Skeletal and Muscular Disorders

Congenital Vertebral Anomalies

 

Congenital Vertebral Anomalies, including butterfly, block, and transitional vertebrae, and hemivertebrae, are a collection of malformations of the spine in animals. Most are not clinically significant, but they can cause compression of the spinal cord by deforming the vertebral canal or causing instability.

 

Craniomandibular Osteopathy

 

Craniomandibular osteopathy is a hereditary disease in West Highland White Terriers and also occurs in other terrier breeds. It is a developmental disease in puppies causing extensive bony changes in the mandible and skull. Signs include pain upon opening the mouth.

 

Elbow Dysplasia

OVERVIEW: 

 

Elbow dysplasia is a term used to describe several closely related medical conditions which impact the elbows of domestic dogs.  Some dogs with elbow dysplasia only exhibit one of the underlying conditions, although many exhibit two or more.  Elbow dysplasia is one of the most common genetically-inherited musculoskeletal conditions found in domestic dogs and is especially common in large and giant breeds.  Elbow dysplasia is also known as any one of the conditions which may be responsible for its presence to include osteochondrosis of the elbow,  osteochondritis dissecans/OCD, osteochondritis of the medial humeral condyle, fragmented medial coronoid process and ununited anconeal process, and incongruent elbow.

 

Three bones comprise the elbows of normal adult dogs, the humerus, radius, and ulna.  The humerus, or upper arm bone, connects the arm to the shoulder and ends in the elbow.  The radius and ulna, which extend from the elbow to the hand, function as essentially a single bone.  All three bones have unique features which allow them to connect together properly and provide the greatest amount of stable movement.  At the end of the humerus are two rounded knobs known as the lateral and medial condyles.  Between the two condyles is the supratrochlear foramen, a hole that extends completely through the bone.  The upper end of the ulna has a hook-like structure known as the anconeal process which fits into the supratrochlear foramen and the troclear notch, a curved ridge that fits between the two condyles of the humerus.  On either side of the troclear notch are the medial and lateral coronoid processes, which the medial and lateral condyles rest on.  The upper end of the radius lies between the two coronoid processes and helps support the weight of the dog.  All of the surfaces on all three bones are covered in cartilage and should be perfectly smooth.  A fluid-filled capsule encases the entire joint.  The joint fluid within provides constant lubrication for skeletal movements.  This system works so well that dogs can support their entire weight and have a wide range of movement, albeit not nearly to the extent that humans have.

 

Each of the conditions which can cause elbow dysplasia impacts the normal joint structure in a different way.  Dogs suffering from osteochondrosis of the elbow have an abnormality of the cartilage which lies in between the bones and prevents them from rubbing directly against each other.  In many dogs, there is something so wrong with the cartilage that a portion of it physically loosens or even separates entirely from the underlying bone.  This condition is known as osteochondritis dissecans and is extremely painful whether the cartilage is hanging on to the bone partially like a flap or completely free and floating around freely in the fluid capsule.  In domestic dogs, the elbow cartilage most likely to separate from the bone is that on the medial side of the humerus, a condition known specifically as osteochondritis dissecans of the medial humeral condyle.  

 

Much like humans, dogs are born with several more bones than they have as adults.  This is because several bones fuse together as they grow, eventually becoming a single structure.  Such a fusion occurs in the ulna, where the coronoid and anconeal processes are initially unique bones.  Sometime this fusion never actually occurs or disintegrates after it has begun.  When the medial coronoid process is the bone so impacted, the condition is known as fragmentation of the medial coronoid process.  When the anconeal process is the bone so impacted, the condition is known as ununited anconeal process.  In those dogs suffering from either fragmentation of the medial coronoid process or ununited anconeal process, the ulna and the smaller bone may either be partially connected with ligaments and/or cartilage, or the smaller bone may be entirely disconnected and floating free within the joint.

 

The bones of the body are designed to fit together perfectly, like the pieces of the puzzle.  In order to function properly, neighboring bones must grow at the same rate so that they continue to fit together.  Unfortunately, sometimes the growth rate of neighboring bones differs dramatically, leaving a dog with bones that do not fit properly together due to size differences.  Sometimes, this occurs within the elbow of dog resulting in a condition known as incongruent elbow.  Dogs suffering from incongruent elbow have radii that are either too large or too small for the radius and ulna (or vice versa). 

 

Regardless of the exact underlying condition, the impacts of elbow dysplasia are quite similar, and in any case many dogs suffer from multiple underlying conditions at the same time, especially osteochondritis dissecans and fragmented medial coronoid process.  The bones in the elbow joint experience a significant amount of stress merely doing their job.  They not only have to support the animal’s entire weight, but they also have to move freely, rub up against each other, and experience the stress of walking and moving.  A good analogy is the parts of a car wheel, which must perform all of the same functions.  The elbows of normal dogs are up to this stress, but those suffering from elbow dysplasia are not.  When the bones of the elbow do not fit together properly, a number of effects occur.  First, the bones move in ways which they were not meant to, usually less tightly.  This weakens the joint, making it both incapable of supporting as much weight and making it more difficult and challenging to support what weight it can.  It also causes the bones to move up against each other in unnatural ways.  If untreated, this unnatural rubbing will cause damage to the cartilage and ligaments in between the bones, damage which can be quite painful.  Eventually, this damage may become permanent, resulting in arthritis.  If the cartilage completely wears off, the bones will rub up against each other directly, causing even more pain.  The situation is even worse in dogs which have a piece of bone or cartilage floating freely within the joint.  Not only is the entire joint weakened  and misshapen as a result, but the floating bone will jab up against fleshy tissue and cause very significant pain (imagine a piece of sharp shrapnel stuck inside the body that pokes and stabs the tissue whenever it is moved).

 

Elbow dysplasia can develop at any point in a dog’s life, but usually develops either quite late in life as a result of general body deterioration or between the ages of 4 and 12 months as a result of a dog’s natural growth to full adult size.  In the vast majority of cases, elbow dysplasia is caused primarily or entirely by genetics, although it can also occur as a result of accident or injury.  Many researchers believe that external factors such as diet and exercise have a significant impact on the timing and severity of elbow dysplasia’s onset, and some believe that they may be able to cause the condition on their own (although this is currently far from universally accepted).  The severity of elbow dysplasia varies significantly from animal to animal.  Minor cases may cause only mild discomfort, while severe cases may cause crippling pain and even permanent lameness.  Most dogs which develop elbow dysplasia are equally impacted in both legs.  However, there are many exceptions.  Some dogs may be dysplastic in one elbow and completely normal in the other.  The condition’s severity may also be quite different in both elbows.  Generally, the same underlying condition(s) will cause elbow dysplasia in both elbows, but there are rare cases where two elbows on the same dog are dysplastic for different reasons.

 

RISK FACTORS: 

 

Age – Although elbow dysplasia may appear at any age, the vast majority of dogs begin to exhibit symptoms at one of two points in their lives.  Most dogs first show symptoms while they are still adolescents.  It is most common for symptoms to first appear between 7 and 10 months of age, although any age between 4 and 12 months is fairly typical.  Many other dogs first exhibit symptoms when they are advanced in age, usually after about 6 depending on the breed.

