Solution & Additional Questions: "What's Your Diagnosis?"
SOLUTION: The list of differential diagnoses includes osteochondrosis (OCD), fragmented medial coronoid process, ununited anconeal process, and panosteitis. Other less common conditions of young large breed dogs can be included, such as hypertrophic osteodystrophy, depending on the clinical signs.
The radiographic changes were very mild and a radiologist read out the films only as possibly mild osteoarthritis of the right elbow.
The puppy was managed medically for the next few months and the signs of lameness continued to reoccur after exercise. The dog was referred to an orthopedic specialist and a computed tomography of the elbows performed for a definitive diagnosis.
QUESTION: What is your interpretation of the CT scan? What is your diagnosis?
SOLUTION: The CT scan shows large fragmented coronoid processes bilaterally. The puppy was taken to surgery and the fragments removed from both elbows arthroscopically. At 14 days post-operatively the dog was improved compared to pre-operatively. His lameness completely resolved at 10 weeks post-operatively and he resumed normal activity. Over the next three years, the dog had only two episodes of right forelimb lameness that resolved in 1-2 days with rest and NSAIDs. He continued to do well and was asymptomatic at a four-year follow-up after surgery.
Arthroscopy is minimally invasive and has a much quicker return to function than open arthrotomy. The recovery period is further shortened by the ability to operate joints (elbows, shoulders, etc.) bilaterally at the same time. Finally, arthroscopy provides a much better visualization of the intra-articular structures and lesions can therefore be treated more effectively.
Fragmented coronoid process is a disease of young, large breed dogs. It is highly prevalent in Labrador Retrievers, Rottweilers, Bernese Mountain Dogs, and Golden Retrievers. It also has been seen at a lower frequency in several other large and giant breed dogs. Fragmented medial coronoid process should be highly suspect in any young large breed dog with chronic elbow pain.