Episode 18 – A Guide to Elbow Dysplasia Surgery with Board-Certified Surgeon Dr. Dominic Valenzano

Have you noticed your dog limping from time to time, stiff getting up after a nap, or reluctant to go up the stairs? It could be nothing, but for many dogs, that limp could be elbow dysplasia—a common, often genetic, developmental condition where the three bones forming the elbow joint (humerus, radius, ulna) do not fit together properly, leading to severe cartilage damage, bone fragments, and chronic pain.

Today, we talk about this often-misdiagnosed condition with Partner Veterinary’s board-certified surgeon Dr. Dominic Valenzano, who focused his research in vet school and residency on elbow dysplasia. In this episode, he tells us what signs to look for, how it’s diagnosed, what surgery entails, and the what the road to recovery looks like. We’ll also learn what happens if elbow dysplasia goes left untreated.

So, whether you’ve noticed subtle changes in your dog’s movement or just want to stay ahead of potential issues, this episode will give you the knowledge you need.

[Music]

Narrator:

Welcome back to Did You Know?, a podcast by Partner Veterinary. In this series, we dive into everything veterinary medicine and everything Partner. In each episode, we tackle some of the most common questions we hear — from HR to emergencies and everything in between. If it happens at Partner, we’ll talk about it.

So, when is a limp more than just a limp? You’ve seen it. Your dog takes a little longer to get up. Hesitates at the stairs. A subtle hitch in their step that’s gone by the afternoon. Easy to brush off. But for many dogs, those small signs point to elbow dysplasia — a developmental condition where the bones of the elbow just don’t fit the way they should. Left alone, it means cartilage damage and chronic pain. Caught early, the story looks very different.

Here to walk us through it is Dr. Dominic Valenzano, our newest board-certified veterinary surgeon at Partner in Frederick, Maryland. He built his research around this exact condition. We’ll cover the signs, the diagnosis, the surgery, and the road to recovery. Let’s get to it.

Dr. Dominic Valenzano:

My name is Dom Valenzano. I’m a veterinary surgeon and I’ll be starting at Partner in April. I originally went to school thinking I wanted to be an architect, and happened to get a summer job at a veterinary practice in College Park, Maryland. I loved it so much that I changed my whole career path and ended up getting a degree in bioengineering, which then helped me as I got into veterinary school. That’s kind of how I got on the path to veterinary medicine and surgery in general.

Jen Mellace:

Dr. Valenzano, thank you so much for joining us today and taking the time to chat with us. Today we’re going to discuss elbow dysplasia in dogs. For someone who’s never heard of this term before, how would you describe it to a pet owner?

Dr. Valenzano:

Elbow dysplasia is basically a developmental condition where the bones of the elbow don’t grow and fit perfectly together. It doesn’t necessarily mean one specific problem — it’s actually a group of a few different conditions. The common ones we often talk about are something called a fragmented medial coronoid, which is a little bone chip that comes off one of the bones. There’s also OCD, or osteochondritis dissecans, where there are erosions of the cartilage within the joint. There can be joint incongruity, where the bones grow at different rates and don’t line up perfectly. And then there’s something called an ununited anconeal process, where a portion of one of the bones fails to attach properly. All of these create pain and inflammation, and they tend to progress to arthritis as the patient ages.

Jen Mellace:

Elbow dysplasia was the main focus of some of your research in veterinary school and residency. What made you so passionate about treating this condition, and do you have a memorable case that sticks with you?

Dr. Valenzano:

When I mentioned the bioengineering aspect of my undergraduate degree, I think when I got to veterinary school there were a lot of research opportunities in orthopedics — many of them biomechanical studies looking to develop novel treatments for certain diseases. One of the ones I got into was a new treatment for elbow dysplasia. Because of my background, I was able to blend engineering, physics, and biological movement to offer a somewhat different perspective than the typical veterinary student. From there, I got more and more involved in orthopedics research, and several of my mentors during residency were heavily interested in elbow dysplasia as well. Learning from them over the years got me more and more interested.

Jen Mellace:

Do you have a case that kind of sticks with you through the years?

Dr. Valenzano:

Not necessarily one specific case, but when I think back, I can think of a few different cases that all presented in different ways and all required different treatment. I think because the disease is so complex, that’s probably part of what makes it interesting — but also frustrating to treat. Every patient may need something a little different, and even with the same treatment, they all respond in different ways. That’s part of what I find so interesting about it.

Jen Mellace:

Are there breeds more commonly affected, and is this something that owners of those breeds should be proactively watching for?