 

Size – Large dogs are much more likely to develop elbow dysplasia than small dogs, and giant dogs are much more likely to develop elbow dysplasia than large dogs.  This is due to a combination of genetic inheritance, growth patterns in large breeds, and the extra stress than added weight puts onto joints.  While less common, elbow dysplasia is still regularly seen in small and medium sized dogs as well.

 

Genetics – There is no better predictive factor for elbow dysplasia than genetics.  Dogs with a close relative which has been diagnosed with elbow dysplasia are much more likely to develop the condition than other dogs, especially if the close relative is a parent or littermate.

 

Gender – Male dogs are considerably more likely to develop elbow dysplasia.  This is thought to be at least partially because male dogs are usually larger than females, an average difference which may be fifty pounds or more in some giant breeds.

 

Breed – Elbow dysplasia is very common and widespread.  The condition has been diagnosed in essentially all large and giant breeds (with a very few exceptions), and is increasingly being detected in small or medium sized breeds as well.  However, some breeds are considerably more likely to develop elbow dysplasia than others including the Basset Hound, Bernese Mountain Dog, Bloodhound, Bouvier des Flandres, Chow Chow, Dogue de Bordeaux, English Bulldog, English Mastiff, German Shepherd Dog, Golden Retriever, Great Pyrenees, Irish Wolfhound, Labrador Retriever, Neapolitan Mastiff, Newfoundland Dog, Rottweiler, St. Bernard, and Weimaraner.  

 

SIGNS & SYMPTOMS: 

 

The first sign of elbow dysplasia is usually a limp.  The exact nature of the limp depends on the case.  When only a single leg is affected by elbow dysplasia, some dogs will only seem to slightly favor the other leg, while others will put no weight on the affected leg whatsoever.  Some dogs keep the leg raised while others hold it out from the body.  Dogs with elbow dysplasia usually do not limp, per se, unless one leg happens to be bothering them more at that specific moment.  Instead, these dogs generally have an unusual gate.  They may seem to walk gingerly or slowly.  Many either hold their elbows out from their body when they walk or turn their feet noticeably outwards.  In most cases, such movement changes are very mild and may be nearly unnoticeable, even by veterinarians.  These symptoms will gradually worsen as the dog ages.  This progression can be much faster, however, and some dogs may develop a full limp seemingly overnight.  Any unusual movement or limping is usually most pronounced after a dog has gotten up from rest or just finished physical activity. 

 

As the condition worsens, the dog begins to experience progressively more pain and discomfort.  Because activity makes the pain worse, most affected dogs become progressively less active.  Many are described as lazy or unenergetic.  Affected dogs often play less than normal dogs and for shorter time periods.  As the condition worsens, dogs may refuse to go up stairs, jump, and may even be extremely reluctant to walk to their food dish.  Many dogs become very resistant to anything touching their elbows, and may react with fear or even aggression when an attempt to do so is made.  In some cases, the elbow becomes visibly swollen.  This swelling may either be permanent or last temporarily after exercises.  Dogs which have been resisting moving their elbows for long periods of time often begin to show muscle atrophy and weight gin due to lack of exercise. 

 

The timing onset at the progression of symptoms varies substantially from dog to dog.  In most cases, dogs first exhibit symptoms between the ages of 4 and 12 months.  These symptoms usually get progressively worse for several months.  In most cases, the symptoms improve dramatically or disappear entirely once the dog reaches an age of 12 to 18 months of age.  This improvement is probably the result of several factors including the dog reaching its maximum size and the dog adapting to the constant discomfort.  Symptoms are usually substantially reduced for a number of years, when they will start back up again.  In many cases, this is the result of the condition progressing to the point where it is so painful that the dog can no longer cope. 

 

DIAGNOSIS & TESTS: 

 

Diagnosis for elbow dysplasia is usually a two or three step process.  The first step is for the veterinarian to take into account many factors specific to the case.  The symptoms which an individual dog is displaying are important, as are its age, breed, and family history if known.  Ideally, the veterinarian will attempt to observe any limps or unusual movement themselves, but this is not always possible, especially in minor cases.  The next step is to perform a physical examination of the elbow and other parts of the legs.  Veterinarians will attempt to see if there is swelling and grating in the elbow, and also to see the dog’s reaction to their elbows being manipulated.  Other parts of the legs will also be examined to see if they are in fact the problem.  Unfortunately, a conclusive diagnosis of elbow dysplasia cannot be made with an external exam alone.  This is because a very wide range of conditions have symptoms which closely match those of elbow dysplasia, some of which only impact the elbow indirectly, such as hip dysplasia, broken and chipped bones, torn ligaments, muscle pulls, severe sprains, and even some nervous system disorders.

 

If elbow dysplasia is suspected to be the cause of a dog’s symptoms, x-rays must be taken (or other internal body images such as those from a CAT scan) to provide a definitive diagnosis.  Because the x-rays required to diagnose elbow dysplasia often require the leg to be maneuvered in painful ways and held in place for a significant period of time, the animal is often sedated with anesthesia.  This both ensures that the animal experiences as little pain and emotional trauma as possible and that the x-rays taken will be sufficient for a diagnosis.  Even with x-rays, elbow dysplasia can be very challenging to diagnose.  This is because many dysplastic elbows exhibit such minor differences from normal elbows that they are nearly impossible for even experienced veterinarians to detect.  For this reason, many veterinarians will send off such x-rays to veterinary radiology specialists.  Of the potential underlying causes for elbow dysplasia, an ununited anconeal process is definitely the easiest to diagnose and the clearest on most x-rays.  The other causes are usually substantially more difficult to diagnose, unless the condition is so severe that a fragment of bone or cartilage has completely broken free.

 

CONVENTIONAL TREATMENT & MANAGEMENT: 

 

Elbow dysplasia is almost always an inherent part of a dog’s genetic makeup and is with that dog from the time it is conceived.  This means that it is not technically possible to cure elbow dysplasia, although its symptoms can be dramatically reduced with treatment.  Treatment options for elbow dysplasia vary tremendously, and each individual case must be treated in a unique manner depending on the underlying condition or conditions, the severity of each, the age of the dog, the amount of pain the dog appears to be in, and a number of other case specific factors.  In cases of osteochondrosis of the elbow and fragmented coronoid processes where there is not a loose bone fragment in the joint, the best option is usually to treat the problem medically rather than surgically.  In the case of very old dogs or those with some other medical condition which makes surgery especially risky, medical treatment is often advisable as well.  In the case of ununited anconeal process or where there is a loose bone fragment surgery combines with medical treatment is often the best option.  Very young puppies may also benefit from surgery if it can prevent problems from developing later in life.  In the case of incongruent elbow, the severity of the incongruence will determine whether surgery is the best option.

 

Medical treatment options for elbow dysplasia have three major goals, to reduce the animal’s pain, to ensure that the animal maintains a necessary level of activity to stay healthy, and to reduce any additional pressure on the joint to the greatest extent possible.  Anti-inflammatory drugs are very frequently prescribed to reduce the swelling, pressure, and pain caused by elbow dysplasia, especially non-steroidal anti-inflammatory drugs (NSAIDS).  In cases where the pain is more severe, stronger pain killers may prove necessary.  The heavier the dog, the greater strain is placed on the elbow joint and its part.  Because overweight dogs experience more and worse symptoms from elbow dysplasia keeping affected dogs in the proper shape is very important.  Diets may be necessary to induce weight loss.  Exercise is also necessary, but providing sufficient amounts can prove challenging for dogs in pain.  Veterinarians often recommend completely changing a dog’s exercise regimen and replacing it with low impact exercises.  In particular, swimming is a very popular and often successful choice. 

