DIAGNOSTIC SENSITIVITY OF RADIOGRAPHY, ULTRASONOGRAPHY, AND MAGNETIC RESONANCE IMAGING FOR DETECTING SHOULDER OSTEOCHONDROSIS/OSTEOCHONDRITIS DISSECANS IN DOGS

The epidemiology of osteochondrosis in an insured Swedish dog population

Osteochondrosis (OC) is a focal disturbance of endochondral ossification due to a failure of blood supply to the epiphyseal growth cartilage. In dogs, OC most commonly affects the shoulder joint, followed by the elbow, tarsal, and stifle joints. The condition is associated with clinical signs such as lameness and pain and the prognosis varies depending on the affected joint. Most epidemiologic studies of OC in dogs were performed over 20 years ago, and updated estimates of disease incidence are lacking. Therefore, the objectives of this study were to provide population-based estimates of the incidence rate, cause-specific mortality rate, and age at diagnosis of appendicular OC (AOC, including OC of the shoulder, elbow, stifle, and tarsal joints) and stifle and tarsal OC separately, using data from Agria Djurförsäkring in Sweden (2011-2016). Further, the study aimed to evaluate the risk of OC in subgroups divided by breed and sex and describe previous, concurrent, and subsequent diagnoses of the affected joint in dogs with stifle or tarsal joint OC. The study population included just over 600,000 dogs, of which 685 were affected by AOC. Stifle joint OC (n = 113) was more common than tarsal joint OC (n = 80). The incidence rate of AOC was 3.77 (95% confidence interval (CI): 3.49-4.07) cases per 10,000 dog-years at risk, while the incidence rate of stifle and joint tarsal OC was 0.64 (95% CI: 0.53-0.77) and 0.43 (95% CI: 0.34-0.54) cases per 10,000 dog-years at risk, respectively. All breeds at increased risk of AOC were large or giant, and male dogs had an increased risk of AOC compared to female dogs (RR 1.76, 95% CI: 1.50-2.07, p < 0.001). The median age at first diagnosis during the study period was 0.74 (0.32-11.5) years for AOC, 2.62 (0.45-8.82) years for stifle joint OC, and 0.73 (0.35-7.35) years for tarsal joint OC. Of the dogs with stifle or tarsal joint OC, 30.2% and 15.0% had a previous diagnosis of stifle/tarsal joint pain or other unspecific clinical signs, respectively, and 13.8% of the dogs with stifle joint OC suffered subsequent cruciate ligament rupture. Osteochondrosis was the most common reason for euthanasia in the affected dogs. In total, 77 dogs were euthanised due to AOC during the study period.

Osteoarthritis, adipokines and the translational research potential in small animal patients

Osteoartritis (OA) is a debilitating disease affecting both humans and animals. In the early stages, OA is characterized by damage to the extracellular matrix (ECM) and apoptosis and depletion of chondrocytes. OA progression is characterized by hyaline cartilage loss, chondrophyte and osteophyte formation, thickening of the joint capsule and function loss in the later stages. As the regenerative potential of cartilage is very limited and osteoarthritic changes are irreversible, prevention of OA, modulation of existing osteoarthritic joint inflammation, reducing joint pain and supporting joint function are the only options. Progression of OA and pain may necessitate surgical intervention with joint replacement or arthrodesis as end-stage procedures. In human medicine, the role of adipokines in the development and progression of OA has received increasing interest. At present, the known adipokines include leptin, adiponectin, visfatin, resistin, progranulin, chemerin, lipocalin-2, vaspin, omentin-1 and nesfatin. Adipokines have been demonstrated to play a pivotal role in joint homeostasis by modulating anabolic and catabolic balance, autophagy, apoptosis and inflammatory responses. In small animals, in terms of dogs and cats, naturally occurring OA has been clearly demonstrated as a clinical problem. Similar to humans, the etiology of OA is multifactorial and has not been fully elucidated. Humans, dogs and cats share many joint related degenerative diseases leading to OA. In this review, joint homeostasis, OA, adipokines and the most common joint diseases in small animals leading to naturally occurring OA and their relation with adipokines are discussed. The purpose of this review is highlighting the translational potential of OA and adipokines research in small animal patients.

