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

Summary

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.

Keywords

Enthesopathy - epicondyle - dog - elbow - radiography

• References

• 1 Morgan JP, Wind A, Davidson AP. Elbow Dysplasia. In: Hereditary Bone and Joint Diseases in the Dog. Hanover: Manson Publishing Ltd; 2003. p. 41-94.
• 2 Ljunggren G, Cawley AJ, Archibald J. The elbow dysplasias in the dog. J Am Vet Med Assoc 1966; 148: 887-891.
• 3 Fox SM, Bloomberg MS, Bright RM. Developmental anomalies of the canine elbow. J Am Anim Hosp Assoc 1983; 19: 605-615.
• 4 Reichle JK, Snaps F. The elbow. Clin Tech Small Anim Pract 1999; 14: 177-186.
• 5 Reichle JK, Park RD, Bahr AM. Computed tomographic findings of dogs with cubital joint lameness. Vet Radiol Ultrasound 2000; 41: 125-130.
• 6 Gielen I, Van Bree H, Van Ryssen B. et al. Radiographic, computed tomographic and arthroscopic findings in 23 dogs with osteochondrosis of the tarsocrural joint. Vet Rec 2002; 150: 442-447.
• 7 Van Ryssen B, van Bree H. Arthroscopic findings in 100 dogs with elbow lameness. Vet Rec 1997; 140: 360-362.
• 8 Berzon JL, Quick CB. Fragmented Coronoid Process: Anatomical, Clinical and Radiographic Considerations with Case Analyses. J Am Anim Hosp Assoc 2006; 16: 241-251.
• 9 Kirberger RM, Fourie SL. Elbow dysplasia in the dog: pathophysiology, diagnosis and control. J S Afr Vet Assoc 1998; 69: 43-54.
• 10 Van Ryssen B, de Bakker E, Beaumlin Y. et al. Primary flexor enthesopathy of the canine elbow: imaging and arthroscopic findings in eight dogs with discrete radiographic changes. Vet Comp Orthop Traumatol 2012; 25: 239-245.
• 11 Hazewinkel HAW. editor. The clinical diagnosis of elbow dysplasia. Proceedings of the 13th Annual Meeting of the IEWG [document on internet]. 2002. October 2 Granada, Spain: Available at: http://www.vet-iewg.org/joomla/index.php/proceedings
• 12 Zontine WJ, Weitkamp RA, Lippincott CL. Redefined type of elbow dysplasia involving calcified flexor tendons attached to the medial humeral epicondyle in three dogs. J Am Vet Med Assoc 1989; 194: 1082-1085.
• 13 Walker TM. A redefined type of elbow dysplasia in the dog-2 cases. Can Vet J 1998; 39: 573-575.
• 14 May C, Bennett D. Medial epicondylar spur associated with lameness in dogs. J Small Anim Pract 1988; 29: 797-803.
• 15 Meyer-Lindberg A, Heinen V, Hewicker-Trautwein M. et al. Vorkommen und Behandlung von knochern Metaplasien in den am medialen Epikondylus des Humerus entspringenden Beugesehnen beim Hund [Occurence and treatment of bone metaplasia in the medial epicondyle of the humerus arising from the flexor tendon in dogs]. Tierarztl Prax 2004; 32: 276-285.
• 16 Grondalen J, Braut T. Lameness in two young dogs caused by a calcified body in the joint capsule of the elbow. J Small Anim Pract 1976; 17: 681-684.
• 17 Culvenor JA, Howlett CR. Avulsion of the medial epicondyle of the humerus in the dog. J Small Anim Pract 1982; 23: 83-89.
• 18 Piermattei DL, Flo GL, DeCamp CE. Brinker, Piermattei and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. Philadelphia: WB Saunders Elsevier; 2006
• 19 Vaughan LC. Muscle and tendon injuries in dogs. J Small Anim Pract 1979; 20: 711-736.
• 20 Harasen G. The mysterious dysplastic elbow. Can Vet J 2003; 44: 673-674.
• 21 Benjamin M, Toumi H, Ralphs JR. et al. Where tendons and ligaments meet bone: attachment sites ('entheses') in relation to exercise and/or mechanical load. J Anat 2006; 208: 471-490.
• 22 de Bakker E, Samoy Y, Gielen I. et al. Medial humeral epicondylar lesions in the canine elbow. Vet Comp Orthop Traumatol 2011; 24: 9-17.
• 23 Carpenter LG, Schwarz PD, Lowry JE. et al. Comparison of radiologic imaging techniques for diagnosis of fragmented medial coronoid process of the cubital joint in dogs. J Am Vet Med Assoc 1993; 203: 78-83.
• 24 Moores AP, Benigni L, Lamb CR. Computed tomography versus arthroscopy for detection of canine elbow dysplasia lesions. Vet Surg 2008; 37: 390-398.
• 25 Hazewinkel HAW. editor. Elbow Dysplasia; definitions and clinical diagnoses. Proceedings of the 23rd Annual Meeting of the IEWG [document on internet]. 2008. August 20 Dublin, Ireland: Available at: http://www.vet-iewg.org/joomla/index.php/proceedings
• 26 Grondalen J. Arthrosis with special reference to the elbow joint of young rapidly growing dogs. I A review of the literature. Nord Vet Med 1979; 31: 62-68.
• 27 Puccio M, Marino DJ, Stefanacci JD. et al. Clinical evaluation and long-term follow-up of dogs having coronoidectomy for elbow incongruity. J Am Anim Hosp Assoc 2003; 39: 473-478.
• 28 Tobias TA, Miabayashi T, Olmstead ML. et al. Surgical removal of fragmented medial coronoid process in the dog: comparative effects of surgical approach and age at time of surgery. J Am Anim Hosp Assoc 1994; 30: 360-368.
• 29 Vermote KA, Bergenhuyzen AL, Gielen I. et al. Elbow lameness in dogs of six years and older. Vet Comp Orthop Traumatol 2010; 23: 43-50.