A brief overview of the 4 steps to diagnosing canine elbow OA include the following:1,2
Step 1: Gait/mobility assessment. The dog is observed at the walk and trot and on various surfaces and inclines to determine gait abnormalities. These include a shortened stride, toe-in/toe-out, stumbling, audible click, leg crisscrossing, dragging toenails, limb circumduction, ataxia, head bob, asymmetric pelvic motion, weakness, hypermetria, and vocalization.
Step 2: Standing exam. The dog’s body confirmation is assessed, evaluating for symmetry and alignment. Any decrease in weight-bearing or altered-limb motion should be noted, as well as trembling or off-loading while standing. A sit-test and a down-test are also recommended.
Step 3: Recumbent exam. Working from distal to proximal, looking for asymmetry from trauma, degenerative changes, inflammation, congenital defects, and neoplasia. Note the presence of painful response, particularly in full extension, such as body shifts and change of facial expression. The joint should be palpated, looking for swelling, heat, malalignment, crepitus, and muscle atrophy, and valgus and varus stresses should be used to assess joint capsule and ligaments/tendons.
Step 4: Diagnostic imaging. It is important to obtain multiple views on conventional radiograph, with orthogonal views of each limb looking for signs of osteophytosis, subchondral bone sclerosis, remodeling, and joint space narrowing. Referral for CT/MRI/MSK ultrasound should be made based on findings.
References: 1. Fox SM. Multimodal management of canine osteoarthritis. 2nd ed. Boca Raton: CBC Press; 2017. 2. Brunke M. 4 steps to addressing canine osteoarthritis (OA). March 2020. Available from Exubrion Therapeutics.