not the
knee. Her elbow is noticeably swollen to the
touch when comparing right side to left. her
condition is very consistent and has been
ongoing for approximately 2 to 3 months. The
vet offered no opinion whatsoever other than
the x-ray looked normal. Is there anything I can
do to determine or narrow the field of possible
causes in order to determine proper
treatment? Is arthritis a possibility? Are there
any medications to reduce joint swelling?
How may I obtain them? Are there any natural
remedies dietary or otherwise that would
reduce joint swelling or promote healthy
cartilage,ligaments,tendons? Can her knee
be wrapped with an ace bandage for periods
of time to assist in the reduction of stress to
the joint and soft tissues? Logic leads me to
believe that to reduce the swelling will reduce
internal pressure which would assist in
healing unless a permanent arthritic type
condition is the cause.Please Help. Thank
You for your time and patience. sincerely
michael singer    P.S. I recently purchased a
house in Lenoir N.C. and can't wait to live in
that beautiful state and start my own garden.
Expert:  Joann Canafax replied 11 years ago.
Rimadyl,Ectodolac,Prednisolone/
Prednisone are all anti inflammatory drugs used to reduce swelling and also for pain you can get them at 1-800-petmeds. they also have a website

http://www.1800petmeds.com/pselect.asp?LV=268&PG=Rimadyl

here is some information on elbow disease

http://vetmedicine.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=vetmedicine&zu=http%3A%2F%2Fwww.acay.com.au%2F%257Edissi %2Felbow.htm

Elbow disease is the preferred term to be used when talking about elbow problems in growing dogs. Unfortunately "elbow displaysia" was the name given to the condition of ununited anconeal process and this term is closely linked in this way in the minds of most veterinarians and some dog breeders.
Elbow disease is a general term to denote joint problems in growing dogs and it includes ununited anconeal process (UAP), fragmented medial coronoid process (FCP) and osteochondrosis of the medial condyle of the humerus (OCD). These are the three most important conditions although there are a number of uncommon conditions included in the term.

Elbow disease has received increasing publicity in recent years due to the high prevalence of foreleg lameness localised to the elbow joint and the realisation that elbow disease has a hereditary basis. There are two important situations to discuss, firstly the management of clinical elbow disease and perhaps more importantly, the monitoring of elbow disease by breed clubs.

1. CLINICAL FEATURES
Elbow disease is a problem of growing dogs and the clinical signs of the three main problems are somewhat similar. The earliest problem recognised was UAP. The German Shepherd Dog and the Basset Hound are the two main breeds involved, although any middle size or larger breed may be affected.

The anconeal process sometimes grows as a separate ossification centre and it is usually recognised as such at around 70 days. It is usually united to the main part of the ulna by about 140 days. However, dogs which have UAP do not necessarily show lameness. Thus dogs with elbow lameness and an UAP which are older than 140 days would be considered to be exhibiting signs relating to this condition. the radiological diagnosis is straightforward and there may be osteoarthritic change in addition to the presence of UAP. It is also possible that dogs with UAP could in addition have FCP and/or OCD.

Dogs with OCD or FCP may present with lameness earlier than UAP cases. there have been cases as young as 3-4 months, but the 5-8 months category would be more common. Cases continue to be presented up to 18 months or older, but dogs of some years presumably present with exacerbation of underlying osteoarthritis.

The forelimb lameness may be unilateral or bilateral. There is often pain on manipulation of the elbow and a reduction in range of movement. There may be swelling of the elbow joint. The specific diagnosis can sometimes be made on x-ray examination, but more frequently the diagnosis relies on the presence of osteoarthrosis of the elbow joining which is the result of either a primary FCP and/or OCD. A variety of views can be used to examine the elbow joint and they may pick up the primary problem. It is more likely that OCD will be identified rather than FCP. Despite high quality x-rays, it is impossible to identify all FCP and OCD lesions without using special techniques and the diagnosis is based on the clinical findings and the radiographic changes of osteoarthrosis.