 

Surgical options for elbow dysplasia vary widely depending on the age of the dog and the features of an individual case.  Dog’s under the age of 1 year of age that have not stopped growing are the best candidates for surgery because they have both more options and greater changes of full recovery.  When a young dog has an ununited anconeal process, there are two options.  The anconeal process can sometimes be reattached with screws, or the ulna can sometimes be cut to relieve stress and allow the anconeal process to attach naturally, a procedure known as an ulnar osteotomy.  Generally, if elbow dysplasia can be identified and surgically repaired early enough, the dog will be prevented from developing osteoarthritis, and many such repaired dogs will go through life as though nothing was ever wrong.  For older dogs, as well as young dogs with other forms of elbow dysplasia, there are fewer options and a less optimistic prognosis.  When there is a fragment of bone or cartilage floating free in the knee, surgeries to remove that fragment are almost always advisable and helpful.  In cases of incongruent elbows, the three bones of the elbow can be surgically sculpted to fit better together, a procedure which is very challenging and has somewhat mixed results.  Although each individual case is different, most older dogs suffering from osteochondrosis and fragmented coronoid process benefit substantially less from surgery than other cases.  While most of these dogs can have their pain level substantially reduced, it is generally not to the extent of other surgical options. 

 

There are two options available for dogs with very severe elbow dysplasia, both of which are considered absolute last resorts.  One is total elbow replacement, where the entire elbow is removed and replaced with an artificial prosthesis.  Because the elbow is a significantly more complicated joint than the hip, elbow replacements are considerably more challenging to perform and considerably less likely to succeed.  The recovery time can also be very long and a limp will almost certainly permanently remain.  Despite these drawbacks, an estimated 80% to 85% of dogs do see improvement after elbow replacement.  Another option is arthrodesis, a procedure which physically fuses the bones of the elbow together.  This procedure eliminates essentially all of the pain of elbow dysplasia, but it leaves the leg completely unable to bend.  The dog will therefore have a permanent limp and severely restricted motion.

 

POTENTIAL COMPLICATIONS: 

 

There are numerous possible complications from elbow dysplasia.  By far the most common is osteoarthritis, which causes chronic pain and soreness.  The pain and soreness caused by elbow dysplasia and the osteoarthritis which follows worsen over time.  As the pain worsens, the dog usually avoids physical activity to the greatest extent possible.  This can result in weight gain and muscle atrophy, both of which put greater stress on the elbow joint and therefore worsen the problem.  At the same time, the dog will attempt to walk in a manner that puts as little stress on its joints as possible.  This results in a highly unnatural form of locomotion such as walking with elbows extended or feet pointing outwards.  If the dog moves in such a way for a long enough period of time, its entire musculo-skeletal structure will be strained in ways which it was not supposed to be.  Osteoarthritis may develop across the entire body as bones rub up against each other in ways which they were not supposed to.  The dog may also put itself at risk of skeletal injuries such as torn ligaments, broken bones, and back injuries.  In severe cases, elbow dysplasia may lead to a total and permanent lameness in an affected leg.

 

There are many potential complications from the treatment of elbow dysplasia.  Any of the medications used to reduce the pain caused by elbow dysplasia may have potential side effects, especially when they work in tandem with other medications.  Veterinarians will be able to discuss the potential side effects of any particular drug which they prescribe. Elbow dysplasia surgery can also be quite risky.  Some dogs are allergic or sensitive to anesthesia, and may experience difficulty breathing, heart palpitations, anabolic shock, and even death when put under.  There is also always a risk that something will go wrong and the dog will bleed to death, especially if the dog has an undiagnosed bleeding disorder such as Von Willebrand’s disease.  Elbow dysplasia surgeries can be particularly tricky because the elbow is such a complex and delicate joint.  There is always an inherent risk that such procedures may either not have the desired effect or even exacerbate the problem, even when performed by the most highly skilled veterinarians.  Many elbow dysplasia surgeries such as total elbow replacement and arthrodesis will leave a dog with permanently restricted movement.  If a dog is forced to overcompensate in other ways, it may develop musculoskeletal problems elsewhere in the body such as osteoarthritis or back injury. 

 

 

HOLISTIC REMEDIES: 

 

Elbow dysplasia is caused by an inherent genetic defect which causes an internal and permanent skeletal deformity.  Because of this, it cannot be cured with holistic remedies, and in many cases surgery is necessary.  However, a number of holistic remedies are believed to substantially reduce the pain and suffering caused by elbow dysplasia.  Many of these treatments may help postpone surgery, perhaps even indefinitely.  Because many holistic remedies may interact with conventional medications, always discuss any which are being considered with a veterinarian before use.  Most of the holistic remedies prescribed for elbow dysplasia are thought to act as anti-inflammatories or pain killers.  Among the most commonly suggested are S-Adenosyl-L-methione (SAMe, Denosyl SD4), omega-3 fatty acids, Rosemary (Rosmarinus officinalus), and Meadow Sweet (Filipendula ulmaria).  There are also some treatments which are believed to help strengthen cartilage and even increase the speed which the body replaces it.  Serna mussels (Perna canaliculus), avocado, soybean, glucosamine, chondroitin, Duralactin, and the sulfurous compound methyl-sulfonyl methane (MSM), are some of the treatments are thought to help cartilage.  Massage and acupuncture are also used to help reduce the pain caused by elbow dysplasia.

 

 

PREVENTION & HELPFUL TIPS: 

 

Because elbow dysplasia is an inherent part of a dog’s genetic code since the time it is conceived, it is impossible to prevent the condition entirely.  The one exception to this is the case of elbow dysplasia which has been caused by an injury, which can be prevented by preventing the injury.  Although owners usually cannot prevent elbow dysplasia from developing, they can help prevent the worst of its symptoms.

 

One of the most important things owners can do is to keep their dogs’ weight at a healthy level.  This can be achieved through proper diet and exercise.  Dogs with elbow dysplasia may take more effort to exercise than normal dogs because their joints are very sensitive, so owners should experiment with low impact exercise such as swimming.

 

It is possible to make many changes to a dog’s home and lifestyle that will cause it to put as little strain on its joints as possible.  For example, small ramps can be placed so that a dog neither has to use stairs nor has to jump up in to beds, cars, sofas, and etcetera.  Another example would be placing a dog’s food bowls right next to its bed so that it doesn’t have to walk across the house to get to the kitchen.

 

One of the best ways that owners can help improve their dog’s prognosis is vigilance and early diagnosis.  The younger a dog is when it is diagnosed with elbow dysplasia, the more treatment options it will have and the more likely those options are to be successful.  Early treatment can prevent elbow dysplasia from progressing into a more serious state and can also prevent potential complications from developing across the entire body.  Perhaps most importantly, the earlier a dog is treated for elbow dysplasia, the less pain that it will have to endure.