Fast field echo resembling a CT using restricted echo-spacing (FRACTURE) sequence for shoulder joint in normal dogs

Shoulder disease is a common cause of forelimb lameness in dogs. Determining the precise underlying cause of shoulder lameness can be challenging, especially in veterinary practice. Computerized tomography (CT) is often the preferred imaging modality for bone evaluation; however, it uses ionizing radiation and provides limited soft tissue contrast. Conversely, magnetic resonance imaging (MRI) offers excellent soft tissue contrast but has limitations in bone imaging. This study aimed to introduce a new technical innovation that enhances cortical and trabecular bone contrast on MRI, which we refer to as Fast Field Echo Resembling a CT Using Restricted Echo-Spacing (FRACTURE). In this prospective pilot study, we aimed to evaluate the use of FRACTURE, CT, and conventional MRI sequences in assessing the normal canine shoulder using a 3.0 Tesla MRI scanner. Five research beagle dogs were included, and the following pulse sequences were acquired for each dog (1): three-dimensional (3D) FRACTURE, (2) T2-weighted (T2W) images using 3D turbo spin echo (TSE), (3) T1-weighted (T1W) images using 3D TSE, (4) PD-weighted (PDW) images using 3D TSE, and (5) CT. Various parameters, including the delineation of cortical bone (intertubercular groove, greater tubercle, and lesser tubercle), conspicuity of the trabecular bone, shoulder joint visualization, and image quality, were measured for each dog and sequence. In all sequences, the shoulder joint was successfully visualized in all planes with mild motion artifacts. The intertubercular groove was best visualized on CT and FRACTURE. Both the greater and lesser tubercles were easily identified on the CT, FRACTURE, and PDW images. The trabecular pattern scored significantly higher in the CT and FRACTURE images compared to the T1W, T2W, and PDW images. Overall, the visualization of the shoulder joint was excellent in all sequences except for T1W. The use of FRACTURE in combination with conventional MRI sequences holds promise for facilitating not only soft tissue evaluation but also cortical and trabecular bone assessment. The findings from this study in normal dogs can serve as a foundation for further FRACTURE studies in dogs with shoulder diseases.

Shoulder magnetic resonance arthrography in dogs: Comparison of craniolateral and caudolateral approach for ultrasound-guided contrast injection

Shoulder joint disease is a common cause of forelimb lameness in dogs. To diagnose this condition, shoulder magnetic resonance arthrography (MRA) is performed, which involves the injection of contrast agents into the shoulder joint space under ultrasound (US)-guidance. The objective of this study was to compare the craniolateral and caudolateral approaches for shoulder MRA using US-guided injection techniques, and investigate their clinical feasibility in dogs. Forty shoulder joints from 10 adult beagles were studied in two repetitions. The craniolateral (n = 20) and caudolateral (n = 20) injection techniques were applied randomly under US-guidance. The shoulder MRA was conducted immediately after the contrast agents was injected. The procedure time (scan and injection time), number of attempts, joint distension and degree of extraarticular extravasation were recorded and compared between the two groups. The results showed that the caudolateral approach had significantly more contrast agents extravasation compared to the craniolateral approach (p < 0.05). However, there were no significant differences between the two groups in terms of procedure time (scan time p = 0.80, injection time p = 0.74), number of attempts (p = 0.70) and joint distension (p = 0.23). The craniolateral approach of US-guided contrast injection techniques for shoulder MRA minimizes damage to the juxta-articular structures and reduces extraarticular extravasation, resulting in good-quality images. This study demonstrates the feasibility and advantages of the craniolateral approach under US-guidance for shoulder MRA in dogs.

Detection of fragment migration into the biceps tendon sheath originating from a humeral osteochondrosis lesion - A case report and review of the literature

The purpose of this report is to demonstrate that radiographic evaluation of the canine shoulder joint alone is not sensitive enough to detect migrated osteochondral fragments within the biceps tendon sheath, as a sequela to osteochondrosis dissecans of the caudal humeral head. A 6-months-old, male, 35 kg Hovawart was referred due to chronic intermittent lameness on the left forelimb. Survey radiographs revealed a semilunar radiolucency surrounded by a moderately sclerotic rim at the caudal aspect of the left humeral head, referred to as osteochondrosis dissecans. However, only computed tomography combined with ultrasonography could clearly confirm a dislodged osteochondral fragment within the left biceps tendon sheath and a consequent tenosynovitis. Arthroscopic treatment on the clinically affected left forelimb followed by an additional approach over the left biceps tendon sheath to remove the migrated fragment resulted in a complete remission of the lameness until the last follow-up one year after surgery. In our opinion, computed tomography should be applied in the medical work up of canine shoulder osteochondrosis (OC) as standard. Combined with ultrasonography, it can further aid in complete evaluation of the shoulder joint and reliable exclusion of displaced osteochondral fragments, which might also be missed during arthroscopy when located too far distally.

Orthopedic Imaging: A Practical Clinical Guide

Many imaging options are available to the practitioner both in-house and on a referral basis to help make a definitive diagnosis for orthopedic injuries. To guide treatment, a complete understanding of the nature and extent of the injury is ideal. While a thorough orthopedic physical examination is the first step, a complete diagnostic work-up will include at least one and often more than one imaging modality. The goal of this article is to discuss the imaging options for some of the more common orthopedic issues encountered in dogs to help guide the practitioner through the selection of which should be considered to accomplish a diagnosis.

