Recently the results were published from one of the largest studies into elbow disease. Cases were taken from a pool of nearly half a million dogs in first opinion practice in the UK over a one-year period.
What causes elbow disease?
In this study three quarters of sufferers had elbow arthritis. This is a chronic condition where the cartilage (‘shock absorber’ of the joint) is worn down over time, or worn abnormally often due to limb confirmation, leading to bone exposure. The friction causes extra bone to form, limiting movement and increasing inflammation, pain and starting a cycle of non-reversible changes. Eventually the pain reduces the use of the limb and muscle wastage occurs.
A third of elbow disease sufferers had elbow dysplasia. The elbow joint is made up of 3 separate bones, the radius, the ulna, and the humerus. Three common developmental abnormalities may occur in the elbow joint, referred to as elbow dysplasia, namely a fragmented coronoid process (FCP), and ununited anconeal process (UAP), and osteochondritis dissecans (OCD). Secondary arthritis forms in the majority of cases. If an OCD lesion is small it may heal with rest and anti-inflammatories. But for many dogs this and the other two abnormalities must be treated surgically. Dogs with elbow dysplasia usually have only one of the three conditions. It is rare for a single dog to have all three components.
In this study it was shown that only a small amount of elbow disease (6.66%) was due to trauma such as fractures, luxations and tendon damage.
How common is elbow disease in dogs?
Elbow joint disease is relatively common and can cause a serious impact on quality and sometimes quantity of life. It affects 0.6% of dogs under primary veterinary care, with more than 60% of these dogs affected in both elbows.
What signs might my dog show?
In this study three quarters of dogs with elbow disease were lame. About a fifth showed difficulty and reluctance to exercise but only around 13% actually showed pain. Sadly, in around 40% of animals that died during this study, elbow disease was a contributing factor. Just above 10% of elbow joint disease cases were identified incidentally at routine veterinary appointments in this study suggesting that owners may think the signs their pet is showing are normal aging signs.
Vets may be able to diagnose arthritis by examining the elbow, but for many cases radiographs are needed and in some cases CT or arthroscopy (using a camera to examine the inside the joint).
Which breeds are most at risk?
Larger breeds are more at risk of elbow dysplasia. Compared to cross breeds, Labradors and Rottweiler are at six times higher risk of elbow disease. German Shepherds are at four times higher risk, while Golden Retrievers are at three times the risk, and English Springer Spaniels have double the risk. The Jack Russell terrier and West Highland white terrier actually had a reduced risk of elbow disease compared to the average crossbreed dog. Within this study dogs aged 9 to 12 years old had around two and a half times the risk of elbow joint disease compared to dogs younger than 3 years of age. Males had one and half times the risk compared with females and the figures were similar with neutered animals at higher risk than un-neutered animals. The risk of elbow joint disease increased substantially as adult bodyweight increases.
What treatments are available?
The main type of painkillers used for elbow disease are Non-steroidal Anti-Inflammatories (NSAIDs). These medications can vastly improve an arthritic pet’s quality of life, although there are pros and cons to all medications which would need to be discussed with your vet. In this study 88.31% of dogs with elbow disease were taking non-steroidal anti-inflammatories. Nearly a fifth were being given tramadol.
Although there’s currently a weak evidence base in animals for this, if NSAIDs are not enough, or cannot be used for some reason, they may be appropriate to try.
Other medications were also used to a lesser extent such as gabapentin, amantadine, glucocorticoids. A small number had intraarticular injections. A fifth of dogs were given a disease modifying agent such as cartrophen, marketed to preserve joint health.
Nutraceuticals were commonly used in primary-care practice, with 40% of dogs receiving them in this study. These do not fall under the strict marketing. Testing that medications do in order to prove they are safe and effective. One component is often omega-3 fatty acid. There is evidence that this slows arthritis, reduces pain and helps joint function after 2-3 months of use. There is also limited evidence that green lipped mussel extract has a positive effect on pain and movement. The quality of both these components is important, however.
Larger breed dogs are more prone to this condition but being overweight also compounds the issues. The heavier the pet the more weight is sent through the joints, speeding up the process of wear and tear, and causing more pain. A little weight reduction can make a huge difference to quality of life. Given these pets often cannot exercise much, speak to your local vet about diet for weight loss.
Hydrotherapy and physiotherapy may be beneficial but are not mentioned in this study. Adapting the home is also a hugely important step to ensuring pets with elbow disease can be comfortable and lessen the chance of falls.
In this study 14 % of cases received surgery. Surgery may be recommended for many forms of elbow dysplasia and for most traumatic elbow disease.
Think your dog might have elbow problems? The study clearly showed that early diagnosis and treatment was beneficial!