 

The best way to prevent future cases of elbow dysplasia is through improved breeding practices.  The exact inheritance mechanisms of elbow dysplasia are not yet fully understood because they are polygenic.  Several different genes working together in very complex ways cause elbow dysplasia, and it has so far proved impossible to find sort it out entirely.  However, it is nearly universally agreed that there is a very strong correlation between inheritance and elbow dysplasia.  Any dog which has been diagnosed with elbow dysplasia (unless it was caused by an accident) should not be bred, nor should any parent, sibling, or offspring of a diagnosed dog.  The Orthopedic Foundation for Animals (OFA) keeps records of dogs which have been diagnosed with elbow dysplasia as well as providing other resources for breeders, owners, and fanciers.

 

Hip Dysplasia

OVERVIEW: 

 

Hip dysplasia is one of the most common serious genetically inherited disorders in domestic dogs, and is probably the most common in large and giant breeds.  Hip dysplasia is caused by a malformation of the hip joint.  In a dog’s hip, the head of the femur, or upper leg bone, connects to the hip by fitting into the acetabulum, a rounded concave socket.  In a healthy dog, the femur head, or caput, fits nearly perfectly into the acetabulum, both of which are coated in a protective layer of cartilage.  This cartilage prevents the two bones from rubbing directly against each other and causing damage.  Dysplastic dogs, or those suffering from hip dysplasia, have something wrong with the shape of the femur, shape of the acetabulum, the cartilage in between them, or possibly some combination of the three.  Although there are many variations, two types of malformations are the most common.  In many cases, the caput does not fit snugly into the acetabulum as it should, but rather loosely or sometimes only partially.  It is also very common for the caput, acetabulum, or both to be misshapen.  In most cases, the same deformities will be found in both hind legs, meaning that the dog will have hip dysplasia in both legs.  Although rare, it is not unheard for only one side of the hip to be dysplastic.

 

Malformations of the hip joint cause many problems for the dog.  If the caput is not snug within the acetabulum, it may move around within the hip joint and may connect with bone in cartilage in unnatural and improper ways.  This also usually weakens the hip and renders it incapable of supporting as much weight as it could if it were normal.  If either the caput or the acetabulum is misshapen, they will rub up against each other improperly.  Either situation causes unusual friction on the bones, friction they were not designed to withstand.  Because the cartilage often cannot withstand this friction, it is damaged over time.  The dog’s body attempts to make up for this damage by constantly producing new cartilage.  Unfortunately, cartilage production is a very slow process which can only rarely keep up with the increasing cartilage damage.  As the cartilage wears down, the hip begins to degrade as well.  This degradation substantially worsens if the cartilage wears down entirely and the bones begin to connect directly with each other.  These problems lead to inflammation within the joint, which in turn leads to pain.  The more damage the hip joint takes, the less able it is to resist further damage.  This leads to a vicious cycle of increasing damage to the joint.  In turn, this leads to increasing pain for the dog.  The impacts of hip dysplasia are largely dependent on how much pain the dog is in and how it handles pain.  Some dogs may not seem affected at all by very severe hip dysplasia while others may be nearly crippled by comparatively minor hip dysplasia.  In most cases hip dysplasia will result in difficulty moving, chronic arthritis, and muscle atrophy.  In severe cases, it can lead to total lameness in one or both hind legs.  Dogs often adapt to their hip dysplasia by moving in a manner which causes them the least pain, such as “bunny hopping.”  Because these forms of movement are unnatural, if they are repeated over time they can cause a number of additional musculoskeletal problems.

 

Hip dysplasia is almost certainly the most studied problem in modern canine medicine.  The condition has been known for decades and intensive research has been conducted since the 1950’s and 1960’s.  A number of national militaries have even conducted intensive studies on the condition because it impacts their police and military dogs at high rates and renders them incapable of performing their duties.  Even after all this time and research, the causes of hip dysplasia are still poorly understood.  It is very clear that the condition is inherited and usually runs in family lines.  However, it is equally clear that hip dysplasia is a polygenic condition, meaning that multiple genes influence its development.  Polygenic conditions are the hardest to figure out an inheritance mechanism for because every gene that influences them has to be studied.  Hip dysplasia is also problematic because different problems may be caused by entirely different sets of genes, and the same problem may be caused by different genes in different breeds.  Although long assumed to be entirely genetic, recent research indicates that there is a substantial environmental component to hip dysplasia as well.  There is now nearly universal agreement that environmental factors such as diet, weight, exercise, and speed of growth influence the age of the onset of hip dysplasia’s symptoms as well as their severity.  Some research indicates that such factors may even partially determine whether a dog develops hip dysplasia at all but this has proven to be substantially more controversial.

 

Hip dysplasia is extremely common and has been diagnosed in almost every single dog breed with a few notable exceptions.  However, the condition is much more commonly seen in large dogs, especially massive ones.  The condition is also considerably more common in purebreds than mixes, especially purebreds that have been the victims of copious amounts of backyard and commercial (puppy mill) breeding practices.  It has long been assumed that large dogs are more vulnerable because they have a greater genetic propensity towards the condition than small dogs, which is certainly true in the case of some breeds.  However, recent environmental studies suggest that small dogs may be less likely to develop hip dysplasia only because of environmental rather than genetic factors, such as the fact that their greatly reduced weight puts a substantially lighter burden on their hip and the tendency for owners to exercise them less.  Dogs of any age may develop hip dysplasia, but it is most commonly diagnosed in dogs between the ages of 6 months and 3 years and then again in dogs over the age of 7.

 

RISK FACTORS: 

 

The following factors have either been shown to or are widely believed to increase both a dog’s likelihood for developing hip dysplasia and/or for having more severe problems.

 

Weight – Overweight dogs are considerably more likely to have severe hip dysplasia symptoms than dogs of proper weight.

 

Size – Hip dysplasia is common in dogs of all sizes, but is substantially more prevalent in large dogs.  As a general rule, the larger the dog, the more likely it is to develop hip dysplasia.

 

Build – Dogs with thicker, stockier bodies are more likely to develop hip dysplasia.  Additionally, dogs with aberrant body types (those that are the least similar to the wolf) are more likely to develop hip dysplasia.

 

Age – Because hip dysplasia is present from birth, dogs of all ages may exhibit symptoms.  However, the condition has a very strong age component, and the older the dog, the more likely it is to exhibit symptoms.
Genetics – Hip dysplasia is a genetically-inherited condition so dogs whose close relatives have had hip dysplasia are considerably more likely to develop the condition.  In fact, there is probably no greater predictor of whether a dog will develop hip dysplasia than genetics.  This is not a rule, however, and two perfectly normal parents may have a severely dysplastic offspring and vice versa.

