Case: Fragmented medial coronoid process in the elbow of a Labrador
2nd March 2014
The elbow is formed by a snug fit between three bones: the humerus above the elbow and the radius and ulna in forearm. This snug precise fit makes it an “unforgiving” joint when things aren’t working tickety-boo. Degenerative joint disease, commonly called osteoarthritis, invariably follows and this DJD is a progressive, debilitating disease.
The medial coronoid process is a feature of the ulna at its proximal (top) end, where it meets the humerus to form the medial (inside) compartment of the elbow joint. The articular cartilage and/or the bone the forms this process can be fragmented and fissured. Fragmented medial coronoid process (FMCP) is a part of the elbow dysplasia problem that besets some young dogs, notably young Labrador retrievers. There is usually pain on elbow manipulation, and especially when manipulations are performed to increase the pressure on the medial side of the elbow joint. Lameness affecting one or both forelimbs typically occurs within a few months of birth, and leads to progressive DJD thereafter. FMCP is only visible on plain x-rays in about 50% of cases, and CT scans or arthroscopy are the best way to diagnose it.
Long term progressive DJD is inevitable, but most (not all) surgeons and studies feel/suggest that early removal of the fragmentations of the coronoid process is indicated to improve short term comfort and to mitigate long term problems. Removal can be performed arthroscopically (with the aid of a “camera” in the joint), but it is often just as quick and expedient to make a small surgical approach.
Percy, a young Lab-retriever presented with bilateral forelimb lameness. FMCP was suspected bilaterally (affecting both sides), and this was confirmed by CT scan. We removed the fragmentations at staged procedures separated by a few weeks. The photos are of the second (the right) side and at the time of admission for this second procedure, the owners felt that he was already very much improved on the first side.
We will follow this treatment up with standard treatments for DJD (see the information sheet in the section of fact sheets in the section for owners), and laser therapy and platelet enhanced therapy are also planned.