I am seeing a 7 year old Sheltie with worsening left front limping. It was a sudden onset a year ago after being at doggy day care. Initially it improved with rest and Metacam but recently it has
become persistent and no longer responds to meds.
X-rays are not the best quality but they appear to show only very mild degenerative changes around the left elbow and right shoulder.
Range of motion is full in both shoulders and the right elbow, but the left elbow flexion is restricted by pain at 90 degrees with the leg pronated. There is tenderness over the radial head.
She has responded very well to radial mobs and ultrasound (no limp for 2 days) and also to some light support from vet wrap. It feels ligamentous, and the owner is considering an orthopedic consult to get a clear diagnosis, but this may not happen for a while due to the weather here! In the meantime I am wondering if anyone could recommend a good off the shelf brace/support? Thanks,Lynn
Elbow pain
-
David Lane
- Posts: 164
- Joined: Mon Oct 24, 2016 10:51 pm
Re: Elbow pain
Hello,
I am not aware of any helpful elbow brace, and I would strongly suspect they would make the situation worse, especially if there are radiographic changes in the shoulder already - if the shoulder is already aggravated secondary to guarding from the elbow OA, then adding the weight of a brace is only going to make things worse (IMHO).
Remember too that severity of elbow radiographic signs do not correlate to severity of lameness (the same is true for the coxofemoral joints, stifles, and spine). eg: I have a case recently where I was the 3rd or 4th opinion in which the original vets thought it was elbow origin pain, but the rads were reviewed by an ACVR and deemed normal, so they decided it was something else but couldn't figure out where... sent the dog for CT and sure enough, bilateral FMCP and lots of effusion. In short, trust your physical exam findings more than the rads for determining how sore those elbows are.
CT would yield additional detail about the nature of the OA, but cases with such advanced degenerative changes are rarely surgical, especially if the limp is not severe or responds to non-surgical interventions, so I would focus on treatment first and consider a CT after if you don't see results. If there is evidence of shoulder pain however, I would be quicker to ultrasound that in order to find out how to tailor treatment.
I am not aware of any helpful elbow brace, and I would strongly suspect they would make the situation worse, especially if there are radiographic changes in the shoulder already - if the shoulder is already aggravated secondary to guarding from the elbow OA, then adding the weight of a brace is only going to make things worse (IMHO).
Remember too that severity of elbow radiographic signs do not correlate to severity of lameness (the same is true for the coxofemoral joints, stifles, and spine). eg: I have a case recently where I was the 3rd or 4th opinion in which the original vets thought it was elbow origin pain, but the rads were reviewed by an ACVR and deemed normal, so they decided it was something else but couldn't figure out where... sent the dog for CT and sure enough, bilateral FMCP and lots of effusion. In short, trust your physical exam findings more than the rads for determining how sore those elbows are.
CT would yield additional detail about the nature of the OA, but cases with such advanced degenerative changes are rarely surgical, especially if the limp is not severe or responds to non-surgical interventions, so I would focus on treatment first and consider a CT after if you don't see results. If there is evidence of shoulder pain however, I would be quicker to ultrasound that in order to find out how to tailor treatment.
David Lane DVM
ACVSMR, CVA, CVSMT, CCRP
ACVSMR, CVA, CVSMT, CCRP
Re: Elbow pain
Thanks for the advice regarding the brace: we'll nix that for now.
Clinically, this dog shows no discomfort or restrictions in either shoulder or the other elbow (radiographs show very mild changes in the opposing shoulder), and her limp is significant and persistent. My feeling is soft tissue rather than joint, especially considering the good response to the mobs (which were mostly radial, and the ultrasound). I would love to see this dog on a regular basis but she lives in PG so not practical at this time of year.
The owner will be contacting me regarding her specialist appointment and what she has decided to do.
Thanks again for the input.
Lynn
Clinically, this dog shows no discomfort or restrictions in either shoulder or the other elbow (radiographs show very mild changes in the opposing shoulder), and her limp is significant and persistent. My feeling is soft tissue rather than joint, especially considering the good response to the mobs (which were mostly radial, and the ultrasound). I would love to see this dog on a regular basis but she lives in PG so not practical at this time of year.
The owner will be contacting me regarding her specialist appointment and what she has decided to do.
Thanks again for the input.
Lynn