Osteochondritis or OCD

OCD surgery in Cheasapeake

Question: Dear Dr. Mike,

My 11 month old Chessie has been favoring his left shoulder for several months. He has had X-rays however no "visible" signs of cartilage tears were visible. There is a clear difference between left and right shoulders and some arthritic evidence can be seen developing in the left shoulder already. Our vet would like to have his orthopedic surgeon do exploratory surgery on Monty's left shoulder. He said that given his age, breed, gender, and symptoms, OCD is the likely problem.

My questions are 1) how can X-ray be used to determine cartilage problems. Shouldn't magnetic resonance be used? 2) If a flap has torn off and it has moved into recessed parts of the shoulder, how would this be visible by X-ray, what could be done to remove it and how will exploratory surgery help?

Our Chessie is an avid bird hunter and duck retriever and does not enjoy lounging around. It is very difficult to lower his high energy. I'm worried that surgery and recovery will be too traumatic for him and us.

I would appreciate your thoughts.

Sincerely, Ken

Answer: Ken-

My understanding of the situation with osteochondrosis dissecans ( OCD ) is that there is an underlying bone defect that leads to the cartilage flap and that the bone defect is visible on radiographs. It can be hard to find, as this tends to show up only at certain angles on the X-ray view and there is an element of luck involved in choosing exactly the right angles. In some cases the cartilage flap calcifies and becomes visible on X-rays. If there are visible joint mice (loose pieces of bone consistency tissue, usually a calcified piece of cartilage that has torn off the bone) in the joint, it is really really likely that OCD is the cause in a large breed dog in this age range.

It would be a good idea to X-ray your Chessie's elbows, too, though. This has probably been done, but elbow dysplasia seems to be pretty common in Chesapeake Bay retrievers in my practice area, so I had to mention it. It won't change the fact that there are shoulder problems, but it could make a difference in decision making on surgery.

I think you are probably right that this sort of lesion would show up a lot better on an MRI. If you want to be really sure of this diagnosis prior to surgery I would think it would be possible for your vet to find a referral center that could do an MRI. Using contrast dyes safe for joints can also help to show a defect.

The surgery has two objectives --- remove stuff that might be irritating, such as cartilage flaps, joint mice and osteophytes (visible ridges of arthritis) and curette the damaged area down to healthy bone so that fibrocartilage will form over the area. This isn't quite as good as articular cartilage but it relieves the pain in most dogs and helps to slow or stop further degeneration of the joint.

This may occur in the other shoulder, even though it looks good now.

Even my medical textbooks only discuss surgery as a treatment option for this condition. Ignoring the problem is an approach taken by many of our clients with wide variations in success. Some dogs do seem to reach a point where they are comfortable after a month or two, even without surgery. Most dogs develop arthritis and it makes them uncomfortable for more than a month. They may adapt to some level of discomfort and do OK for several years but often there is a gradual worsening of the arthritis and it becomes a clinical problem again later in life. So we recommend surgery for this condition when we think it is present, too.

If I didn't answer the question about what surgery does, well enough, please feel free to write back. Recovery from this particular surgery is not usually too traumatic, as confinement is only necessary for a day or two and restricted exercise is only necessary for about a month.

Hope this helps some.

Mike Richards, DVM 5/17/2000

OCD causes

Q: Thank you very much for such a quick reply. We are going to try Glucosamine and Chondroitin and I will let you know what we think. Just one other thing. Do you have any information on the causes of OCD? I've heard of:

Nutrition - TOO MUCH protein, calcium is that so?

Is there a hereditary factor?

Could it be related to trauma, or walking/running on hard ground like concrete?

Thank you once again for your help. --------

A: Elizabeth-

At the present time the nutritionists who I trust the most believe that excessive protein is a minor factor in the development of OCD. The hereditability of OCD is not fully known but it is thought to be a disorder that is at least partially influenced by heredity and some veterinary researchers believe it is strongly influenced by heredity.

Other than heredity the identified risk factors include living in a multi-dog household, drinking well water instead of city water (which the authors of the study that uncovered this link think relates to the increased opportunity for exercise among rural dogs), excessive caloric intake and excessive calcium in the diet. It is hard to separate excessive calcium intake from excessive caloric intake because they are usually related.

The best way to avoid orthopedic diseases that are influenced by heredity and environmental occurrences in puppies is to keep them thin while they are growing up. Being overweight by even a small amount seems to predispose active puppies to orthopedic diseases such as hip dysplasia, OCD and elbow dysplasia. In big breed puppies keeping them thin enough to see three to five ribs easily is best. The problem is that most people think that is too thin, including the neighbors and other casual observers who feel free to comment on the puppy's appearance. It makes it hard to stick to the plan and help reduce orthopedic illnesses when the neighbors are threatening to call the humane society and turn you in for starving your puppy. But thin is good until they are grown.

Since excessive exercise appears to be the reason behind the multi-dog household and well water problems it is likely that running and playing on concrete is bad for puppies predisposed to this condition, too.

