||What is Elbow dysplasia? How can my dog get it? How does a vet diagnose the problem and what are the recommended treatment options? Watch this video to find the answers so that you can make an educated decision for your pet's health.
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- Elbow dysplasia can cause lameness in young large-breed dogs and is commonly found in both elbows.
- Elbow dysplasia is a generic term meaning arthritis in the elbow joint.
- There are four developmental causes of elbow arthritis in dogs:
- osteochondritis dessicans, ununited anconeal process, fragmented coronoid process, and elbow incongruency.
- The photo below of a dog's elbow shows the three bones that make up the joint: radius, ulna and humerus. The humerus bone has been separated from the radius and the ulna bone in this photo to reveal the three problems within the joint. The red painted regions on the specimen denote the location of osteochondritis dessicans of the lower part of the humerus bone (labeled OCD), fragmented coronoid process (labeled FCP) and an ununited anconeal process (UAP).
- Osteochondritis dissecans (OCD)
- OCD is a condition in which a piece of cartilage becomes partially or fully detached from the surface of the elbow joint. This results in inflammation of the lining of the joint and pain. Below in this photo an intraoperative open approach shows the OCD flap (labeled OCD); with the advent of arthroscopic surgery in our practice, we rarely do an open approach to remove the OCD flaps in dogs.
- Fragmented medial coronoid process
- Fragmented medial coronoid process is a condition in which a small piece of bone on the inner side of the joint has broken off of the ulna bone. This piece of bone irritates the lining of the joint and grinds off the cartilage of the adjacent humerus (similar to having a pebble in your shoe). In the photo below is a large fragmented coronoid process (labeled FCP) as seen at the time of arthroscopy.
- Ununited anconeal process
- Ununited anconeal process is a condition in which a fragment of bone on the back side of the joint has failed to unite with the ulna bone during growth. Normally this bony process fuses with the ulna bone by 20 weeks of age. The breeds most commonly affected include German Shepherds, Bassets, Mastiffs, and St. Bernards. In the photo below the ununited anconeal process (labeled UAP) is clearly visible on the radiograph; the black line (labeled L) in the bone is the cardinal sign that an UAP is present.
- In the photo below, a large ununited anconeal process from the from the dog whose radiograph is just above
- Elbow incongruency
- Elbow incongruency is a condition in which the joint does not have perfect conformation, and the cartilage of the joint wears out rapidly. In simple terms the joint does not fit together well and the final result is progressive arthritis.
- X-rays of the elbow joint will allow us to make a diagnosis of ununited anconeal process and sometimes OCD and fragmented coronoid process.
- CT scan is more accurate at arriving at a definitive diagnosis than plain x-rays, but has a 15% margin of error.
- If we have an index of suspicion of a fragmented coronoid or OCD we usually recommend diagnostic arthroscopy as it is minimally invasive and these conditions can be then treated at the same time.
- Arthroscopic surgery is used to treat OCD and fragmented coronoid processes. This technique allows us to treat the lesions more accurately and allows us to examine more of the joint. Because it is minimally invasive, the patients recover much quicker and have less pain.
- Usually we can successfully remove the offending loose pieces from the joint using arthroscopic surgery, however if we are unsuccessful, a small incision is made on the inner side of the elbow. If your pet has an ununited anconeal process, arthroscopy of the joint is recommended to rule out a concurrent fragmented coronoid. Because an ununited anconeal process is fairly large, it is removed via a small incision made on the outer (lateral) side of the elbow joint.
- If arthroscopic surgery is done, most pets will be using the limb on the day of surgery.
- By 2 weeks after surgery the lameness is mild.
- By 2 to 3 months after surgery, your pet should be using the limb well.
- Recovery can be somewhat variable from one pet to another.
- Most of the dogs with ununited anconeal process will be helped with surgery (about 60% return to normal function, 30% are improved, and 10% do not improve with surgery).
- Approximately 75% of the dogs with having a fragmented coronoid process or OCD of the elbow will be helped with surgery. Unfortunately, surgery will not remove the arthritis that is already present in the joint. As a result, some pets may have some stiffness of the limb or lameness after very heavy exercise or during weather changes (cool damp conditions).
- Dogs that have dramatically swollen elbows prior to surgery tend to be have a lower success rate.
- Anesthetic death is an uncommon complication.
- One complication is infection of the surgical site, but this complication is uncommon.
- Unresolved lameness may be due to elbow arthritis.
- Monitor the stab incisions for signs of infection, which include signs of swelling, redness, pain, yellow or green discharge.
- During the first 6 to 8 weeks after surgery, activity is restricted to short leash walks outside. Running, jumping, and rough play are forbidden.
- After 8 weeks of rest, the activity can be gradually increased over the next two months.
Frequently Asked Questions After Surgery
When should my dog have the first bowel movement after surgery?
- Many dogs will not have a bowel movement for the first 4 to 5 days after surgery
- Reasons that a dog will not have regular bowel movements after surgery include:
- The dog has been fasted prior to surgery
- Dogs do not eat well during the hospital stay
- They frequently do not eat well when they go home
- They are fed highly digestible food that produces little stool
- Pain medication that contain narcotics (such as morphine, fentanyl patches, and tramadol) can be constipating
- If a pet does not have a bowel movement on the 5th day of being home, a stool softener such as metamucil can be fed
- Dose of metamucil is 1 tsp per 25 Kg mixed in with each meal (canned dog food); feed immediately after mixing, as the metamucil will gel the food and may make it less palatable
My pet had surgery and will not eat. What can be done?
