NEW Diagnosis Fragmented Coronoid

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Scout is my 6 year old staffie x boxer.  He about 18 months ago after unsuccessful conservative treatment had his biceps tendon cut after the had an avulsion fracture .    It took ages to heal and he never been fully right.. he has days where he is amazing and days when he is like an old boy and doesn’t want to walk.

I wanted to see what was going on as the vets have said he doesn’t present like a dog with arthritus symptoms wise.

Anyway cut a long story short scans show his shoulder is actually OK some arthritus but better than u might expect .. his elbow is the problem .. fragmented coronoid prices.  He had debridement and flushed out and back to 10 minute walks.

Vet said Was quite bad and will see how he gets on with this.  Again further conservative treatment could include arthrimed steroid injections or prp the latter two we been through already with his shoulder.

There are some surgical options that sound hardcore

Just wondered how successful the debridement can be .. how quick recovery time might be and any useful information.   Is he an unlucky fellow.. or could here be a link between the two joint conditions he has had.  Is on same leg

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Good to hear that it sounds like you’re getting some improvement with him being more interactive.
I think really careful rehab and good close monitoring are going to be key for him. I can imaging a 6 year old staffy isn’t going to be the easiest dog to keep rested!! Make sure you give him plenty of stuff to keep him occupied and maybe speak with a physio about some options for gentle exercises you can do with him at home.

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Thank you both for replying. Lots to take in at least  we are well practised in our management from thinking it was a shoulder issue and he is already on supplements and hydro and having his walks and environment managed.   I’m used to things not working but can’t help but get my hopes up a bit that we’ve got to the root cause hopefully.  The ortho vet did say the procedure he has had may not be a cure all.
I wish we had taken him to the specialist sooner and feel a bit guilty but at least being on here gave me the confidence to keep asking at my vets and for them to be happy to ‘re refer him.
At his last scan before this one about 18 months ago maybe they said his elbows looked like didn’t quite sit right from one angle but both ortho specialists agreed was nothing of any concern at that stage.
Interesting that the non replacement surgery options are not a great fix 🙁
He does seem happier in himself these past few days.. more affectionate and interactive and bringing us toys to show us.

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That was from David Dycus xxx

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It sounds like from the discussion the shoulder was actually never the primary problem but rather secondary to the elbows. This is something we see commonly, over 55% of the dogs that present with shoulder pain actually have elbow issues.

The dog has been through arthroscopy to remove fragments; however, this is only step 1 of the management. We can’t cure these and most of them will remain lame and have good days and bad days. For me in terms of prognosis it would really depend on what the cartage looked like (Outerbridge score), what was done in the elbow, if there was incongruity, etc, etc. After removing the fragment all of these dogs are clinically worse, then around the 12 week mark they get back to about where they were pre-operatively. No one can determine if they will continue to improve or remain static. The theory in removing the fragments is to take away a source of pain, but to also slow down and minimize OA progression.

From a immediate post op period I recommend 12 weeks of exercise restriction with formal rehab beginning at 2 weeks post op. The goal is to improve pain, ROM, and stiffness and in the later parts build muscle mass. I expect these dogs to be sore and stiff throughout so expectations have to be set from the beginning.

For the long term I recommend developing a baseline of at least 20 minutes twice daily walking on level flat ground with no clinical signs prior to adding in hills, stairs, etc. I have them on supplements (glucosamine/chondroitin sulfate, omega-3 FA, and Adequan) with a focus on maintenance of a lean body weight through diet and daily exercise. During periods of flare ups I will recommend an IA injection (either steroid/HA or PRP (as a series)) to get the inflammation under control along with pharmaceuticals as needed and a formal rehab program for about 4-6 weeks to get it under control and them back to their baseline.

The end process of OA especially with elbows is an end-stage elbow that may benefit from an elbow replacement, which is slowly becoming more of a reality in dogs. Outside of an elbow replacement all the surgical procedures are designed to unload the medial compartment and at the end of the day dont do that great of a job (the dogs are still stiff, sore, and have periods of lameness).

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I will ask David dycus what he thinks and get back to you… I have had some dogs do really well after the flush out, but others not so.

x

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