EJCAP Online 22(4), December 2012, English

7 Elbow dysplasia scoring

7 Elbow dysplasia scoring

Elbow dysplasia is scored according to the severity of the arthrosis and/or presence of a primary lesion using the IEWG protocol, as shown in this table.

SUMMARY

Developmental abnormalities of the elbow joint are a common problem in many dogs, particularly in medium and large breeds. Growth disturbances of the subchondral bone or of the growth plates of radius and ulna may result in incongruity and/or instability, which may result in clinical lameness and elbow arthrosis of variable degrees. Clinical signs may occur as early as 4 months of age, but sometimes only after many years. Diagnosis is usually based on radiographs. ED may or may not elicit clinically overt lameness. Radiological presence of DJD may or may not be present particularly in growing or young adult dogs. Consequently recognition of subtle or indirect radiographic findings of elbow malformation is essential for a correct diagnosis particularly in cases of medial coronoid disease. ED scoring is done independently of the clinical findings as these are unknown to the scrutineer panel.

Severe elbow arthrosis. Osteophytes at multiple locations. Sclerosis at the base of the medial coronoid process (MCP). The MCP itself is poorly defined. There is step formation between radial head and MCP. Findings are suspicious for medial coronoid disease, which would be scored as grade II. Final score is ED grade III due to osteophytes of more than 5 mm in height.

11/11

How would you score this elbow?

Click on the image to see the author’s comments and score.

There is new bone formation of 2 to 5 mm in height at the AP and at the lateral humeral epicondyle (white arrows). The osteophytes at the radial head are difficult to quantify due to hyperflexion. Extensive new bone formation along the entire length of the trochlear notch (black arrows). Moderate elbow arthrosis, score II.

10/11

How would you score this elbow?

Click on the image to see the author’s comments and score.

Mediolateral projection, 40° opening angle. New bone formation of less than 2 mm in height is visible on the anconeal process and the radial head (arrows). There is also mild osteophyte formation at the lateral humeral epicondyle. Mild elbow arthrosis, score I.

9/11

Obvious sclerosis of the base of the medial coronoid process. The process itself shows reduced opacity. The humero-radial joint space is slightly incongruent. Suspect medial coronoid disease, score grade II.

8/11

Mediolateral projection. Suspect medial coronoid disease. A large defect is seen at the cranial tip of the medial coronoid process (arrow). There is no evidence of osteophyte formation nor is there sclerosis of the base of the medial coronoid process. Moderate ED, score ED II.

7/11

There is obvious sclerosis of the base of the medial coronoid process (white arrow) and blurring and reduced opacity of the medial coronoid process (black arrow) suggest medial coronoid disease, score grade II.

6/11

Left: There is a small fragment at the tip of the medial coronoid process, score ED III. Right: Opposite elbow joint, normal medial coronoid process.

L

R

5/11

There is a small fragment at the tip of the medial coronoid process, score ED III

4/11

Loss of margination of the medial coronoid process, suggesting medial coronoid disease, score grade II.

3/11

German Shepherd Dog, 1 year old. Incompletely united anconeal process in the right elbow. There is evidence of residual growth plate surrounded by mild bone sclerosis (arrow). The left elbow joint appears normal. While lameness is very uncommon in a dog with incomplete fusion of the anconeal process, the dog is genetically affected, resulting in an ED score grade II.

Left

Right

2/11

a) Mediolateral projection. Articular step formation (arrow), incongruent humeroradial and humero-ulnar joint. The medial coronoid process is mildly blurred and reduced in opacity. Obvious step formation is an indirect sign of medial coronoid disease resulting in a scoring ED II

b) German Shepherd Dog, 2 years old. Mild step formation. Osteophyte formation at the anconeal process, moderate arthrosis, grade ED II.coronoid disease resulting in a scoring ED II

1/11

How would you score this elbow?

Click on the image to see the author’s comments and score.

Author

Bernd Tellhelm

Clinic for Small Animal Surgery,

Frankfurter Strasse 108,

D- 35392 Giessen,

Germany

E-mail:

bernd.tellhelm@vetmed.uni-giessen.de

Until September 2009, Bernd Tellhelm was Professor and Director at the Small Animal Clinic of the Department of Surgery of the University of Giessen (Germany), responsible for diagnostic radiology. He has since retired, but is still involved in clinical work concerning skeletal diseases.

He is a Fachtierarzt für Chirurgie (German specialist degree in veterinary surgery) and a Diplomate of the European College for Diagnostic Imaging (ECVDI). He is currently President of the International Veterinary Radiology Association (IVRA), board member of the International Elbow Working Group (IEWG) and President of the German Association for Radiological Diagnosis of Genetically affected Skeletal Diseases in small animals (GRSK). He is also a member of the European Association for Veterinary Diagnostic Imaging (EAVDI) and a member of the expert group for hip dysplasia and elbow dysplasia for the FCI (Fédération Cynologique Internationale).

What’s your score?

Based on the protocol of the International Elbow Working Group (see table), how would you score the following lesions and why? Click on the images to assess the elbows.

Elbow dysplasia is scored according to the severity of the arthrosis and/or presence of a primary lesion using the IEWG protocol, as shown in this table.

Commissioned paper

Click to read more about this author

by Bernd Tellhelm and Mark Flückiger

Read more...

Back to content page

Volume 22(4), December 2012 SPECIAL ISSUE

Elbow dysplasia scoring

FECAVA Symposium

Dysplasia of the Canine Elbow Joint (CED) - Radiographic Technique and Radiological Interpretation

Developmental abnormalities of the elbow joint are a common problem in many dogs, particularly in medium and large breeds. Growth disturbances of the subchondral bone or of the growth plates of radius and ulna may result in incongruity and/or instability, which may result in clinical lameness and elbow arthrosis of variable degrees. Clinical signs may occur as early as 4 months of age, but sometimes only after many years. Diagnosis is usually based on radiographs. ED may or may not elicit clinically overt lameness. Radiological presence of DJD may or may not be present particularly in growing or young adult dogs. Consequently recognition of subtle or indirect radiographic findings of elbow malformation is essential for a correct diagnosis particularly in cases of medial coronoid disease. ED scoring is done independently of the clinical findings as these are unknown to the scrutineer panel.