Diagnosis of canine elbow dysplasia and treatment with extracorporeal shockwave therapy

Objective: To provide a video tutorial on assessment and diagnosis of canine elbow dysplasia and treatment with extracorporeal shockwave therapy. Animals: Dogs undergoing shockwave therapy for therapeutic purpose. Methods: Assess the patient through gait analysis and examination. Elbow discomfort is investigated with diagnostic imaging (CT scan or orthogonal radiographs) to confirm a diagnosis of elbow dysplasia and secondary osteoarthritis. Prepare the elbow for treatment by shaving the hair over the target anatomy, cleaning the skin with 70% isopropyl alcohol, and applying coupling gel. Select appropriate shockwave settings and standoff for the patient. Position the trode perpendicular to the medial elbow joint and deliver the treatment while slowly moving the trode over the medial humeral epicondyle, medial coronoid process, and medial joint capsule attachments. Repeat the process on the lateral aspect of the elbow. The treatment can be repeated in the contralateral elbow if indicated. Record treatment including the number of shocks delivered and energy flux density in mJ/mm2. Shockwave therapy can be prescribed as a series of 3 treatments followed by reassessment. Assessment after a treatment series is necessary to quantify response to the therapy and determine whether treatment should be continued. Results: Shockwave therapy is a noninvasive therapy that causes the release of growth factors and anti-inflammatory cytokines that improve analgesia and encourage better healing. Clinical Relevance: Shockwave is a simple noninvasive therapeutic option for management of secondary elbow osteoarthritis. With appropriate diagnosis of the underlying condition, shockwave can be easily applied to the target anatomy for maximal analgesic effect and functional improvement.