Yves Samoy

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.

Computed tomography findings in 32 joints affected with severe elbow incongruity and fragmented medial coronoid process.

OBJECTIVE To describe the computed tomography (CT) findings in dogs with severe elbow incongruity combined with a fragmented medial coronoid process (FCP) and compare these with normal joints and congruent joints affected by FCP. STUDY DESIGN Clinical study. ANIMALS Client-owned dogs with elbow lameness (n = 40) and purpose bred dogs (n = 5; controls). METHODS The CT features of 32 severely incongruent joints with concomitant FCP were compared with those of 32 congruent elbow joints affected with FCP and 10 normal joints. RESULTS In severely incongruent elbow joints, a radioulnar step and widened joint spaces were visible on each CT plane. Additional features typically seen in severely incongruent elbows were a cyst at the radioulnar transition and fragmentation of the axial border of the medial coronoid incisure. None of these features appeared in normal or in congruent FCP joints. CONCLUSION On CT, several features associated with severe elbow incongruity and concomitant FCP were detected, which were not found in normal joints or congruent joints affected by FCP.Objective To describe the computed tomography (CT) findings in dogs with severe elbow incongruity combined with a fragmented medial coronoid process (FCP) and compare these with normal joints and congruent joints affected by FCP. Study Design Clinical study. Animals Client-owned dogs with elbow lameness (n = 40) and purpose bred dogs (n = 5; controls). Methods The CT features of 32 severely incongruent joints with concomitant FCP were compared with those of 32 congruent elbow joints affected with FCP and 10 normal joints. Results In severely incongruent elbow joints, a radioulnar step and widened joint spaces were visible on each CT plane. Additional features typically seen in severely incongruent elbows were a cyst at the radioulnar transition and fragmentation of the axial border of the medial coronoid incisure. None of these features appeared in normal or in congruent FCP joints. Conclusion On CT, several features associated with severe elbow incongruity and concomitant FCP were detected, which were not found in normal joints or congruent joints affected by FCP.

Arthroscopic findings in 32 joints affected by severe elbow incongruity with concomitant fragmented medial coronoid process.

Objective To report arthroscopic findings in dogs with severe elbow incongruity combined with fragmented medial coronoid process (FCP) and compare these findings in normal joints and congruent joints affected by FCP. Study design Clinical study. Animals Dogs with elbow lameness (n = 40) and purpose bred dogs (5; controls). Materials and Methods Arthroscopic features of 32 severely incongruent joints with concomitant FCP were compared with 32 congruent elbow joints affected with FCP and 10 normal joints. A radioulnar step of ≥3 mm on radiographs and computed tomography (CT) scans was the selection criterion for a severely incongruent joint. Intraarticular structures were visually assessed at various sites within the joint. Regions of interest were: the radioulnar transition, humeroradial and humeroulnar joint space, trochlear notch, primary and secondary lesions of the medial coronoid process, and radial head. Results Incongruent joints had a radioulnar step and changes at the cartilage in the center of the trochlear notch, an irregular radioulnar transition, and an abnormal surface of the radial head. Coronoid pathology was present in every pathologic joint. Conclusion Arthroscopy allowed detection of several features that were signs or consequences of severe elbow incongruity or accompanying inflammation. After a prominent radioulnar step, cartilage changes involving the radial head and trochlear notch were most frequently seen.OBJECTIVE To report arthroscopic findings in dogs with severe elbow incongruity combined with fragmented medial coronoid process (FCP) and compare these findings in normal joints and congruent joints affected by FCP. STUDY DESIGN Clinical study. ANIMALS Dogs with elbow lameness (n = 40) and purpose bred dogs (5; controls). MATERIALS AND METHODS Arthroscopic features of 32 severely incongruent joints with concomitant FCP were compared with 32 congruent elbow joints affected with FCP and 10 normal joints. A radioulnar step of ≥ 3 mm on radiographs and computed tomography (CT) scans was the selection criterion for a severely incongruent joint. Intraarticular structures were visually assessed at various sites within the joint. Regions of interest were: the radioulnar transition, humeroradial and humeroulnar joint space, trochlear notch, primary and secondary lesions of the medial coronoid process, and radial head. RESULTS Incongruent joints had a radioulnar step and changes at the cartilage in the center of the trochlear notch, an irregular radioulnar transition, and an abnormal surface of the radial head. Coronoid pathology was present in every pathologic joint. CONCLUSION Arthroscopy allowed detection of several features that were signs or consequences of severe elbow incongruity or accompanying inflammation. After a prominent radioulnar step, cartilage changes involving the radial head and trochlear notch were most frequently seen.