 

Breed -  After family history, there is probably no greater risk factor for hip dysplasia than breeds.  Although the condition has been identified in most breeds (with a very, very short list of exceptions), hip dysplasia is dramatically more common in some breeds than others.  According to the OFA, the English Bulldog is the most likely breed to suffer from hip dysplasia, with an estimated 72.1% dysplastic and only 0.2% being excellent.  Behind the English Bulldog are the Pug (66% dysplastic, 0% excellent), Dogue de Bordeaux  (56.7% dysplastic, 1% excellent), and Otterhound (51.1% dysplastic, 0.3% excellent).  Other breeds which had more than 40% of all breed members being found dysplastic include the Boerboel, Neapolitan Mastiff, St. Bernard, Clumber Spaniel, Black Russian Terrier, Sussex Spaniel, Dogo Argentino, and Cane Corso.  Hip dysplasia is regarded as one of the most serious problems in a very large number of breeds, even those that are not nearly as high on the OFA’s list.  Some of the most famous include the German Shepherd Dog, Belgian Shepherd Dog (Malinois), Labrador Retriever, Golden Retriever, French Bulldog, American Bulldog, American Pit Bull Terrier, American Staffordshire Terrier, Newfoundland Dog, Bloodhound, Louisiana Catahoula Leopard Dog, and Rottweiler.

 

 

SIGNS & SYMPTOMS: 

 

Unfortunately, most of the signs of the early stages of hip dysplasia are entirely internal and cannot be identified without x-rays or other similar procedures.  It is only when hip dysplasia has advanced to the point where the dog is in serious pain and/or discomfort that the owner becomes aware, and then usually only by behavioral changes.  Most dogs with hip dysplasia begin to display either difficulty moving or a reluctance to do so.  This initially may be limited to a dog seeming to favor one leg over the other or simply taking a little extra time to come when called.  Gradually, symptoms worsen.  The dog may totally refuse to put any weight on a leg, walking with a permanent limp.  Some dogs may refuse to get up and walk altogether and may have to be carried to their food bowl or outside to go putty.  Other common signs include hopping instead of walking, whimpering, whining, lethargy, and a reluctance or refusal to go up stairs.

 

Although there are not as many external physical signs of hip dysplasia as behavioral ones, a few do become apparent as the condition worsens.  The most common is a narrow stance in the hip joints, causing the back legs to appear unnaturally close together.  As the dog’s behavior changes, physiological changes often follow.  Because dysplastic dogs usually use their back limbs considerably less, the muscles on the rear legs often atrophy sometimes to an extreme state.  At the same time, the front legs need to pick up the slack, and begin to do considerably more work than they would otherwise.  This leads to a very muscular shoulder and chest region.

 

DIAGNOSIS & TESTS: 

 

Diagnosis of hip dysplasia is conducted primarily for two reasons, to help relieve the pain and symptoms of an individual dog and to screen a dog that may potentially be bred to ensure that it does not pass the condition on to its offspring.  Screenings of potential parents are very useful for a condition such as hip dysplasia which often does not begin to manifest symptoms until many years after most dogs are first bred.

 

In cases where a dog has begun to display symptoms of hip dysplasia, veterinarians will typically take three or four stages to make a diagnosis.  To begin, the veterinarian will take into account a dog’s breed, size, age, and all of its symptoms.  Next, a complete physical exam will be conducted that will include blood work.  This blood work may indicate the presence of inflammation in the hip joint.  Although the first steps are helpful, the critical test is x-rays.  Dogs that have begun to show signs of pain and arthritis usually have a case of hip dysplasia that is so advanced that it is clearly visible on x-rays.  Many veterinarians choose to have dogs suspected of being dysplastic anaesthetized for their x-rays.  This allows them to manipulate the hips in various ways without hurting or unnerving the dog.  Such manipulations can help the vet make a diagnosis by sound and feeling, and can also aid in the x-ray process by allowing for multiple angles.

 

In cases where a dog is being screened for breeding purposes, there are two major testing methods.  The most common method is the OFA method, developed by the Orthopedic Foundation for Animals in the 1960’s.  The OFA requires that all dogs tested be at least 24 months of age and recommends that all female dogs tested not be in heat, pregnant, or nursing.  This is because canine hips are rarely fully developed until 2 years of age and the hips of female dogs naturally widen slightly as a result of reproductive cycles.  X-rays are taken of anaesthetized dogs which are then graded by three separate OFA certified radiologists.  The average score of the three radiologists is then determined and becomes the dog’s OFA grade.  There are 7 OFA grades.  Normal dogs are graded fair, good, or excellent.  If the radiologists are not able to reach a consensus the dog is labeled borderline dysplastic.  For dogs that are determined to be dysplastic, they are given a grade of mild, moderate, or severe.    The OFA will provide preliminary evaluations (performed by 1 radiologist) for dogs less than 24 months to aid in breeding purposes.  Such evaluations are reliable between 70% and 100% of the time depending on the breed.

 

In 1983, the University of Pennsylvania conceived the University of Pennsylvania Hip Improvement Program (PennHip), which became a usable system for veterinarians ten years later.  Like the OFA method, PennHip requires dogs to be anaesthetized for their x-rays.  Unlike the OFA method, the PennHip method can be used on puppies as young as 16 weeks.  During the x-rays, weights and external devices are used to manipulate the femur away from the acetabulum.  The amount that the caput moves (also known as joint laxity) is measured by using a distraction index or DI.  The PennHip DI ranges from 0 to 1 and is determined by dividing the distance the caput moves laterally from the center of the acetabulum by the radius of the femur head.  The lower the DI the less dysplastic the hip is.  As a rule, a DI of under 0.3 is considered acceptable, and the vast majority of dogs with a score of 0.3 or better do not develop osteoarthritis as a result of hip dysplasia studies have shown that PennHip scores given at 4 months are a very good indicator of future development of hip dysplasia, although scores given at 6 months and 1 year are better.  Although slightly different, PennHip and OFA achieve very similar results.  A comparison of the PennHip and OFA scores of 65 dogs found that all dogs scored as mildly, moderately, or severely dysplastic by the OFA scored higher than a 0.3 using the PennHip method.

 

CONVENTIONAL TREATMENT & MANAGEMENT: 

 

Because hip dysplasia is a hereditary condition that is an inherent part of a dog’s genetic code, it is impossible to cure entirely.  However, there are numerous treatments available to alleviate the condition’s symptoms and the pain that it can inflict.  There are currently thousands of different treatments currently available for hip dysplasia, and new ones are being developed constantly.

 

The treatment options selected for each individual case of hip dysplasia will vary tremendously depending on the individual circumstances of that case.  The first step is often to reduce or eliminate any factors which may be exacerbating the problem.  In cases of overweight dogs, it is very important that the dog’s weight be brought under control in a manner that will not cause it even more pain.  Exercise routines may need to be changed to ensure that the dog is in as little pain afterwards as possible.  Diets may need to be modified as well.  Dysplastic dogs should be kept warm at all times and should always be provided a proper place to sleep.  Special accommodations should be provided whenever possible, such as ramps which allow a dog to walk onto a bed or into a car instead of jumping into them.