One last thing --- controlling weight is also the single factor most likely to reduce chronic pain associated with degenerative joint diseases, too. It is reported to outperform administration of aspirin but I haven't seen a comparison to the newer medications like carprofen (Rimadyl Rx) and etodolac (Etogesic Rx).

Mike Richards, DVM

OCD treatments - - Labrador

Q: My labrador puppy, Glasha, was diagnosed with Osteochondritis Dissecans in her left shoulder when she was 6 months old. She had surgery for this on 21st September 1998 and recovered well with no swelling. She had cage confinement for 10 days, followed by 20 days of walking only exercise, of 5 minutes and building up to 10 minutes three times a day. Then the exercise was increased to include some free running on level ground, followed by running with other dogs on level ground. Lameness in her RIGHT shoulder appeared end of October and xrays have shown a possibility of OCD in this shoulder. Two days ago we also noticed a lameness had returned in the left shoulder, albeit of a temporary nature. I have read through your answers to various people regarding OCD and found them very helpful. I noticed that Glucosamine (with Chondroitin) may be helpful for existing arthritic conditions. Would it also assist in the prevention of future arthritis? You also mention Cosequin - what is this? would it be helpful as well, or instead? I can purchase Glucosamine (with Chondroitin) as a non-branded product for human purposes but I'm not sure how much Glasha should have. Each tablet contains 400 mg Glucosamine plus 100 mg Chondroitin Sulphate - human dose is 2 tablets a day, would you be able to guide me on the dose for a 55 lb labrador bitch (now 8 months old).

A: Elizabeth-

I have searched for a general dosage recommendation for glucosamine and glucosamine/chondroitin sulphate combinations and have not been able to find one. There is general agreement that these products are safe, so overdosage is not likely to cause medical problems although it might cause some financial discomfort due to the cost of these products. It would be reasonable to give the adult human dosage if you wish to try the product you have access to at this time.

Cosequin (TM) is a patented combination of glucosamine, chondroitin and manganese. The company that manufactures this (Nutramax) has funded studies to support its use and most of the studies dealing with these types of products that have made it into the veterinary literature have been done using Cosequin. So far, I still think there is some question of efficacy based solely on the literature but there are a lot of people that think these products work and they appear to be reasonably safe, so I can't argue much with their use.

There was a study using Adequan (Rx), an injectable product that is related to the oral glucosamines in its functionality that was shown in one study (and only one that I am aware of) to be somewhat protective against the degenerative effects of hip dysplasia when given during the growth phase to try to limit damage from inflammatory changes. If the oral products are effective there is no reason I can think of to believe they wouldn't also be protective in this situation or similar situations. They may help with the changes associated with OCD in that case. I know that is really non-committal but it is early still in the evaluation of these products on a scientific basis.

It is unfortunate, but it isn't uncommon for dogs with OCD in one shoulder to develop the disease in the other one later, or concurrently. It is also not uncommon for dogs to have more than one orthopedic problem. In breeds that are also prone to hip dysplasia and elbow dysplasia it is a good idea to consider the possibility of a second problem when lameness recurs in an affected limb. I certainly hope that isn't the case but if the left leg continues to be sore it would be worthwhile to consider the possibility of another problem. There are still degenerative changes in many joints after surgery for OCD, though. Occasional bouts of minor lameness are not unexpected as a result of this.

If you have any further questions I hope I can be a little more precise in answering them and would be glad to try.

Mike Richards, DVM

ODC in Hock - Rottie

Q: Dear sir,

I have read some of your articles on the internet and thought you may be just the person to give me some information on a disease our dog has just been diagnosed with. We have a 1 yr old Rottweiler that has just been diagnosed with OCD in her left hock. The radiologist has told us that the lesion is very small and that arthritis is already present. She does show signs of lameness and her hips have been x-rayed and have came back good. Her right hock was also x-rayed and nothing was found. We were wondering if you could give us any information on this disease of the HOCK(all articles we have read are not involving the hock). I already understand the disease, what I would like to have is some info. on treatment of the disease. My veterinarian has recommended surgery but I have heard that surgery probably won't help this because is is a very difficult place to treat. Also, any info you could give me on arthritis would be appreciated. Thanks in advance. Jaida

A: Jaida-

OCD of the hock is most common in Rottweilers but has been noted in other breeds. Due to the prevalence in Rotts it is assumed by many veterinary authors that a genetic component is likely.

Surgical repair of OCD lesions in the hock, if they can be treated early, is strongly supported by veterinary orthopedic surgeons, who really seem to feel that it is helpful in increasing long term mobility and decreasing the severity of secondary arthritis formation. I can not remember the author or publication but I have seen at least one report that followed several patients after surgery and several patients that did not have surgery. The author or authors felt that there wasn't a lot of difference in the amount of arthritis in the two sets of patients. I think that there is a general agreement that even though some improvement is likely with surgery it will not preclude the need someday for medical treatment of arthritic symptoms associated with OCD. I have a very hard time advising clients in my own practice about having surgery for this condition. If cost is not a factor at all, I think I would definitely consider surgery. If cost is an important factor it is much much harder to figure out whether or not the benefit of surgery justifies spending limited funds available for care of the pet.