Dr. Valenzano:

Absolutely. There are definitely breeds that are over-represented. Mostly we see medium to large breed dogs, and we tend to see signs emerge early in their growth phase. The most common ones are Labrador Retrievers, German Shepherds, and Bernese Mountain Dogs — but I’ve certainly seen it in Pit Bulls and dogs around 30 pounds, as well as very large breeds. So it can appear in any dog, but those three are the most common.

Jen Mellace:

Is it more common in young dogs — do you see it more frequently when they’re younger?

Dr. Valenzano:

Yes, absolutely. When the disease is severe enough, dogs will often start showing signs between 4 to 12 months of age. Sometimes, because it might take a while to figure out what’s going on or the dog improves briefly before worsening again, we might not get a diagnosis until they’re one or two years old. If signs are mild or the dog isn’t seen early on, we can sometimes see them present much later — at seven, eight, or nine years old — when they’ve developed significant arthritis.

Jen Mellace:

What are the early warning signs a dog owner can notice on their own at home?

Dr. Valenzano:

If you have a young dog and you start to notice some sort of lameness in the front legs, that doesn’t always mean they’ll hold up their paw or refuse to use the leg entirely. When we’re looking for a dog limping on its front leg, we look for a head bob. The head will tend to come down on the leg they’re more comfortable on, and come up to take weight off the leg that’s bothering them. It can get a little tricky because elbow dysplasia often affects both legs. If the dog is trying to equally compensate on both sides, the head bob might not be as obvious. You might also notice it’s worse after play, that they seem stiff after getting up from rest, or that they’re generally reluctant to play, jump, or do the things a normal puppy would want to do when the condition is more severe.

Jen Mellace:

Yeah, having had two dogs that have gone through elbow dysplasia, sometimes it’s very subtle, but you catch it every once in a while. It is hard to go to the vet and say, “Hey, I see something, but I don’t know what I’m seeing.” But that head bob is definitely what I remember seeing.

Dr. Valenzano:

Definitely. And if it’s not something that’s occurring all the time, taking a video at home when you do see it can be really helpful. We can look at that video, slow it down, and try to figure out which leg seems more uncomfortable. Pretty commonly, dogs come to the vet full of energy and super happy to be there — especially young puppies — and they’re not going to show the same signs they might be showing at home.

Jen Mellace:

That’s a good point. I actually remember doing that — taking videos as we were walking, trying to capture it. Can you walk us through what happens when a dog comes in suspected of elbow dysplasia, and what the diagnostic process looks like?

Dr. Valenzano:

Usually the first thing is a really thorough orthopedic exam. We want to watch the dog walk around — which is another reason why those home videos can be so helpful — and then we’ll feel all the bones and joints in the legs and put them through a range of motion. Some common findings include pain when fully flexing or extending the elbow, or when pressure is applied to certain areas. It’s also important to check for other orthopedic conditions at the same time, because dogs can have problems in both the elbows and the shoulders, or elbows and the wrists. We want to identify where the pet seems most uncomfortable and use that to narrow down the testing.

X-rays are probably the more common starting point for assessing elbow dysplasia. With that said, they’re really not the most sensitive test. Some reports suggest that maybe only 65% of cases are caught on X-rays alone, and I think it’s because it’s a complex joint where three bones come together and it’s difficult to see clearly on a 2D image. So what surgeons generally recommend is a CT scan as the first-line imaging test. This gives us essentially a 3D X-ray of the elbow. We’ll often image the shoulder, elbow, and wrist at the same time to make sure we’re not missing anything else. The gold standard for imaging is arthroscopy — putting a small camera directly into the joint — but that’s typically done at the same time as treatment.

Jen Mellace:

So would you do the CT scan before the arthroscopy?

Dr. Valenzano:

Yes. We’ll typically do a CT scan first, take time to review it, and assess how severe the disease is. We’re often looking for bone fragments and other findings to determine whether there’s something worth treating.

Jen Mellace:

If a dog is diagnosed with elbow dysplasia, does that automatically mean surgery?

Dr. Valenzano:

Not always. It really depends on the severity of the disease and sometimes its progression. If we’re seeing large bone fragments, obvious sources of pain, or pretty severe cartilage erosion, those are typically the dogs we’d recommend surgery for. If signs are mild and there are no severe abnormalities, it becomes more of a conversation with the pet parent. We might say something like: if you want to be 100% sure there’s nothing abnormal, we can always go in and check — it’s a minimally invasive procedure, and we’ll know for certain. Or we can continue to monitor and pursue medical management, which can work well for many pets.