2. MANAGEMENT OF CASES OF ELBOW DISEASE
Ununited anconeal process can be managed by either removing the UAP or attaching it firmly to the ulna using a lag screw. The former is the simplest and normally gives excellent results. Fragmented coronoid process and OCD lesions may produce a temporary lameness that responds to rest or medical treatment. If the lameness persists then surgery is indicated. This involves a medial approach to the elbow joint on the opposite side to surgery for UAP, and both the medial coronoid process of the ulna and the medial condyle of the humerus must be examined carefully. One or both lesions may be present and they can cause "kissing lesions" on the opposite side of the joint. The surgical results vary with breed and age, but many dogs will settle satisfactorily.

3. MONITORING OF ELBOW DISEASE
The monitoring of elbow disease has been undertaken for some years now in some parts of the world, particularly on the Continent of Europe. The breeds which have serious problems with hip displaysia appear to have elbow disease as an equally important problem. There have been a number of papers suggesting the UAP has an inherited basis, but little has been done to control it. It was only when studies on elbow arthrosis indicated that elbow disease was inherited that action began to be taken to monitor its incidence.

Early work documented the presence of elbow arthrosis, the secondary osteoarthritic change, and various workers graded the degree of change similarly to what was happening with hip displaysia. The increasing international awareness of the importance of elbow lameness in growing dogs led to the formation of the International Elbow Working Group. The aims of this group were to establish an internationally accepted radiological interpretation system and to encourage research into the cause(s) of the development of the primary problems. The working group is independent but has held its meetings in conjunction with the World small animal Veterinary Association conferences. It is growing in membership and recently played the major role at the meeting organised by the WSAVA and reported in the VCA gazette by Dr. Robert Zammit, the ANKC representative at the meeting.

The International Elbow working Group's guidelines for monitoring of elbow disease were documented in the Gazette. there is simply a requirement for good quality flexed lateral elbow views which are assessed for the presence of arthrosis. This view will readily identify UAP but only rarely picks up FCP and OCD. There is not really a problem as at present no other causes of disease have been commonly identified. However there is a problem in the reporting of findings where there is no definite differentiation between UAP cases and those with degenerative joint disease. As mentioned earlier, it is possible to find UAP in the presence of other primary elbow problems.

It is all very well to monitor the elbow disease but unless some constraints are put on breeding, then there will be a lot of x-rays taken but no improvement in the prevention of lameness in the breeds affected. The research from the continents of Europe, Britain, Australia, and USA has shown that elbow disease is inherited . There is also information to show that those dogs with the more severe lesions are most likely to produce puppies with serious elbow disease. Consequently grade 3 elbow disease dogs should not be used for breeding and the grade 2 cases should be considered as serious risks.

The suggested age for x-ray examination is 12 months when the hip x-rays are taken. It is likely that the severity of the osteoarthritis will increase with age and consequently for the monitoring programmes at present, dogs should be examined when young. It may be that later the age for screening will be raised, but this will mean an alteration to the current breeding programmes. Owners and breeders need to be aware that not all breeds behave in the same way in regard to elbow disease. for example, most published reports suggest that surgery in Rottweilers has little benefit compared to medical therapy, whereas our results in the Labrador Retriever have been rewarding. Certainly elbow disease is not as straightforward a problem to handle as OCD of the shoulder and in some cases, the severity of the chronic elbow disease may lead to dogs being destroyed.

Responsible owners and breeders of dogs of the breeds where elbow disease is a recognised problem should consider monitoring the elbows in the same way as they monitor hip displaysia and eye disease. The x-ray examination is simple and the Australian Veterinary Association will shortly have application forms for elbow disease assessment. The German shepherd dog Club has forms available to enable assessment of both hip and elbow x-rays or either alone through the club schemes.

Nil Arthrosis (Grade 0)

Minimal Arthosis (Grade 1) = one or more of the following findings:


(a) less than 2 mm high osteophyte formation seen on the dorsal edge of the anconeal process
(b) minimal osteophyte formation (less than 2 mm in any direction) on the dorsal proximal edge of the radius
(c) or the dorsal edge of the coronoid process,
(d) or the leteral palmar part of the humeral trochiea;
(e) sclerosis in the area caudal to the distal end of the ulnar trochlear notch and to the proximal
Moderate Arthosis (Grade 2) = one or more of the following findings:


(a) osteophytes 2 - 5 mm high on the anconeal process
(b) moderate osteophyte formation (2 - 5 mm in any direction) on locations b, c, d.
Severe Arthosis (Grade 3) = one or more of the following findings:


(a) more than 5 mm high osteophyte formation on the anconeal process
(b) severe osteophyte formation (more than 5 mm in any direction) on lcations b, c, d.
Additionally - in cranio-caudal radiographs osteophytes are most easily seen on the distal, medial part of the humeral condyle (f) and the medial part of the coronoid process (g).

