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Elbow incongruity

Elbow incongruity: a non-fitting joint

Although there is still some debate about the impact of elbow incongruity on a joint, two pathological forms have been described: on the one hand, uneven growth between the radius and ulna, resulting in a “stub” in the joint, and on the other hand, a poorly fitting elbow joint.

An ulna that is too short can lead to the development of a loose anconeal process. It is likely that elbow incongruity is also one of the factors contributing to the development of medial coronoid disease.

Elbow incongruence is frequently seen in Bernese Mountain Dogs, but also occurs in other breeds with elbow dysplasia.

The symptoms usually start around 4 to 6 months of age. Because it often occurs together with other forms of elbow dysplasia, it is not always easy to determine whether the symptoms are caused by incongruence or another elbow problem. The more severe the incongruence, the greater the chance that the dog will actually limp.

Joint incongruity can be diagnosed using radiography, CT and arthroscopy. In cases of severe joint incongruity in young dogs, in addition to arthroscopic treatment of the joint, an additional surgical procedure is sometimes performed to improve the fit of the joint: an ulnotomy. In an ulnotomy, the ulna is cut at an angle so that the bone can be slightly repositioned, thereby reducing the “step” in the joint.

Photo - A 7-month-old Swiss White Shepherd with medial coronoid disease and elbow incongruity. The radiograph (left) shows early osteoarthritis. During arthroscopy, a loose piece of the medial coronoid was identified (above) and, after removing the piece, a clear difference in level (step) was observed between the radius and the ulna (below). It was therefore decided to also perform an ulnotomy (right).