Jen Mellace:

Is a joint injection something that’s used if surgery is not an option? Can a joint injection with hyaluronic acid, for instance, be beneficial?

Dr. Valenzano:

Yes, we’ll often use injections in addition to surgery, or they can certainly be used in place of it. The most common thing I’d recommend is PRP, or platelet-rich plasma. The important thing to understand about PRP is that it’s not necessarily going to regrow normal cartilage or make things new. But it’s very effective at decreasing inflammation within the joint, and in a variety of orthopedic scenarios it has been shown to get patients back to a more functional and comfortable level more quickly.

Jen Mellace:

If a patient goes through surgery for elbow dysplasia, can this injection be used later down the road if they seem uncomfortable again?

Dr. Valenzano:

Yes, you can certainly use PRP down the line on an intermittent basis. It is a low-risk procedure, but it does involve using the patient’s own blood — spinning it down and separating out the platelet-rich plasma portion and then injecting it into the joint — so there’s a low risk of infection, and it requires sedation each time, with an associated cost. I don’t see a lot of patients coming in three times a year for it, but once a year or as they age and their arthritis becomes more significant could be a great time for it.

Jen Mellace:

How important is catching this early, and is there a window of opportunity for the best outcomes?

Dr. Valenzano:

Catching it early is really important. Because every patient is different, it can sometimes be difficult to catch it early. But where we feel best about intervening is when they’re under two years old. Once arthritis really starts to progress, it’s another conversation — if the owner wants to try everything possible, we can certainly go in and perform certain procedures, but it becomes less effective and there’s more uncertainty about what the response will be. The other reason early diagnosis matters is that a lot of the surgical procedures we do are really just the starting point of treatment, because this is a disease we’re managing, not necessarily curing. Diagnosing it early allows us to set up the patient for lifelong management and monitoring so they can do well at every stage of their life.

Jen Mellace:

When we’re talking about surgery — if a dog does need to go down that path — are there different surgical approaches, and how do you decide which one is right for a particular dog?

Dr. Valenzano:

If you start looking online, you’ll find 10, 20, maybe more different surgeries that have been designed for this condition. Unfortunately, what that means is that there’s no single treatment that works best for every patient, and no single treatment that’s an instant cure or the best option across the board. You can broadly separate treatment types into two categories: minimally invasive arthroscopic fragment removal, which is definitely the most common procedure most surgeons will perform, and more involved bone-cutting techniques.

With arthroscopic surgery, we put a small camera and instruments into the joint. If there are bone fragments, we remove them. If there’s abnormal cartilage, we clean that away to expose healthy, vascularized bone underneath, and we’ll often pair that with platelet-rich plasma and rehabilitation afterward. The bone-cutting procedures aim to change the biomechanics of the joint and redistribute where the load falls. I wouldn’t say any one of those particular procedures has really taken off and become widely adopted, but there are quite a few out there with varying levels of research behind them.

Because elbow dysplasia is complex and involves several different components, we also look at congruity. Sometimes we’ll find that either the ulna or the radius — the two bones in the forearm — is longer than the other, which creates an uneven joint surface. In those cases, we can sometimes cut a small fragment of bone to allow the joint to re-establish a normal, level surface. That is, I think, more commonly needed than some of the other procedures.

Jen Mellace:

So that would even out their gait, so they’re not putting so much pressure on one leg?

Dr. Valenzano:

Yes. It would even out the gait, but more specifically it would even out the joint surface itself — so the bones are gliding more smoothly together.

Jen Mellace:

Aside from the usual risks associated with surgery, are there specific risks related to elbow dysplasia surgery?

Dr. Valenzano:

Within the surgery itself, beyond anesthesia, there’s usually not a great deal of risk. There’s always a low risk of joint infection. The incisions are typically quite small, so incisional infection is possible but uncommon. What we typically see is that the patient will get a bit worse in the first week or two afterward as the inflammation from the procedure settles down, and then they start to make progress after that. I think you have to be prepared for that initial period. The other important thing to keep in mind, as we’ve already touched on, is that arthritis is going to progress over time no matter what in these patients. We’re doing our best to minimize that progression and manage their activity and lifestyle on an ongoing basis.

Jen Mellace:

That leads into what we were going to discuss next — recovery and life after surgery — because like you said, this is not a cure-all. What happens after surgery is really, really important. What does the recovery journey look like, and what should owners expect in the days, weeks, and months after the procedure?