Congratulations on your new house!Hope this helps!
Expert:  Tammy F. replied 11 years ago.

 Boy, you have a lot of questions.  Let me see if I can answer them all:


Is there anything I can
do to determine or narrow the field of possible
causes in order to determine proper
treatment?


Your vet can rule out a lot of possibilities with a simple exam.


Is arthritis a possibility?


Arthritis is always a possibility and is a little harder to diagnose. 


Are there
any medications to reduce joint swelling?


There are a lot of great anti-inflammatories that you can discuss with your vet.  Most have limited side effects and provide a great deal of relief for your pet.



How may I obtain them?


Your vet can help you to choose the right one.  They are only available by prescription.


Can her knee
be wrapped with an ace bandage for periods
of time to assist in the reduction of stress to
the joint and soft tissues?


I would not recommend this.  You could do more damage than you might do harm if you try to do this at home.


Swelling can more effectively be reduced by using anti-inflammatories and steroids.


 


Does this answer most of your questions?










Customer: replied 11 years ago.
Reply to Tammy Falkner's Post: Are all elbow related issues referred to as
elbow disease?
What is the veterinrians process for
diagnosing, ununited anconeal process?
What is the veterinarians process for
diagnosing, fragmented medial coronoid
process?
What is the veterinarians process for
diagnosing,osteochondrosis of the medial
condoyle of the humerus?
What are the specific differences between
these three diagnoses?
which of these three occur naturally?
which of these three occur as a result of
injury?
what are the differences in surgical treatment
of these three?
what are the differences in non surgical
treatment of these three?
Thank you for your time and patience,sincerely
michael singer
Expert:  NancyH replied 11 years ago.
As your dog had an x-ray of the elbow area I doubt the problem is osteochondritis or elbow displasia. Those bone and cartilege problems should show on x-ray.
As its the front leg it would not be a patella issue.
As you adopted this dog potentially she might have had an underlying injury to tendons or ligaments in the elbow area that getting out and about with you and using the joint brought out as a 'new' problem.
This could also be a result of a tick carried disease. Checking for lymph node enlargement and fever can help to rule out the tick borne diseases (Lyme, ehrlichiosis,Rocky Mountain spotted fever), as can serum titer tests.
I am very concerned that you are not comfortable with the explanation your vet gave you over why he or she wanted to do blood work as the next step in ruling out a problem and why it would be so expensive to do it. My feeling is you should have a good rapport with your veterinarian and be able to discuss issues and treatments and understand what needs to be done and why instead of going away unhappy. You may wish to seek a second vet's opinion with your new pet.
You can read about some lameness problems in dogs here http://www.northcreek.com/s_bonedis.html
You can see pictures of how the joints look when some of the diseases are present (such as the Fragmented Coronoid Process) here
http://www.vetmed.ufl.edu/sacs/Lewis/Lewis-Elbows/fcp.htm
and how it is diagnosed.
I really think you need to find a vet you are comfortable with to work on this problem with your new pet. Maybe ask at the shelter if they know a good vet in your area.
Hope this helps you!
Customer: replied 11 years ago.
Reply to Nancy Holmes's Post: thanks for the info I'll check it out and see
what I can find that will be helpful. mike singer
Customer: replied 11 years ago.
Reply to Joann Canafax's Post: thank you for your time and info I will continue
researching.mike singer
Expert:  NancyH replied 11 years ago.
If you found my post helpful you can hit the accept for it.
I hope you find what is wrong with your dog and that you find a vet you are comfortable working with to resolve the problem.
Customer: replied 11 years ago.
Reply to Nancy Holmes's Post: I did find some of the information helpful
although I'm currently waiting to see if I recieve
more detailed answers to the specific
questions I've been posting. thank you for your
time. sincerely, XXXXX XXXXX
Expert:  NancyH replied 11 years ago.
There are some supplements you can use that people find effective if its arthritis type inflammation - things like glucosamine chondroitin and MSM can work to help cartilege and replenish the sinuvial fluids in joints and inflammation.