TTA Rapid: Description of the Technique and Short Term Clinical Trial Results of the First 50 Cases

OBJECTIVE To (1) describe a modified technique for tibial tuberosity advancement (TTA) in dogs with cranial cruciate ligament (CCL) rupture and (2) report short term outcome and complications. STUDY DESIGN Prospective clinical study. ANIMALS Dogs with unilateral CCL rupture (n = 50). METHODS TTA was performed with a novel implant to achieve advancement of the tibial crest. The technical protocol, specific implants and instrumentation, and the short term outcome are described. RESULTS Various breeds (mean ± SD weight, 31.9 ± 13.3 kg) were included. Mean age at treatment was 64 ± 30.6 months. Minor complications occurred in 30% and major complications in 4% of the cases. Forty-eight (96%) dogs had a good to excellent outcome 3 months after surgery. CONCLUSION The modified technique is a viable alternative to other osteotomy techniques.

Recognition of anatomical predilection sites in canine elbow pathology on bone scans using micro-single photon emission tomography.

The limited resolution of planar bone scintigraphy precludes exact anatomical localisation within a joint. Micro-single photon emission tomography (μ-SPECT) has a much higher resolution, and in this study the use of μ-SPECT in the evaluation of the canine elbow joint and fusion with structural imaging data were tested. Twelve elbows of seven normal dogs were included. μ-SPECT was performed with a conventional triple head gamma camera adapted with three multi-pinhole collimators (HiSPECT). Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) were performed on all elbows and data from CT and MRI were fused to the HiSPECT data using dedicated software. Different important anatomical regions could be recognised on the HiSPECT images. The improved resolution of the HiSPECT system allowed better differentiation of the anatomical areas in the elbow joint. Two case studies were included to demonstrate the potential of this methodology. Fusion software facilitated the use of combined structural and functional information.

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.

SENSITIVITY AND SPECIFICITY OF RADIOGRAPHY FOR DETECTION OF ELBOW INCONGRUITY IN CLINICAL PATIENTS

Elbow incongruity is an important factor regarding the treatment and prognosis of elbow dysplasia. Our purpose was to determine the sensitivity and specificity for radiographic detection of elbow incongruity in clinical patients, to establish inter- and intraobserver variation for different parameters, and to evaluate the possibility of radiographic grading of incongruity. Standard radiographic projections were acquired from 29 incongruent and nine congruent elbows of dogs of various ages and breeds. Computed tomography (CT) was used to diagnose and grade the incongruity. All radiographs were evaluated by four observers for detection and grading of elbow incongruity. Sensitivity, specificity, inter- and intraobserver variability were calculated. The mean sensitivity for detection of incongruity was very good (88.8%) with a mean specificity of 91.7%. Correct grading of incongruity was difficult. The radioulnar step and the widening of the humeroulnar and humeroradial joint space were seen most frequently. Intraobserver and interobserver variability were fair to excellent (Kappa = 0.372-0.809), depending on the investigated parameters. Radiography is valuable to screen for elbow incongruity. In over 91% of the patients, a clear distinction could be made between a congruent and an incongruent joint grading was not possible.

Arthroscopic treatment of fragmented coronoid process with severe elbow incongruity. Long-term follow-up in eight Bernese Mountain Dogs.

