B. Van Ryssen

Arthroscopic findings in 100 dogs with elbow lameness

Elbow arthroscopy was perfonned in 100 dogs with foreleg lameness localised to the elbow joint, bilaterally in 48 of them, making a total of 148 joints examined. Lesions in the area of the medial coronoid process varied from cartilage fissures in 13 to fragmentation in 91, and chondromalacia-like lesions in 27. This last lesion has not been reported previously in the veterinary literature. Kissing lesions on the medial side of the humeral condyle were present in 83 joints, whereas lesions of osteochondritis dissecans were found in only three. All these lesions were associated with varying signs of synovitis and arthrosis. Arthroscopic signs of arthrosis and/or synovitis without associated medial coronoid lesions were found in 14 elbow joints.

Diagnosis of cranial cruciate ligament injury in dogs by tibial compression radiography

Stress radiographs were taken of 42 sound stifle joints, of five stifles with injuries other than cruciate disease, and of 72 stifles with surgically confirmed cranial cruciate damage. The stifles were also examined by the cranial drawer test. No false positive compression radiographs were obtained. In the 72 stifles with cranial cruciate damage, instability was diagnosed on the stressed view in all but two cases. The sensitivity of the radiographic tibial compression test was 97 per cent, compared with 86 per cent for the cranial drawer test; the specificities of the tests were 100 per cent and nearly 98 per cent, respectively.

Medial humeral epicondylar lesions in the canine elbow: a review of the literature

A calcified fragment near the medial epicondyle of the humerus was originally described as an ununited medial epicondyle in 1966. Since then several papers reported similar lesions as a cause of elbow lameness. The aetiology and clinical significance of those lesions is poorly known. This paper gives an overview of the veterinary and human literature in an attempt to explain the aetiology and to suggest a diagnostic protocol and treatment plan.

Radiographic, computed tomographic and arthroscopic findings in 23 dogs with osteochondrosis of the tarsocrural joint

Twenty-three dogs with osteochondrosis of the tarsocrural joint were evaluated by radiography, computed tomography (Cr) and arthroscopy. The radiographic examination included an extended and flexed mediolateral, a plantarodorsal, a flexed dorsoplantar skyline view, and a plantaromedial-dorsolateral and a plantarolateral-dorsomedial view (two oblique views). The cT examination was carried out in ventral recumbency and 1 mm slices were taken with a bone window setting; 31 lesions were identified in the 46 joints examined. The arthroscopic exploration used either a plantar or a dorsal puncture, depending on the site of the lesion. In six cases the lateral, and in 17 cases the medial trochlear ridge was involved. Although the survey radiographs were sufficient to make a diagnosis, the cT examination helped to determine the exact site, and the number and size of the fragments of bone. A four-stage classification system comparable to the one used in man was established. Arthroscopy provided information about synovial inflammation and damage to the joint cartilage, and made it possible to remove fragments of bone from one-third of the cases.

Radiographic findings of the medial humeral epicondyle in 200 canine elbow joints

OBJECTIVES To determine the frequency and radiographic aspect of medial humeral epicondylar lesions as a primary or concomitant finding and to evaluate the association with osteoarthritis. METHODS Medical records of dogs diagnosed with elbow lameness were reviewed. Inclusion criteria for this study were a complete clinical examination, a complete set of digital radiographs and a final diagnosis made by computed tomography or magnetic resonance imaging and arthroscopy. Changes of the medial humeral epicondyle were recorded and correlated with the radiographic osteoarthritis and final diagnosis. RESULTS Eighty of the 200 elbows showed changes of the medial humeral epicondyle. In 12 of these 80 elbows, changes of the medial epicondyle were the only findings within the joint, and these elbows were diagnosed with primary flexor enthesopathy. In the remaining 68 elbows, other concomitant elbow pathologies were found. In those cases of concomitant epicondylar changes, high grades of osteoarthritis were recorded, while most elbows with primary flexor enthesopathy showed a low grade of osteoarthritis. CLINICAL SIGNIFICANCE Changes of the medial humeral epicondyle are often considered clinically unimportant and are regarded as an expression of osteoarthritis. This study showed the relatively frequent presence of epicondylar changes of which the majority were considered concomitant to a primary elbow problem. If changes of the medial humeral epicondyle are the only pathologic finding (primary flexor enthesopathy) they should be considered as the cause of lameness and not as a sign of osteoarthritis.

Thoracoscopic anatomy of dogs positioned in lateral recumbency.

In four healthy, adult male German shepherd dogs, thoracoscopy was performed to provide a detailed description and illustration of the endoscopic anatomy of the normal intrathoracic structures of dogs. The dogs were anesthetized and placed in left or right lateral recumbency. The cannula and the endoscope were advanced into the thoracic cavity via entry of the free upper side in the dorsal third of the eighth intercostal space. Most intrathoracic structures of the left and right hemithorax were endoscopically visible. During the four thoracoscopic procedures, endoscopic photographs were taken and are illustrated in this paper. A sound knowledge of the anatomy of intrathoracic structures is a prerequisite for diagnostic and therapeutic thoracoscopy.