But you should also make sure to check for tick carried diseases (bloodwork is involved in that).
At this point too if your vet is not giving you the answers you want you need to perhaps be seeing a veterinary orthopedic specialist instead of your regular vet.
There are pain meds like Metacam that your vet can prescribe - but that won't cure anything just block the pain.
Customer: replied 11 years ago.
Reply to Nancy Holmes's Post: I've been giving my pet glucosamine &
ibuprofen which definitely helps. My dog has
never had any ticks and according to the
humane society was given a clean bill of
health upon adoption, although 14 days after
she was home she became a three legged
animal. the vet I had taken her to could not be
helpful unless I was prepared to spend
$485.00 but he stated (no gaurantees) and
really avoided answering any basic questions
which I found unsettling.
Expert:  NancyH replied 11 years ago.
Ibuprofen is toxic to dogs as is Tylenol.
I would cease using Ibuprofen in your pet and hope that no liver damage has been done and no ulcers formed in the gastric system.
Please notify your vet that your dog has had Ibuprofen too as that may factor into problems the vet is seeing.
Customer: replied 11 years ago.
Reply to Nancy Holmes's Post: thanks, XXXXX XXXXX definitely usable information,
I'm a little surprised someone didn't let me
know this tidbit earlier in my correspondence.
I've only been giving it to her for about two
weeks. Is There another substitute you would
recommend? Thank you again, sincerely
michael singer
Expert:  NancyH replied 11 years ago.
I would not give her anything until a check on bloodwork was done to see if any major organs were compromised or if she had internal bleeding.
You might want to get her to an orthopedic veterinarian if your vet is not giving you any assistance.
Metacam, Deramaxx are two meds from the vet that do good pain relief but are not safe to use unless the liver is in good shape.
This could be referred pain from a neck injury, it could be that a couple weeks of using the elbow due to the pain reliever has now changed things so an x-ray will show damage etc. I'd get her into a specialist vet and see what is found.
Customer: replied 11 years ago.
Reply to Nancy Holmes's Post: thanks for the feedback.
Expert:  NancyH replied 11 years ago.
You are in AZ - one other thing to consider is Valley Fever - even though it mostly shows in lung issues it can show as lameness.
here is a page on that problem
http://www.vfce.arizona.edu/ValleyFever/canine/canine.htm
Customer: replied 11 years ago.
Reply to Nancy Holmes's Post: thanks very much.
Expert:  NancyH replied 11 years ago.
You are welcome - I know how distressing it is to have a pet that has something wrong and the vet can't figure it out until more symptoms show up!
I think I mentioned before you can accept any helpful answer.
Customer: replied 11 years ago.
Reply to Nancy Holmes's Post: I'm still waiting for more detailed answers to
my previous questions, many questions I
asked still have not been answered. I don't
know why, whenever my clients ask me
anything I give them detailed answers at no
charge whatsoever because I'm a firm
believer in common courtesy. should I recieve
accurate answers to my previously posted
questions I would then have the specific
information I've been seeking. should people
find my questions unanswerable a simple (I
don't know )would be helpful as well. thank
you. sincerely, XXXXX XXXXX
Expert:  NancyH replied 11 years ago.
I for one ignored the questions I felt had nothing to do with the problem.
For example a luxating patella has nothing to do with an elbow problem.
Your vet already ruled out many of the problems other specialists mentioned and you are asking about by reviewing x-rays.
I think you have had a great deal of very polite response to your question. The next step is yours to get your dog appropriate care.
Expert:  Tammy F. replied 11 years ago.
What other specific questions do you have? I am sure that someone can help you to understand fully what's going on.
Customer: replied 11 years ago.
Reply to Nancy Holmes's Post: everyone has been very polite, I already knew
the first response was incorrect because my
question stated right front elbow. have a good
day.
Customer: replied 11 years ago.
Reply to Tammy Falkner's Post: The questions I posted require direct answers
for my own personal knowledge and research.
If the questions I'm asking based on the
responses are inappropriate then I am very
sorry. I thought my course of action in seeking
accurate knowledge was appropriate. Thank
you for your time, care&concern. sincerely,
michael singer

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