- Most pets will not eat their regular dog food after surgery, especially if it is kibble.
- Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source. The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low in fat and should be cooked (drain off all fat after the meat has been cooked). The carbohydrate can be pasta, potato or white rice.
- Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth (Chicken-in-a- MugTM or Beef-in-a-MugTM products)
- Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal
- Try Hill's A/D diet available at most veterinary hospitals
- Hand feeding: place a small amount of food in the mouth so that your dog gets the flavor
- Warm the food slightly in a microwave, as the food will be more aromatic; stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
- Remember that most pets will not eat the first day or two after they get home from surgery
- Offer smelly foods that contain fish such as tuna or smelly cat foods
- Try Gerber strained meats for babies such as the chicken, beef, turkey or veal
- Hand feeding: with your finger place a small amount of food on the roof of your cat's mouth; use a syringe to get soft food into the mouth
- Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature; it should be only luke-warm
- Some cats will only eat dry food, try kibble if your cat normally has been fed that food
- Petting and stroking your cat frequently will help to stimulate appetite
- Remember that most pets will not eat the first day or two after they get home from surgery
- Appetite stimulants such as cyproheptadine may be helpful
- If your cat refuses to eat anything for 7 days a stomach tube or nasogastric tube should be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop
My pet is vomiting. What can be done?
- The first thing for you to discern is whether your pet is vomiting or regurgitating. Both will result in fluid or food being brought up. Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus. Regurgitation is not associated with heaving and the pet usually just opens the mouth and fluid or food will be expelled. Usually the regurgited material will be clear or brown colored fluid.
- Next is to identify the cause of the vomiting or regurgitation.
- Causes and treatment of vomiting after surgery
- When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be the case, the water should be limited to frequent smaller amounts.
- Medications such as antibiotics, narcotics or nonsteroidal anti-inflammatory medication commonly cause vomiting after surgery. In order to see which medication is causing the problem, the administration of each drug should be separated 2 hours apart. Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to. The antibiotic in some cases may be changed to a different one, or may be discontinued.
- Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days.
- An uncommon cause of vomiting after surgery is internal organ failure. Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
- If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present. Do not ignore this sign.
- Symptomatic treatment of vomiting involves withholding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then gradually wean him/her back onto the regular diet after 3 days. In order to decrease the acidity of the stomach, Pepcid AC 0.5 mg/kg can be given by mouth twice daily for 5 days. Metoclopramide and Cerenia are good anti-vomiting medications for dogs and cats. You should always consult a veterinary healthcare professional before administering medication.
- Causes and treatment of regurgitation after surgery
- The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia. Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, called esophagitis. This results in poor motility of the esophagus, therefore water and food will accumulate in this structure. In most cases, esphagitis is self-eliminating and will resolve within two or three days.
- If the esophagitis is severe the esophagus may develop one or more strictures. A stricture is a narrowing or stenosis of the esophagus and does not allow passage of food down the esophagus, in regurgitation that lasts longer than one week. This problem should be brought to the attention of your pet's doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure, as it is done with the aide of an endoscope). If an esophageal stricture is chronic surgery is needed.
- Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent (sucralfate) and an acid blocker (omeprazole or other). Consult a veterinary health care professional if the regurgitation continues for more than a couple of days.
How do I know that my dog is in pain following surgery?
- Signs of pain include
- biting if you get near the surgical site
- grimacing (lips are pulled back and the the dog looks anxious)
- tragic facial expression
- restlessness and unable to sleep; pacing
- if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
- the worst pain will be for the first 2 to 3 days after surgery
What can I do to control my dog's pain?
- Narcotic medications that control pain: tramadol, butorphanol, Duragesic (fentanyl patch)
- Anti-inflammatories used to control pain: Deramaxx, Rimadyl, Previcox, or Etogesic
- If an orthopedic surgery has been done cold packing the surgical site may be helpful
- A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack. An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out. Cool the surgical site around the incision by rubbing the exposed ice directly on the skin in a circular pattern. Cooling the surgical site helps to numb the area.
How do I know that my cat is in pain following surgery?
- Pain is more difficult to assess in cats versus dogs, as signs can be more subtle and they usually do not vocalize when in pain
- Signs of pain in a cat include the following:
- biting if you get near the surgical site
- growling or deep cry
- not wanting to eat
- hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)
What can be done for pain at home for my cat?
- Pain medication such as buprenorphine or a Duragesic (fentanyl) patch
- Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver
- Anti-inflammatories can be used, but the dose is much less than dogs
Is it okay for my pet to lick the incision?
- If a dog licks the incision, the healing process may be delayed.
- Licking can remove stitches and cause the incision to open
- Licking can become a severe habit that is difficult to break
- Licking can cause infection as the mouth has many bacteria
- Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.
- To stop your pet from licking the following can be tried:
- Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
- Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
- A tee shirt can be used to cover an incision on the chest or front part of the abdomen; gather the waist of the shirt up over the dog's back and wrap an elastic band around this part of the shirt.
- A bandage or sock can be used to cover an incision on a limb; fasten the top of the sock to the dog's limb with tape.
- Bitter apple can be applied around the incision; many dogs will continue to lick after application of this topical
- Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
- Antipsychotic medication in some cases is needed