Hi Laurie,
Hope you had a great Christmas with a bit of time off for yourself and family.
Query about elbows.... to be perfectly honest I feel like I avoided this joint for the past few years and all of a sudden I had three today... puppy, old dog with now bad OA and one going for surgery next week.
Questions:
- 8 month old Berner with suspected FCP (rads done, recommended CT but owners are not going to go do it). I've tried to look this up on the forum - is the main way of thinking still wait until he's grown to consider surgery? And in your experience what's the best thing that can be done for these guys?
- Re: surgery: 2 year old lab and having both done in Calgary next week, I have your protocol from fourleg, any updates to that in the past few years? I haven't seen post-surgical elbows before....
Joanna
Elbows
Re: Elbows
Hey Joanna,
Okay, so as for the elbows. (Nobody likes elbows!) Limping young dog with FCP… might as well do surgery. There will be OA inevitably and potentially a limp forever. The thought is that the limp won’t be due to pain if they remove the fragmented coronoid, but rather biomechanical, until OA sets in. If you wait for OA, then there is no point in doing surgery - so they say.
Post-op. Nothing new to add. As mentioned above, likely good to brief the owner that the dog may have a perpetual limp - mechanical versus pain. That OA will set in. Get the dog on joint supplements asap and do so aggressively now. Don’t wait.
Happy Sunday!
Cheers,
Laurie
Okay, so as for the elbows. (Nobody likes elbows!) Limping young dog with FCP… might as well do surgery. There will be OA inevitably and potentially a limp forever. The thought is that the limp won’t be due to pain if they remove the fragmented coronoid, but rather biomechanical, until OA sets in. If you wait for OA, then there is no point in doing surgery - so they say.
Post-op. Nothing new to add. As mentioned above, likely good to brief the owner that the dog may have a perpetual limp - mechanical versus pain. That OA will set in. Get the dog on joint supplements asap and do so aggressively now. Don’t wait.
Happy Sunday!
Cheers,
Laurie
LAURIE EDGE-HUGHES
Re: Elbows
With the pup I thought on the forum there was the discussion about waiting until he’s done growing? Don’t want to do them a disservice waiting if it’s best to do it now. They are waiting till 18 months to neuter him. We are limiting activity for a month and I have them massage and gentle loading, he’s tight into shoulder extension so got them working on that. They live in out of town so I can only follow up monthly....
J
J
Re: Elbows
Okay, so puppies is a crap shoot. Yes, if things are not too far gone and the coronoid process is only cracked, then they might grow out of it as their body heals and or any bone growth discrepancies between the radius and ulna catch up. You’re not crazy. I am. Yes, I’ve said that in the past! I just forgot!
So, it all boils down to ‘there is no ‘one’ answer!’
Carry on with your plan and see how the dog is next month. If reduced activity didn’t reduce the lameness, then you reconsider the plan you’re on.
Thank you for reminding me of this.
Laurie
So, it all boils down to ‘there is no ‘one’ answer!’
Carry on with your plan and see how the dog is next month. If reduced activity didn’t reduce the lameness, then you reconsider the plan you’re on.
Thank you for reminding me of this.
Laurie
LAURIE EDGE-HUGHES
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David Lane
- Posts: 164
- Joined: Mon Oct 24, 2016 10:51 pm
Re: Elbows
It's unfortunate that the owners declined CT, as that will hedge your bets with determining who should or should not proceed to surgery. Also, if a dog is lame enough to merit surgery, there is no advantage in waiting, as that will likely only result in worsening OA that reduces the post surgical Px.
FWIW, the following is the summary of guidelines that I use when determining which cases to refer for scoping:
Inclusion criterion (generally) for surgical candidates:
· Typically younger dogs, but any dog with minimal arthritic changes in the elbow
· Demonstrable lameness that is limiting quality of life, and has proven to be poorly responsive to NSAIDs and rest.
· Supportive CT findings (displaced fragment, fissure, effusion, etc.)
· Pain localizable to the elbow joint
Owners need to know:
· Clinical response to surgery is not guaranteed
· Progressive OA is inevitable even with surgery
· In my mind, a successful case is to have improvement or resolution of the existing lameness for several years, before OA rears its head producing lameness again
· Lifestyle changes, including exercise modification, will be needed even with surgery
FWIW, the following is the summary of guidelines that I use when determining which cases to refer for scoping:
Inclusion criterion (generally) for surgical candidates:
· Typically younger dogs, but any dog with minimal arthritic changes in the elbow
· Demonstrable lameness that is limiting quality of life, and has proven to be poorly responsive to NSAIDs and rest.
· Supportive CT findings (displaced fragment, fissure, effusion, etc.)
· Pain localizable to the elbow joint
Owners need to know:
· Clinical response to surgery is not guaranteed
· Progressive OA is inevitable even with surgery
· In my mind, a successful case is to have improvement or resolution of the existing lameness for several years, before OA rears its head producing lameness again
· Lifestyle changes, including exercise modification, will be needed even with surgery
David Lane DVM
ACVSMR, CVA, CVSMT, CCRP
ACVSMR, CVA, CVSMT, CCRP
Re: Elbows
Thank you for your reply David, I will be following up with these owner in a few weeks just to see how the dog is doing. The CT is definitely a financial concern for them. I'll be able to see how he responded to NSAIDs and activity modification over the past 6 weeks since I saw him last and provide an update.