Primary flexor enthesopathy of the canine elbow: imaging and arthroscopic findings in eight dogs with discrete radiographic changes

OBJECTIVE To describe the radiographic, ultrasonographic, computed tomography (CT), magnetic resonance imaging (MRI), and arthroscopic findings in eight dogs with elbow lameness caused by primary flexor enthesopathy. STUDY DESIGN Clinical study. ANIMALS Eight client-owned dogs. METHODS In all dogs, lameness was localized to the elbow by clinical examination. Radiographic examination, ultrasound, CT and MRI were performed prior to arthroscopy. In seven dogs, surgical treatment and subsequent histopathology were performed. RESULTS Primary enthesopathy of the medial epicondyle was diagnosed in eight dogs (13 joints) by combining the minimal radiographic changes with specific ultrasonographic, CT, MRI and arthroscopic findings at the medial epicondyle. In all joints, any other pathology could be excluded. Histopathology of the affected tissue revealed degeneration and metaplasia in the flexor muscles. CONCLUSIONS Primary flexor enthesopathy at the medial epicondyle is an unrecognized condition and is a possible cause of elbow lameness in the dog. Diagnosis is based on specific imaging and arthroscopic findings. CLINICAL RELEVANCE The most important cause of elbow lameness in dogs is medial coronoid disease. Often this condition presents with minimal radiographic and arthroscopic changes. In these cases, primary enthesopathy of the medial epicondyle should be considered as a differential diagnosis, in order to make the correct treatment decision.

A review of the human and veterinary literature on local anaesthetics and their intra-articular use. Relevant information for lameness diagnosis in the dog.

Lameness in dogs is often a diagnostic challenge. In many cases it is difficult to determine the exact localisation of lameness because of the absence of palpable changes, or because of unreliable pain response due to high pain tolerance, stress or aggression of the dog. In horses and humans, intra-articular administration of local anaesthetics is commonly used for diagnostic purposes. In this review, information from human and veterinary studies on different local anaesthetic agents and their application for diagnostic intra-articular anaesthesia is given. Based on this information, a protocol for diagnostic intra-articular anaesthesia in the dog can be developed and evaluated in future studies.

Erosion of the medial compartment of the canine elbow: occurrence, diagnosis and currently available treatment options

Erosion of the medial compartment of the elbow joint refers to full thickness cartilage loss with exposure of the subchondral bone (modified Outerbridge grades 4-5) of the medial part of the humeral condyle (MHC) and the corresponding ulnar contact area. This finding may appear in the absence of an osteochondral fragment or a cartilage flap, or in combination with fragmentation of the medial coronoid process (MCP) or osteochondritis dissecans (OCD) of the MHC. With regard to the prognosis, it is important to diagnose these severe erosions. Imaging of cartilage lesions by means of radiography, ultrasonography, computed tomography or magnetic resonance imaging is challenging in dogs. In contrast, direct arthroscopic inspection provides detailed information about the cartilage. The treatment of these severe erosions is difficult because of the limited regenerative capacity of cartilage and presumed mechanical or physical triggering factors. Several conservative and surgical treatment methods have been proposed to treat elbows with severe cartilage defects. However, due to irreversible loss of cartilage, the prognosis in these cases remains guarded.

Primary and concomitant flexor enthesopathy of the canine elbow

OBJECTIVES To report the characteristics of two types of flexor enthesopathy, primary and concomitant, based on different diagnostic techniques. MATERIALS AND METHODS Over a period of three years a prospective study was performed on dogs admitted for the complaint of elbow lameness. Based on the radiographic findings a selection of dogs underwent a complete series of different imaging modalities. With each technique, pathology of the medial epicondyle and the presence of other elbow disorders were recorded. All joints with signs of flexor pathology apparent with at least three techniques were selected. A distinction was made between primary and concomitant flexor enthesopathy based on the absence or presence of other elbow disorders. RESULTS Primary flexor enthesopathy was diagnosed in 23 joints and concomitant flexor enthesopathy in 20 joints. In 43% of the joints with primary and in 75% of the joints with concomitant flexor enthesopathy, pathology at the medial epicondyle was demonstrated by all techniques. All joints with concomitant flexor enthesopathy had a diagnosis of medial coronoid disease, osteochondritis dissecans, or both. CLINICAL SIGNIFICANCE Pathology at the medial epicondyle is a sign of flexor enthesopathy. It may be present as the only sign in a joint with primary flexor enthesopathy or concomitant with other elbow pathology. In both groups flexor lesions can be demonstrated with different imaging techniques. The distinction between the primary and concomitant form is based on the presence or absence of other elbow pathology, mainly medial coronoid disease. Recognizing both types is important for a correct treatment decision.