Ultrasound screening protocol for osteochondrosis at selected predilection sites in thoroughbred yearlings

Background

Osteochondrosis is a common condition of young horses where there is a failure of endochondral ossification, usually at predisposed sites. The estimated prevalence of osteochondrosis is 33–44%, with radiographic screening of yearlings being used to identify lesions. Radiography has two major limitations: poor sensitivity in detecting cartilaginous lesions and secondly, the exposure of the horse and personnel to ionising radiation. Ultrasonography allows imaging of the articular cartilage and subchondral bone margins and has been shown to be more sensitive in identifying osteochondrosis lesions. However, the ultrasonographic technique for examining joints is operator dependant, resulting in highly variable examinations, thus affecting its reliability and reproducibility as a screening test.

Results

A prospective observational clinical population study was undertaken involving twenty-two clinically normal weanling thoroughbred horses on-farm, describing a detailed protocol of the ultrasonographic examination technique for on-farm screening of common sites of osteochondral disease in the young horse, namely the carpal, metacarpophalangeal, stifle, tarsal and metatarsophalangeal joints.

Conclusion

Two veterinary practitioners used the technique to illustrate the repeatability of the protocol. The step-by-step protocol provides a valuable, reliable, repeatable technique for veterinary professionals performing screening ultrasound in the field.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13620-022-00216-7.

Detection of osteoarthritis in dogs by metabolic, pro-inflammatory and degenerative synovial fluid biomarkers and traditional radiographic screening: A pilot study

Secondary osteoarthritis (OA) is a slow progressive, common disorder of synovial joints in dogs. It is characterized by a loss of balance between the synthesis and degeneration of articular cartilage components. Its diagnosis is currently based on the presence of clear radiographic changes, which only occur in the later stages of the disease. Hence, early diagnosis of OA remains a major problem. Therefore, interest in synovial fluid (SF) biomarkers has emerged. Besides pro-inflammatory and degenerative markers, i.e. tumor necrosis factor alpha (TNF-alpha), interleukin-1beta (IL-1beta), tenascin-c (TN-C) and matrix metalloproteinase-2 (MMP-2), metabolic parameters, i.e. pH, glucose and lactate, can potentially be used to detect OA. The current study demonstrated statistically significant differences in the SF levels of pH, glucose and lactate between OA-affected and normal joints. In addition, the in-house validated immuno-assays for TNF-alpha, IL-1beta, TN-C and MMP-2 allowed to demonstrate also statistically significant differences in the SF concentrations for all these biomarkers - except TNF-alpha - between OA-affected and normal joints. However, no correlation was found between any of these biomarkers and the currently used radiographic scoring system for OA in dogs. Future research is warranted to explore the potential of these biomarkers in the early detection of OA and in the severity characterization of this disease.

The Shoulder Joint and Common Abnormalities

The shoulder is a complex joint composed mostly of static and dynamic capsuloligamentous structures and plays an important role in forelimb lameness. Its complex anatomy and biomechanics necessitate thorough examination and diagnostic work-up for accurate diagnosis. This article provides an updated review of common canine shoulder pathologies, including osteochondrosis, bicipital and supraspinatus tendinopathies, infraspinatus contracture, medial shoulder syndrome, and luxation.

Shoulder Lameness in Dogs: Preliminary Investigation on Ultrasonography, Signalment and Hemato-Biochemical Findings Correlation

Forelimb lameness in medium and large breed dogs is frequently caused by traumatic or degenerative injuries of the shoulder. Patient history, physical examination, x-rays, blood, and chemical work are routinely used to achieve diagnosis, and may be associated with ultrasonography or magnetic resonance imaging. Ultrasonography is increasingly popular in small animal practice due to its low cost, ease of repetition, and the fact that it is non-invasive and can be performed in conscious patients. It is also widely accepted that muscular stress or injuries can induce detectable variations in blood and chemical work. The aim of this preliminary study is to search for correlation between measurements of selected hematobiochemical parameters and ultrasound diagnosis in dogs affected by shoulder injuries. A retrospective study was conducted on orthopedic clinical records of dogs presented to our Veterinary Teaching Hospital for lameness caused by shoulder problems over a period of 5 years. Dogs with both hematobiochemical and ultrasound examinations were selected. Patients were classified into 5 groups according to ultrasound diagnosis: (1) mild/moderate tendinopathy, (2) severe tendinopathy, (3) articular damage, (4) chronic myopathy, and (5) neoplastic injury. Statistical analysis was performed to detect possible correlations between group and hematobiochemical parameters. Forty-four dogs met the inclusion criteria and forty-nine shoulders were diagnosed as injured. Significant differences were found between the age, sex, body weight, neutrophil count, and AST levels. In particular, statistically significant increases were found for neutrophil count and AST concentration in case of ultrasonographically diagnosed severe tendinopathy, articular damage, and neoplastic pathology. Further and wider studies are suggested to determine whether these biomarkers can become a useful diagnostic aid.