Dr. Valenzano:

Recovery will vary somewhat by surgeon, but typically for the first two weeks, dogs will be on oral pain medication and we advise pretty strict rest at home. That usually means being confined to a small area where they’re not jumping or playing with other dogs. They can go out for short leashed walks and then rest when they come back inside. I always joke that I have the easy part — I just have to do the surgery, and then the owners have to keep their one-year-old Labrador calm afterward. That’s much harder.

But it really is important, because especially after the initial surgery, we want to let the initial inflammation and discomfort settle down. After those first two weeks, we’ll start to increase activity, but we want it to be controlled — on a leash, avoiding high-impact activities like running and jumping. The jumping down in particular can really irritate things, since they’re landing on their front legs. From two to six weeks, it’s about gradually easing back into normal activity. By week seven or so, they shouldn’t be going for an off-leash run at the dog park for two hours. We want to build up over time and take cues from the dog to make sure they’re comfortable.

Jen Mellace:

Physiotherapy and rehabilitation are really crucial when it comes to elbow dysplasia and what the animal will look like moving forward. What role does the owner play at home when it comes to that?

Dr. Valenzano:

Rehab is really important. There are honestly some studies showing that for certain patients, rehab can be just as effective as surgery for treating elbow dysplasia — and I think a combination of both is probably going to give us our best outcomes. A lot of the goals of rehab are to build strength, restore range of motion, and improve comfort. It really can help improve long-term outcomes. We can set up an at-home rehab protocol for pet owners to do different exercises with their pet throughout the healing process — everything from gentle range of motion work to specific walking patterns or stepping over objects. There are also places that offer more formal rehab programs, which are great. They have a lot more tools available, like underwater treadmill therapy, laser therapy, acupuncture, and shockwave therapy. So a combination of surgery followed by rehab and physiotherapy, I think, will give us the best outcome for most of our orthopedic patients.

Jen Mellace:

Can a dog who’s had elbow dysplasia surgery go on to live a full and active life?

Dr. Valenzano:

Absolutely. What we’re hoping for is that once we’re two to four months out from surgery, the dog should be able to run, play, and do all the things a young dog would normally do. Because the elbow will never be completely normal, if they have a day where they play really hard or go on a very long walk, they might be a little sorer afterward. So it’s okay to use pain medication as needed on those days. And as they age and arthritis starts to develop, we’ll need to modify their lifestyle accordingly. Probably the most important factor from a medical standpoint is weight management. The heavier the dog, the more weight and force is placed on the joints, and the harder things will be. A large part of why early diagnosis matters is that if we can start keeping a close eye on their weight from the very beginning, that’s going to result in much better lifelong function and comfort at every life stage.

Jen Mellace:

I know I have family members who say to me, “Your dogs are so skinny.” But they’re not — they’re really healthy and lean. And it does make a huge difference on their joints. So, what are your thoughts on supplements that can help? For instance, I have my dogs on Adequan, Welactin, and Dasuquin. What are your thoughts on things like that helping on a day-to-day basis?

Dr. Valenzano:

I think a lot of those can be really great options. The evidence on some of them is mixed, and many — particularly the omega-3s — are very dose-dependent, with some products better regulated than others. But in general, things like glucosamine, fish oils, and Adequan are all helpful. There’s also some evidence that certain CBD supplements can be beneficial for dogs with arthritis. What’s important is that you research the specific product you’re giving and make sure it’s appropriate and safe for your pet.

Jen Mellace:

If a listener is sitting at home wondering whether their dog’s limping could be elbow dysplasia, what’s your advice to them right now?

Dr. Valenzano:

I think we often get asked whether a dog is actually in pain. Typically, if your dog is limping or not wanting to use a leg, it’s because there’s some discomfort there. There are some lamenesses that are more mechanical in nature, but for the most part, limping is related to discomfort. Not every time your dog limps do you need to rush to an orthopedic surgeon — but if you’re seeing a recurring lameness, where every time they play hard they’re limping, or every time they get up in the morning they seem stiff, then it’s probably worth having it checked out. That kind of pattern usually means it’s not something that’s going to resolve on its own with a few weeks of pain medication and rest.

Jen Mellace:

Dr. Valenzano, thank you so much for taking the time to talk to us about this. It’s definitely a complex topic, and I think this really helped shed a lot of light on it. Thank you.

Dr. Valenzano:

Thank you for having me.

Narrator:

“Thank you for listening to ‘Did You Know?’ Is there something about Partner that you want to know? Email us at [email protected]. Who knows? We might turn your question into an entire episode! And you can now find us wherever you listen to all of your other favorite podcasts. Subscribe now!”