 

The next step is to attempt to alleviate the dog’s suffering by non-surgical remedies.  Most vets will prescribe one or several anti-inflammatories.  Such drugs will hopefully reduce swelling and inflammation in the joint and therefore reduce the dog’s pain.  Among the most commonly prescribed are carprofin, etodolac, deracoxib, firocoxib, tepoxalin, meloxicam, buffered aspirin, and corticosteroids.  In addition to these medications, veterinarians usually recommend an assorted of vitamins and other supplements.  In certain cases, massage and physical therapy are beneficial as well.  In recent years, a number of injections have become popular in fighting the osteoarthritis caused by hip dysplasia.  Every injection will have a slightly different impact.  Two of the most popular are polsulfurated glycosaminoglycan, which helps prevent cartilage breakdown and aids in cartilage production, and hyaluronic acid, which increases the viscosity of the joint fluid.  For dogs which are in severe pain, many veterinarians will provide stronger pain killers, although caution is always necessary for their use.

 

Sometimes, a dog will not respond to any of the non-surgical treatments available for hip dysplasia, leaving surgery as the only option.  Because the surgical options available for hip dysplasia are all very major surgeries and quite expensive, veterinarians are loathe to use them unless absolutely necessary.  A number of factors will help determine whether surgery is a viable option including the age of the dog, risk factors such as potentially complicating conditions, cost of the surgery, and the degree of pain and discomfort experienced by the dog.  There are a variety of hip dysplasia surgeries available for older dogs, but two have become the most common.  For dogs less than 40 pounds, sometimes femoral head and neck excision are possible.  This surgery does not replace the entire joint, but rather the caput and neighboring parts of the femur.  During this surgery, the caput is removed and replaced with a fibrous pseudo-joint made either out of natural scar tissue or artificial materials.  Femoral head and neck excision is primarily used only in cases where total hip replacement is not feasible due to other medical conditions or cost.  This procedure is very useful in reducing pain and discomfort, but usually results in a loss of full movement and joint stability.  For adult dogs which are not suitable for femoral head and neck excision, total hip replacement is usually the best option.  Total hip replacement can now be performed on any dog regardless of size, although certain medical conditions may make it impossible.  Dogs undergoing total hip replacement have the entire hip joint removed during surgery and replaced with an artificial prosthesis.  If a dog requires both joints to be replaced, a wait time of three months is usually necessary in between surgeries.  Total hip replacement is a very major surgery, but it has very good results.  Most dogs eventually return to a normal level of activity free of pain.

 

In recent years, preventative hip dysplasia surgery performed on puppies has become increasingly common.  These surgeries are designed to correct joint problems before they lead to long term pain and suffering.  Two such procedures are most common.  Juvenile pubic symphysiodesis is the less invasive of the two options.  This surgery fuses the two pelvic bones together earlier than they would naturally, allowing the other parts of the hip to develop naturally.  Unfortunately, this procedure can only be performed prior to an age of 20 weeks (preferably 16) meaning that very early diagnosis is a necessity.  For dogs less than 10 or 11 months old, triple pelvic osteotomy is also an option.  In this surgery, the pelvic bones are surgically broken and the caput and acetabulum are realigned.  Although both of these surgeries are somewhat risky and quite expensive, they have been shown to have very good results in preventing the development of serious hip dysplasia.

 

POTENTIAL COMPLICATIONS: 

 

There are numerous very serious complications from hip dysplasia.  The most common complication is osteoarthritis, which is eventually seen in the vast, vast majority of hip dysplasia cases.  Osteoarthritis causes chronic pain, which is often very severe.  As the dog’s pain level increases, it begins to move in a progressively unnatural way.  Regularly moving in a way that the body is not supposed to results in a number of skeletal and muscular problems if done over a long period of time.  The muscles in the back legs often deteriorate due to lack of use, substantially weakening them.  Dogs which routinely hop instead of walking often do long term damage to the joints in their limbs.  Many dogs develop spinal problems as well, especially in the vertebrae closest to the hips.  These problems can range anywhere from mild arthritis to crippling injuries such as slipped discs.  One of the greatest problems with hip dysplasia is that many of the complications further exacerbate the problem.  For example, dogs experiencing joint pain in addition to hip dysplasia will often become even more inactive and gain even more weight, which increases the strain on the joints and the pain the dog experiences.

 

There are also a large number of complications from the various treatment options for hip dysplasia.  There are always potential side effects from any medicine, pill, or supplement, especially if a dog is taking multiple products.  Veterinarians should be carefully consulted over any side effects present in each individual medication and the combination of multiple medications.  Surgery is also inherently risky.  This risk is greatly heightened for hip dysplasia surgeries, which are incredibly invasive and major.  Many dogs are sensitive or allergic to anesthesia and may experience difficulty breathing, heart palpitations, anabolic shock, or even death when put under.  There is also always the possibility that the dog will bleed to death on the operating table, especially if the dog has an undiagnosed blood disorder such as Von Willebrand’s disease.  Even the most careful and skilled surgeon may cause unanticipated damage to another part of the dog’s body during surgery.  Because hip dysplasia surgery comes close to many other parts of the body such as the spine, lower digestive tract, and limbs, there are nearly endless possibilities for damage.  Although rare, it is also possible for hip dysplasia surgery to worsen a dog’s condition because it is often difficult to anticipate how an individual dog may recover.

 

HOLISTIC REMEDIES: 

 

Because hip dysplasia is caused largely by a genetic defect in the dog’s skeletal structure from birth, holistic remedies are incapable of curing the condition.  The only way to “fix” the structural problems responsible for hip dysplasia is with corrective surgery, surgery that is not possible with holistic medicine.  However, there are a very large number of holistic treatments available to treat the many symptoms of hip dysplasia, especially the pain it causes.  Many of these remedies may substantially reduce a dog’s suffering, and may even make it possible to delay corrective surgery, in some cases permanently.  Always remember to consult with a veterinarian before using any holistic remedies, especially if the dog is already taking regular conventional medications, to avoid possibly dangerous side effects.

 

Some of the holistic remedies prescribed to treat hip dysplasia are thought to protect and strengthen cartilage and other connective tissue such as ligaments and even to stimulate their growth and repair.  Among the most common include perna mussels (Perna canaliculus), avocado, soybean, glucosamine, chondroitin,  Duralactin, and the sulfurous compound methyl-sulfonyl methane (MSM).  A vast array of anti-inflammatory and pain-relief options is also available.  Some of the most common include S-Adenosyl-L-methione (SAMe, Denosyl SD4), omega-3 fatty acids, Rosemary (Rosmarinus officinalus), and Meadow Sweet (Filipendula ulmaria).  In recent years, physical treatments have also become increasingly popular to treat hip dysplasia holistically.  Regular massage and acupuncture are thought to greatly reduce a dog’s pain, especially for the short-term.

 

 

Hip dysplasia is an inherited disease in dogs that is characterized by abnormal development of the acetabulum and head of the femur. It is more common in large breeds

 

Hypertrophic Osteodystrophy

 

Hypertrophic Osteodystrophy is a bone disease in rapidly growing large breed dogs. Signs include swelling of the metaphysis (the part of the bone adjacent to the joint), pain, depression, loss of appetite, and fever. The disease is usually bilateral in the limb bones.

 

Hypertrophic Osteopathy

 

Hypertrophic Osteopathy is a bone disease secondary to disease in the lungs. It is characterized by new bone formation on the outside of the long bones.

 

Intervertebral Disk Disease

 

Intervertebral Disk Disease (IVD), is caused by the degeneration and protrusion of the disks and compression of the spinal cord. It occurs most commonly in the cervical and thoracolumbar regions. Signs include back pain, hind limb weakness, and paralysis. This condition is particularly common in long-backed breeds, such as the Basset Hound and Dachshund.

