Why It's Time to Look Beyond the Hips

Hip dysplasia is the condition most dog owners have heard of. Yet recent research suggests that the elbow deserves just as much attention.

What Elbow Dysplasia Actually Is

Elbow dysplasia is a collective term for several developmental abnormalities officially defined by the International Elbow Working Group (IEWG). A dog may develop one lesion or several at the same time, affecting one elbow or both.

The most common form is fragmented medial coronoid process (FCP). Part of the medial coronoid process develops abnormally and may crack or fragment, damaging the surrounding cartilage. This lesion is especially common in Rottweilers and Retrievers.

Another form is osteochondritis dissecans (OCD), where a flap of cartilage separates from the joint surface, leading to inflammation and progressive joint damage. It is frequently seen alongside FCP in Labradors, Golden Retrievers and Bernese Mountain Dogs.

Ununited anconeal process (UAP) occurs when a small bone projection at the back of the elbow fails to fuse with the ulna during growth. This fusion normally takes place between 16 and 20 weeks of age. German Shepherds are particularly predisposed because of differences in skeletal development.

The final component is joint incongruity, where the radius and ulna do not fit together perfectly. Today, this is generally viewed as one of the underlying causes that contributes to the development of the other lesions rather than a disease in its own right.

The elbow is particularly vulnerable because it carries around 60% of a dog's body weight while standing. It is also one of the most precisely aligned joints in the body. Even a tiny mismatch between the bones can create abnormal pressure that gradually wears away the cartilage.

Breeds Most at Risk

A large French retrospective study published in the American Journal of Veterinary Research analysed 17,861 elbow radiographs collected between 2002 and 2022 across 13 breeds. The overall prevalence of elbow dysplasia was 11.4%, although the risk varied greatly between breeds.

Males are affected about twice as often as females, a finding that has been reported consistently across several studies and suggests that sex hormones may influence disease development.

The encouraging news is that responsible breeding programmes have already helped reduce the prevalence of elbow dysplasia in several breeds over the past decades. However, genetics is only part of the story. Early detection and appropriate management remain essential for individual dogs.

How to Recognise the Signs (They Are Often Easy to Miss)

One of the biggest challenges with elbow dysplasia is that both elbows are affected in 50 to 90% of dogs, depending on the type of lesion.

Because both front legs hurt at the same time, many dogs never develop the classic limp owners expect. Instead, they simply become a little stiffer, slower or less willing to move. These changes often develop gradually and are easily mistaken for tiredness, ageing or a naturally calm temperament.

Some of the most common warning signs include:

• Stiffness after resting, especially when getting up.

• Elbows held slightly outward while standing, a posture that helps relieve pressure on the painful part of the joint.

• Shorter strides with the front legs.

• Less enthusiasm for playing, climbing stairs or jumping.

• Swelling or thickening around the elbow.

• Joint clicking or cracking during movement.

If clicking or cracking can be heard, osteoarthritis is usually already well established. Ideally, elbow dysplasia should be identified long before reaching that stage.

Why a Normal X-ray Doesn't Rule It Out

One of the most common misconceptions about elbow dysplasia is that a normal radiograph means the joint is healthy. Unfortunately, that is not always true.

According to La Semaine Vétérinaire (2024), the sensitivity of radiography for detecting medial coronoid process disease ranges from 10 to 62%, depending on the study. In one series of 236 dogs whose lesions were confirmed by arthroscopy, nearly one in four had radiographs that initially appeared normal.

Radiographs remain an essential first-line examination and are still used for official screening programmes. They are particularly useful for identifying advanced osteoarthritis or lesions such as an ununited anconeal process.

However, subtle coronoid fractures and mild joint incongruity are frequently missed.

CT Scan

Computed tomography (CT) is now considered the reference imaging technique for diagnosing elbow dysplasia.

Unlike conventional radiographs, CT provides a three-dimensional view of the joint, eliminates the overlap between bones and can detect very small bone fragments, fissures and subtle joint incongruity that may otherwise go unnoticed.

Access to CT is becoming increasingly common in referral veterinary hospitals and specialist orthopaedic centres.

