Clean Run - December 2011 - 21

Signs & Diagnosis
Dogs with MCD may have intermittent or chronic lameness that is often worse after exercise. As with most forms of arthritis, dogs are stiff following rest. Dogs can warm up out of the lameness, only to become lame again with exercise. The pain of MCD stems from bone on bone grinding and subsequent inflammation. Dogs may attempt to compensate and decrease this pain by standing with their elbows turned outward. MCD may be suspected in dogs with chronic forelimb lameness and pain associated with movement of the elbow joint. Keep in mind there are many other causes of forelimb lameness and of elbow pain. In most cases, dogs with MCD will have muscle atrophy, loss of range of motion of the elbow joint (particularly in flexion), and thickening of the elbow joint due to scar tissue formation and new bone proliferation. The diagnosis of elbow dysplasia is usually made from palpation and confirmed with an imaging modality. X-rays should be obtained, and those may reveal new bone formation and sclerosis (hardening) of the bone around the joint. However these changes usually become evident once the condition is advanced. CAT scans and MRI can aid in earlier confirmation, but cannot accurately tell the condition of the cartilage in the elbow joint of the dog. Therefore arthroscopy is typically recommended to confirm the diagnosis and to assess the condition of the cartilage. With arthroscopy the surgeon looks for areas of major cartilage damage and addresses the damage if deemed appropriate. Open surgery is an alternative, but it is not nearly as effective and is more invasive.

Well-established Treatment & Management Methods
Treatment of MCD is difficult. A cure is rare and management is what must be pursued. Treatment is divided into medical and surgical realms. Medical treatment includes both proven and controversial remedies for osteoarthritis. The single most important step in the management of osteoarthritis is limiting body weight. It has been proven over and over in dogs that decreasing body weight to a healthy level decreases the signs and pain of arthritis. Weight management is the first of the five principles of arthritis management that also include nutritional supplementation, exercise moderation, physical rehabilitation, and anti-inflammatory medications. Well-established methods of decreasing arthritis pain include the use of analgesics, particularly NSAIDs (Rimadyl, Deramaxx, Etogesic, Metacam, Previcox). Other effective analgesics include tramadol, gabapentin, and amantidine. Nutritional supplements, particularly glucosamine, chondroitin, and fatty acids, are widely used to help decrease inflammation in the joint. Injectable polysulfated glycosaminoglycans (Adequan) may also decrease joint inflammation. Over the last several years, companies that concentrate or grow stem cells have suggested that injection of stem cells into joints can decrease arthritis pain. Other joint injections include hyaluronan, platelet-rich plasma, and steroids. It is important to understand that none of these treatments are going to re-grow cartilage. In MCD there are severe mechanical forces that grind away cartilage, and without the elimination of the grinding, cartilage can never heal.

December 11

| Clean Run

http://www.peakveterinaryreferral.com http://www.peakveterinaryreferral.com

Clean Run - December 2011

Table of Contents for the Digital Edition of Clean Run - December 2011