 

Legg-Calve-Perthes Syndrome

 

Legg-Calve-Perthes syndrome, also known as Perthes disease or aseptic necrosis of the femoral head, is characterized by a deformity of the head of the femur and hip pain. It occurs in small breed puppies.

 

Luxating Patella

OVERVIEW: 

 

Patellar Luxation is one of the most common skeletal problems found in small dog breeds and among the most common serious conditions in general.  Patellar Luxation is also sometimes referred to medically as luxating patella or luxating patellas, depending on whether one or both knees are affected.  There are also a wide range of colloquial terms for the condition, among the most common of which are loose knee, slipped knee, slipping knee, and trick knee.  Because the patella is located in the hind leg of the dog, only the hind legs are impacted by this condition.

 

Patellar Luxation occurs when a dog’s kneecap shifts to an improper location within the leg.  The natural position of the knee cap, or patella, is inside of a special groove on the dog’s femur, or leg bone.  As the dog walks, the patella moves up and down the groove in a set path.  The patellas of dogs suffering from luxating patella move outside of that groove.  There are many forms and variations of patellar Luxation.  For example, the condition may either be unilateral, meaning that only one leg is affected, or bilateral, meaning both legs are affected.  The condition may also either be an isolated single event or a chronic recurring condition.  Patellar Luxation also widely varies in its severity.  Some cases are so mild that they only last for a few minutes and are unnoticeable to observers while others are so severe that they cause permanent, crippling damage.

 

The impact on the dog caused by patellar Luxation varies widely depending on the severity of the condition.  In minor cases, the dog may not seem to be impacted at all, or at most suffer from a few moments of pain or reduced movement.  In severe cases, the dog may be in so much pain and discomfort that it is completely unable to walk.  Most cases are somewhere in between these two extremes, leaving the dog in pain and discomfort and with substantially reduced mobility.

 

In order to help them classify and treat the many variations of patellar Luxation, veterinarians have devised a grading scale for the severity of patellar Luxation which includes four categories.  Grade I patellar Luxation is the mildest form.  The patellas of impacted dogs usually quickly return to their natural positions, often without manual maneuvering.  Grade II is defined by patellas that are usually in their natural positions, but may come off track occasionally.  The patellas of dogs suffering from Grade II patellar Luxation may require manual maneuvering to return to their proper placement but often do not provided the dog extends the joint and de-rotates the tibia.  Grade III is defined by patellas that are luxated most of the time and require manual maneuvering to return to their proper track.  Grade IV is the most severe form of patellar Luxation.  The patellas of dogs suffering from Grade IV patellar Luxation are permanently off-track and cannot be manually maneuvered back into place.

 

The causes of patellar Luxation are not completely understood.  One known cause is trauma, such as an accident or injury.  Although still fairly common, trauma-caused patellar Luxation cases are a small minority of the total number.  Most cases are a result of genetics.  The exact genes responsible are not known, and most researchers now believe that patellar Luxation is a polygenic condition, meaning that several different and possibly unrelated, genes are responsible.  Many researchers believe that a malformed femur, patella, tibia, or groove is responsible for patellar Luxation in many cases, although it does not appear that this is a universal consensus.  Other veterinarians have suggested that malformation of tendons and ligaments may also play a key role.  Although it is widely agreed that patellar Luxation is hereditary in nature, there is no agreement on exactly how it is inherited.

 

Although patellar Luxation is not life-threatening, it can be a very serious condition.  An isolated incident will cause a dog great discomfort and reduced mobility until it is successfully treated.  Dogs are likely to limp or refuse to put weight on a leg with a luxated patella, or may not be willing or able to move at all if both patellas are luxated.  Chronic problems, even if each individual occurrence is very mild, can have long-lasting and permanent effects.  Repeated occurrences can further damage the patella and/or other leg bones, resulting in a number of complications.  Most frequently, osteoarthritis results from long-term untreated patellar Luxation, a condition that can be every bit as painful and crippling as patellar Luxation itself.

 

RISK FACTORS: 

 

The following factors have either been shown to or are widely believed to increase a dog’s chances of developing patellar Luxation:

 

  • Breed: Certain dog breeds are known to suffer from high rates of patellar Luxation.  Some of the breeds most likely to exhibit patellar Luxation include: Miniature Poodles, Toy Poodles, Chihuahuas, Labrador Retrievers, Boston Terriers, Yorkshire Terriers, Basset Hounds, Pekingese, Shih Tzus, Lhasa Apsos, and a number of other breeds.
  • Size: Patellar Luxation is one of the few conditions which are considerably more prevalent in small dogs than larger dogs.  Although there are many exceptions, generally the smaller the dog the more likely it is to develop patellar Luxation.  Although highly disputed by their breeders, most in the veterinary community believe that extremely small dogs, usually those described as Tea Cup, Tiny Toy, or related terms, are considerably more likely to develop patellar Luxation than normally sized breed members.
  • Other Conditions:  Although more studies need to be conducted for more information, most believe that dogs with other skeletal problems are more likely to develop patellar Luxation.  This is especially true of those conditions which impact a dog’s leg structure or its walking such as hip and elbow dysplasia, panosteitis, and skeletal growth abnormalities.  The presence of other skeletal problems and abnormalities can also impact the severity of patellar Luxation and the likelihood of surgical success.
     

 

SIGNS & SYMPTOMS: 

 

The signs of symptoms of patellar Luxation vary greatly depending on the severity of the condition.  Dogs with very mild cases may not show any symptoms until after they have had the condition for some time.  The owner usually notices something wrong when their dog seems to have reduced mobility or discomfort when walking, symptoms that gradually increase over time.  The actual patellar Luxation may not be visible to the naked eye in such cases, or it may return to normal so quickly that an owner is not able to see it before the problem is solved.  Dogs with more severe cases have much more obvious symptoms.  One of the most common is limping or reluctance to put weight on one or both legs.  This limping can develop very quickly, sometimes nearly immediately.

 

Dogs with patellar Luxation in both legs may refuse to move entirely.  In some cases, a dog may refuse to move an affected leg entirely, even holding it out from the body.  Some dogs repeatedly shake their legs in an attempt to return the patella to its normal position.  Most dogs suffering from severe cases of patellar Luxation show signs that they are clearly in pain such as whimpering, heavy breathing, and/or refusing to participate in activities that they usually enjoy.  Sometimes, the patella is so far off track that even a veterinary novice can clearly see the problem.  The longer that patellar Luxation goes untreated, the more severe the symptoms usually become.  In cases of chronic severe patellar Luxation, a dog may also exhibit weight gain or more rarely loss as a result of decreased activity.  Puppies experiencing patellar Luxation often appear to be bow-legged.  If the condition is not corrected, the dog becomes increasingly bow-legged as it ages.