Arthroscopy

Arthroscopy plays a dual role.

It allows the surgeon to examine the cartilage directly, confirm the diagnosis and treat many lesions during the same procedure by removing damaged fragments and cleaning the joint.

For fragmented medial coronoid process disease and osteochondritis dissecans, it has become the preferred surgical technique because it is minimally invasive and generally allows a faster recovery than traditional open surgery.

A thorough orthopaedic examination remains just as important as imaging.

One example is the Campbell test, which combines elbow flexion, carpal flexion and forearm pronation to reproduce pain associated with medial coronoid disease. In predisposed breeds showing compatible clinical signs, it should be part of every complete orthopaedic assessment.

Treatment Options

As with hip dysplasia, the underlying developmental abnormality cannot be reversed.

Treatment focuses on three main objectives: relieving pain, slowing the progression of osteoarthritis and maintaining the dog's quality of life for as long as possible.

Conservative Management

Many dogs can be managed without surgery.

Treatment typically combines anti-inflammatory medication when appropriate, strict weight management, adapted exercise, physiotherapy and evidence-based joint support.

This approach is generally recommended for mild cases, older dogs or patients that are not good surgical candidates.

Corrective Surgery

When significant joint incongruity or unstable lesions are present, surgery may offer the best long-term outcome.

Several procedures are available depending on the specific lesion and the age of the dog. Whatever the technique, the prognosis depends largely on how early the condition is diagnosed.

The less cartilage damage that has already occurred, the greater the chance of preserving long-term joint function.

What You Can Do Today

While elbow dysplasia cannot always be prevented, early recognition can make a real difference.

If your dog belongs to a predisposed breed, don't ignore subtle changes in the way they move. A puppy that seems unusually quiet or reluctant to run, jump or play may not simply have a calm personality, it may already be avoiding movements that cause discomfort.

Keeping your dog at a healthy body weight is one of the most effective ways to reduce stress on the elbows. Every extra kilogram increases the load placed on joints that may already be vulnerable.

If elbow dysplasia is suspected, seek veterinary advice as early as possible. In many cases, a CT scan provides far more information than standard radiographs and can reveal lesions before osteoarthritis becomes advanced.

Most importantly, remember that a normal X-ray does not always rule out elbow dysplasia. If clinical signs persist despite reassuring radiographs, discussing further imaging with your veterinarian may be appropriate.

Elbow Dysplasia Deserves More Attention

Hip dysplasia has long dominated discussions about canine orthopaedic disease, but the elbow is just as important.

Its anatomy is remarkably complex, the lesions are often subtle, and many affected dogs never develop the obvious lameness owners expect. By the time clear signs appear, osteoarthritis may already be well established.

The encouraging news is that veterinary medicine has made considerable progress. Better imaging, improved surgical techniques and earlier diagnosis now allow many dogs to maintain a good quality of life for years.

Recognising the warning signs early (and acting on them) remains one of the best ways to protect long-term joint health.

Sources

1. Roitner M. et al. (2024). Prevalence of osteoarthritis of the shoulder, elbow, hip, and stifle joints in dogs over 8 years of age. The Veterinary Journal, 305, 106132.

2. Roels J. et al. (2024). Prevalence of elbow dysplasia in 13 dog breeds in France: a retrospective radiographic study (2002–2022). American Journal of Veterinary Research, 85(6).

3. O'Neill D.G. et al. (2020). Epidemiology and clinical management of elbow disorders in dogs attending first-opinion veterinary practices in the UK. Canine Medicine and Genetics, 7(1):1.

4. Oberbauer A.M. et al. (2017). Long-term genetic selection has reduced the prevalence of hip and elbow dysplasia in 60 breeds of dog. PLOS ONE, 12(2):e0172918.

5. La Semaine Vétérinaire, No. 2046 (2024). Diagnosis of Elbow Dysplasia.

6. Le Point Vétérinaire, No. 328 (2012). Treatment of Elbow Dysplasia in Dogs.

7. Frégis Veterinary Hospital. Elbow Dysplasia in Dogs.

8. Université de Montréal Veterinary Teaching Hospital (CHUV). Elbow Dysplasia.