At the present time there is some evidence to suggest that glycosamines (Arthroflex TM, Gluco-Tabs TM, Glyco-Flex TM) and combination products like Cosequin (TM) are beneficial in reducing inflammation associated with degenerative joint diseases over the long term. These products have no known side effects and are safe to try even if they don't work well for your pet. Aspirin can be used safely for long periods in many dogs but does cause gastro-intestinal upset in some dogs. This can lead to ulcers if signs of the problem are ignored, such as continuing to give aspirin when a dog isn't eating. Carprofen (Rimadyl Rx) is a very good anti-arthritic medication. It causes liver damage in a small number of dogs and should be discontinued if there are signs such as inappetance, depression, vomiting or anything else that is worrisome after administration. It can make a huge difference in the comfort level of a dog with arthritis and is the best non-steroidal medication for this condition that I know of.

Mike Richards, DVM

OCD and arthritis in Lab

Q: Dear Dr. Mike: Thank you for providing a wonderful, useful website. Our yellow lab, Jake, developed OCD in his right elbow at age 6 months. We had it operated on and he consequently developed arthritis in the joint as well as another OCD in a knee, which we chose not to oeprate on. He is now 2-1/2 and slightly lame, but comfortable. We give him one asprin per day and two cosequin capsules. We try and massage the aflicted joints when he is resting and today, when he pawed at me for attention, I felt the joint "grind". It seemed to be rather rough when he moved it. I'm not sure if it was ligaments but assume it is the joint. I will contact our vet, but any opinions, advice or comments will be appreciated. Thanks! Steve

A: Steve- I am assuming you are referring to the elbow since Jake was pawing at you. It is not unusual for arthritis in the elbow to produce noticeable grinding. It might go on for long time before there is severe disability. You probably could use a higher dosage of aspirin (ask you vet). If the current treatment loses effectiveness carprofen (Rimadyl Rx) or Adequan (Rx) may be helpful as well. I am not aware of a surgical procedure that will help after degenerative joint disease sets in.

Mike Richards, DVM

OCD and Hip Dysplasia connection

Q: I have a five month old Kuvasz that has a limp with its front leg, and I have heard some things about OCD, etc., with these dogs. The online lit and our Vet has recommended aspirin (as does your site) to see if the lameness is simply a sprain. There seems some controversy over whether a dog with this problem may in fact be a strong candidate for hip dysplasia later. Your comments are appreciated. The dog was imported from Canada, and carries a three year warranty, but I wanted to hear a general commentary on this. Thanks. John

A: There is evidence that hip dysplasia may be part of an larger syndrome of problems affecting bone. The current theory, as I understand it, is that the changes leading to hip dysplasia may be occurring in multiple sites in the bones but that it shows up best in the hip joint, leading to the tendency to focus attention there. I do not know of a link between OCD and hip dysplasia that has been firmly established but there has been some speculation about a connection. While it would not surprise me if we find an underlying syndrome leading to several of the common orthopedic problems I can say for sure that this will happen at this time. I would continue to check reference sources for information on this over the next few years, though.

I often recommend a short course of conservative treatment in conditions such as this, too. If your dog continues to limp at this time, though, please talk to your vet about elbow and shoulder X-rays. If you would contemplate surgical correction for something like elbow dysplasia it should be done early in the course of the disease, if possible.

Mike Richards, DVM

Osteochondritis (OCD)- treatment

Q: Dr. Mike...I very much enjoyed browsing through your web site. I was searching for information on non-surgical treatment for OCD. Our 6 month old male Bernese is suspected of having the condition. He was x-rayed last week and our vet showed me the x-rays pointing out the somewhat flattened areas of the humer bone of both shoulders. For the untrained eye such as mine, the condition was not readily apparent. Although Eli limps on his left front leg, our vet said the condition exists in both shoulders. Another thing is that Eli shows no whimpering or any other vocalization of pain. For the moment Eli is on 25mg of Rimadyl per day. At times Eli seems quite frisky but shows some lameness upon getting up from resting fro a while. Are any other treatments for this condition possible other than surgery on both shoulders? Mark

A: Mark- I think that most orthopedic surgeons and probably most veterinarians consider surgical correction of OCD to be preferable to non-surgical treatment. There has been at least one study supporting non-surgical treatment consisting of rest and analgesic administration but the dogs were only followed for four years or so and several orthopedic surgeons I have spoken with feel that there is eventually sufficient degeneration of the joints. Their feeling is that the study did not follow these dogs long enough to really be accurate. Some dogs do OK without surgery. If six weeks of confinement and analgesic therapy resolve the lameness there may be no need for surgery. If not, it can be done at that time or even later.

Osteochondritis lesions can be hard to see, even for vets. The damaged area of cartilage may be relatively small or located in a position it is hard to highlight on X-rays. Any visible lesion should probably be considered to be significant when lameness is present.

Mike Richards, DVM