 

DIAGNOSIS & TESTS: 

 

Patellar Luxation is very simple for a veterinarian to diagnose.  A veterinarian will review a dog’s symptoms and manually examine the dog’s hind legs.  In particular, the dog’s patellas will be manually maneuvered and examined.  A quick manual exam is often enough to determine the grade (severity) of the patellar Luxation, and also whether or not the condition is unilateral or bilateral.  Most veterinarians will follow up a manual examination with x-rays.  X-rays can help to more accurately assess the grade of the patellar Luxation, and also to identify it in cases where the symptoms are so mild that the veterinarian may have trouble identifying them visually or manually.  Perhaps most importantly, x-rays will allow the veterinarian to determine if the condition has caused serious side effects such as osteoarthritis.  If the veterinarian deems it necessary, 3-D medical imaging technology may also be employed to give the fullest picture of the extent of the condition.

 

CONVENTIONAL TREATMENT & MANAGEMENT: 

 

The treatment necessary to correct patellar Luxation varies depending on the severity of the condition.  Very mild cases often correct themselves without any intervention and may not require any veterinary treatment.  This is especially true of mild, single cases.  Dogs experiencing pain or discomfort as a result of long-term mild patellar Luxation can often be treated with pain killers and anti-inflammatory medications.  Grade I patellar Luxation cases are most commonly treated in such a way.

 

More severe cases of patellar Luxation (usually Grades II, III, and IV) often require surgical correction.  There are several commonly used surgeries to repair patellar Luxation, and the exact one selected will be determined by a number of factors including the severity of the condition, whether it is present in one or both legs, the underlying cause of the condition, and the direction which the patella moves.  Some surgeries focus on reconstructing the soft tissue around the patella, often loosening the side to which the patella moves and tightening the opposite side.  Other surgeries deepen the femoral grove allowing the patella to move within it easier.  Some veterinarians remove the cartilage entirely to achieve this, but most now remove a wedge or block of both cartilage and bone, preserving some cartilage in the process.  Another commonly practiced procedure transposes the tibial crest, helping to realign the quadriceps, patella, and tendons.  Very severe cases of patellar Luxation may require the entirely femur to be reshaped, especially in instances where a malformed femur is at the heart of the problem.  Such surgeries require pieces of the femur to be removed and reconstructed and a bone plate to be put in.

 

After a dog has undergone surgery to correct patellar Luxation, substantial post-operative care must be provided.  The exact regimen will be determined by the surgery performed and the veterinarian’s recommendation, but owners can expect regular bandage changing, wound cleaning, and anti-biotic provision at the very least.  Depending on the outcome of the surgery, the dog may require additional treatment.  Many dogs require long term pain killers and anti-inflammatory medications, especially if they have developed secondary conditions.  Some dogs may require additional surgical procedures if the first did not prove successful.  In extreme cases, a dog may remain permanently immobilized and may require additional measures such as using a canine wheelchair.

 

Treatment of patellar Luxation is very often successful.  More than 90% of owners are satisfied with the improvements their dogs show after a successful surgery.  Surgeries are less likely to be successful in large dogs or those whose patellar Luxation is combined with other abnormalities.

 

POTENTIAL COMPLICATIONS: 

 

There are a number of potential complications from patellar Luxation and its treatments.  By far the most common is osteoarthritis.  Patellar Luxation, especially if it is chronic, can lead to long-term or even permanent osteoarthritis.  Osteoarthritis can be extremely painful for a dog, and may even partially or completely immobilize it in severe cases.  Osteoarthritis is controllable with medications but is usually not-curable.  Rapid treatment of patellar Luxation will greatly reduce the likelihood of it causes osteoarthritis, but there are no guarantees.

 

Depending on the severity of the patellar Luxation and the amount of time it has been present, a number of other leg deformities may result.  Patellas moving outside of their natural track for long periods of time often rub up against the femur and/or the tibia incorrectly, which can cause serious and permanent damage.  Sometimes this damage actually makes the patellar Luxation worse, leading to a vicious cycle.  The soft tissue around the patella may also be damaged in a similar fashion.  Such damage to the inside of the leg can lead to pain, discomfort, difficulty, moving, and in severe cases total lameness.  The stress put on the legs as a result of chronic patellar Luxation may lead to other complications across the rest of the body such as the hips, spine, and musculature.

 

There are always potential complications from any surgery, including those which may be necessary to correct patellar Luxation.  Some dogs have allergies to anesthesia and may experience anything from a mild rash and difficulty breathing to anabolic shock and death when put under.  There is always a risk that a dog will bleed to death when on the operating table, especially if it has an undiagnosed blood disorder such as Von Willebrand’s Disease.  Other body parts may be injured during surgery, damage which may require additional surgeries to repair.  There is also always a chance that any procedures performed on the dog’s skeleton will result in unforeseen complications and mobility problems later on.

 

HOLISTIC REMEDIES: 

 

There are a number of available holistic treatments for the symptoms of patellar Luxation, although such remedies are not usually able to cure the patellar Luxation itself.  Many holistic healers will be able to manually maneuver the dog’s patella back into its correct place in much the same way as a veterinarian.  However, there are not widely accepted holistic treatments which will prevent the patella from luxating again.  Some evidence suggests that certain types of massage and acupuncture can help reduce the reoccurrence of Luxation episodes, but there is no general consensus.

 

Holistic remedies are often best suited to pain relief.  For example, herbs such as German Chamomile (Matricaria recutita) and Feverfew (Tanacetum parthenium) have been shown to provide significant relief because they act as anti-inflammatories.  Other herbs such as Skullcap (Scutellaria sp.) and St. John’s Wort (Hypericum perforatum) are believed to be highly effective pain reducers or killers.  These treatments are considered most effective for chronic arthritis problems such as the osteoarthritis that can result from patellar Luxation.  Other commonly recommended holistic remedies include cayenne, licorice, ginger, turmeric, and yucca.

 

PREVENTION & HELPFUL TIPS: 

 

Because the vast majority of patellar Luxation cases are genetic in nature, there is not much that can be done to prevent the condition.  Making sure that all dogs are kept reasonably safe from accidents and injuries is all that can be done to prevent those cases of patellar Luxation resulting from physical damage.  Some believe that proper nutrition has an impact of patellar Luxation, but the linkage has not been definitively proven.  It is possible for owners to prevent many complications from arising by early detection and treatment.  The sooner that patellar Luxation is diagnosed and treated, the less likely it is that complications such as osteoarthritis or bone damage are to occur.  Owners should closely monitor their dogs’ behavior, taking special notice of any limping or apparent discomfort, no matter how slight, and report any abnormal behavior to their veterinarians.

 

Although there is substantial disagreement as to the exact inheritance mechanism of patellar Luxation, most experts agree that dogs with patellar Luxation should not be bred in order to prevent the condition from appearing in future generations.  Many experts also recommend preventing any parents, siblings, or offspring of a dog impacted by patellar Luxation from breeding as well, although not all think that this is necessary.  The Orthopedic Foundation for Animals (OFA) has a number of resources, including records of dogs which have been diagnosed with patellar Luxation, for interested owners and breeders.

 

Masticatory Muscle Myositis

 

Masticatory Muscle Myositis (MMM) is an inflammatory disease in dogs affecting the muscles of the jaw. Signs include swelling of the jaw muscles and pain on opening the mouth. In chronic MMM there is atrophy of the jaw muscles, and scarring of the masticatory muscles due to fibrosis may result in inability to open the mouth (trismus).

 

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