Arthroscopic Management of Osteochondrosis of the Glenoid Cavity in a Dog

A 5 mo old English setter dog was presented with mild left forelimb lameness. Physical examination revealed pain upon shoulder palpation and extension. Mediolateral radiographs of both shoulders showed a subchondral bone defect in the mid-portion of the glenoid cavity. Computed tomography arthrography and arthroscopy revealed a cartilage flap, suggesting osteochondritis dissecans of the glenoid cavity. Subchondral bone cysts of the glenoid cavity and incomplete fusion of the supraglenoid tubercle were also observed. Arthroscopic removal of the fragment led to a favorable outcome.

Ultrasonographic findings of shoulder teno-muscular structures in symptomatic and asymptomatic dogs

PURPOSE

B-mode sonographic evaluation of shoulder joint in dogs provides qualitative information concerning mainly tendon and muscles structures. Although the sonographic findings of tenomuscular lesions have been described previously, their frequency in symptomatic and asymptomatic patients has not been reported yet. Aim of the study was to describe and compare qualitative ultrasonographic findings of shoulder joint in clinically symptomatic and asymptomatic dogs and to speculate which lesions might be considered major responsible for lameness.

METHODS

Fifty-two dogs with shoulder lameness and 58 asymptomatic dogs (both with unremarkable radiographic findings) underwent ultrasonographic B-mode examination of the scapulohumeral joint. Lesions detected were recorded and statistically compared between groups.

RESULTS

Significant differences between groups were observed for the number of ultrasonographic abnormalities detected and for fluid accumulation, biceps brachii tendon (BT) lesions and bone surface irregularities. Sonography was considered useful for the determination of lesions absence and for the detection of BT lesions, fluid accumulation, muscle lacerations and bone surface irregularities. The odds for symptomatic dogs were greater than for asymptomatic patients to ultrasonographically diagnose BT lesions, fluid accumulation and bone surface irregularities.

CONCLUSIONS

Ultrasound has proven to be a useful tool in the evaluation of tenomusculoskeletal structures of shoulder in dogs with unremarkable radiographic findings. Our results suggest that ultrasonography is useful in the diagnosis of tendon abnormalities, fluid accumulation, muscle lacerations and bone surface irregularities as potential contributors to shoulder lameness in dogs.

Pathology of Gray Wolf Shoulders: Lessons in Species and Aging

We examined scapula glenoids (n = 14) and proximal articular humeri (n = 14) of seven gray wolves that were maintained in a sanctuary park setting. Immediately after death, observations were made visually in situ and by radiography. Further observations were made in a museum laboratory setting, prior to and following clearing of soft tissues. Selected dry bone specimens were evaluated using computed tomography. Significant cartilage erosion and osteoarthropathy were identified in all shoulder joints. No single evaluation method yielded maximal information. Plain film radiography revealed only more severe changes. Computed tomography yielded more detail and clarity than standard radiography. Direct examination of articular cartilage informed about joint soft tissue, and dry bone informed about externally visible bone pathology. These data provide a basis for biological, biomedical, ecological, and archaeological scientists to improve retrospective interpretations of bone lesions. They further support developing plausible differential diagnoses for features of ancient and modern animal bones. We noted a dog‐like capacity for wolf longevity in a non‐free‐roaming environment. However, aged wolves' life spans far exceeded those of similar‐sized domestic dogs and breeds, suggesting the possibility of an important species difference that should be explored. We suggest also a hypothesis that the driving force for joint pathology in sheltered non‐domestic species may relate significantly to achieving the longevity that is possible biologically, but is uncommon in the wild because of differential stochastic influences. Anat Rec, 299:1338–1347, 2016. © 2016 Wiley Periodicals, Inc.

Musculoskeletal MRI

MRI has the unique ability to detect abnormal fluid content, and is therefore unparalleled in its role of detection, diagnosis, prognosis, treatment planning and follow-up evaluation of musculoskeletal disease. MRI in companion animals should be considered in the following circumstances: a definitive diagnosis cannot be made on radiographs; a patient is nonresponsive to medical or surgical therapy; prognostic information is desired; assessing surgical margins and traumatic and/or infectious joint and bone disease; ruling out subtle developmental or early aggressive bone lesions. The MRI features of common disorders affecting the shoulder, elbow, stifle, carpal, and tarsal joints are included in this chapter.