The purpose of this study was to investigate the long-term treatment results of fragmented coronoid process (FCP) in joints with a radio-ulnar step greater than 3 mm. Treatment of these patients only consisted of fragment removal, without correction of the incongruity. The eight Bernese Mountain Dogs (11 joints) included in this study showed obvious clinical signs of elbow disease and were diagnosed with severe elbow incongruity and concomitant FCP in the time period from 1999-2003. At that time, elbow radiography, computed tomography, and arthroscopy were performed. The mean follow-up period was 5.6 years. The follow-up consisted of a telephone questionnaire combined with a clinical and radiographic re-evaluation at our clinic. The questionnaire revealed that all dogs were either free of lameness or only lame following heavy exercise. One dog sporadically required medication after heavy exercise. The owner satisfaction rate was 100%. The clinical re-evaluation did not reveal any signs of pain or lameness in all cases. Range-of- motion was decreased in nine of the 11 elbows. Radiographs revealed an increase in severity of osteoarthritis in every case.In this case series, arthroscopic fragment removal without treatment of incongruity was demonstrated to be a valuable treatment option and may provide a satisfactory long-term outcome.

Single-phase bone scintigraphy in dogs with obscure lameness

OBJECTIVES To evaluate the diagnostic merits of scintigraphy in dogs with clinically obscure lameness origin. METHODS In 43 dogs, the scintigraphic findings were compared with the results of subsequent radiological, computed tomography and/or arthroscopic findings and/or additional neurological examination. RESULTS In all dogs, focal increased uptake was found in one or more joints or bones. The presence of associated pathology was confirmed by radiography, computed tomography and/or arthroscopy of the limb region of interest. Additional neurological examination was performed when indicated. In cases of elbow pathology, unilateral involvement of the elbow was confirmed with computed tomography/arthroscopy in 14 cases, while bilateral increased uptake could not be confirmed with radiography or computed tomography in three cases. Three dogs showed an increased activity in one joint on the bone scan, while computed tomography, arthroscopy or radiography revealed bilateral joint disease. Generalised mild increased radionuclide uptake in all joints and bones was observed in the lame limb in 15 forelimbs and five hindlimbs. Generalised prominent uptake of an entire limb was noted in three cases suffering from neurological disease. CLINICAL SIGNIFICANCE Scintigraphy may provide information on areas of increased radionuclide uptake, thereby aiding in the localisation of obscure lameness. Generalised mild increased uptake of radionuclide in all joints and bones in the lame limb may occur in the older dog. The generalised prominent uptake, seen in three cases with neurological disease, may resemble reflex sympathetic dystrophy syndrome seen in human beings.

Diagnostic intra-articular anaesthesia of the elbow in dogs with medial coronoid disease

OBJECTIVE Assessment of the effect of intra-articular anaesthesia on lameness caused by medial coronoid disease. METHODS This study included 90 dogs that were evaluated for the complaint of unilateral forelimb lameness. All dogs were suspected of having an elbow problem for which orthopaedic examination and radiographs showed inconclusive findings. Following a short sedation, mepivacaine was injected intra-articularly to determine whether lameness was caused by a suspected elbow problem. This effect was compared with the final diagnosis based on computed tomography and arthroscopy. RESULTS Out of 90 dogs, 78 (87%) dogs had an improvement of lameness after injection of the local anaesthetic, which confirmed the elbow joint as the primary source of lameness. A positive response was seen in all types of medial coronoid lesions. A false negative result was observed in 12 dogs (13%). CLINICAL RELEVANCE Medial coronoid disease is represented by different types of pathologic lesions including chondromalacia, fissures, fragments, and medial compartment disease. Diagnosis may be difficult because of limited clinical or radiographic signs or a combination of both. Intra-articular anaesthesia can be a helpful diagnostic tool to localize the problem by eliminating pain and reducing lameness to a great extent in all types of coronoid lesions.