Enzo: When a Subtle Lameness Points to Elbow Dysplasia
A case from the orthopedic consultation room – objectified with the LupoGait gait analysis system
Not every lameness is obvious at first glance. In young, large-breed dogs especially, early joint changes can stay hidden for a long time before they become clinically apparent. The case of Enzo, a two-year-old Labrador, illustrates how combining clinical examination, imaging, and objective gait analysis can uncover early elbow dysplasia (ED) with a beginning FCP lesion and why exactly this combination is key to a reliable diagnosis.
History
Enzo, a two-year-old Labrador, was presented at the orthopedic consultation after his owners had noticed an intermittent lameness of the right forelimb for about two months. Notably, the symptoms worsened after exercise, an observation that carried significant weight in the further work-up.
Clinical Examination
Even while sitting, a flexed posture of the right shoulder limb was apparent: the limb was held retracted, and the right point of the shoulder was clearly set back compared to the left side. On gait examination, a swing-phase (non-weight-bearing type) lameness of the right forelimb was evident. The affected limb was not fully protracted, and both flexion and extension were reduced. An occasional slight head nod was observed – a typical sign of a painful forelimb lameness. The movement pattern resembled a “Charlie Chaplin gait,” caused by a slight varus positioning of the forelimb, particularly on the right.
Palpation revealed marked atrophy of the right M. supraspinatus, along with restricted flexion of the elbow joint and reduced pronation and supination of the affected limb. The left side was unremarkable.
Diagnostic Imaging
Radiographs of the right elbow joint showed a rounded, poorly defined contour of the medial coronoid process of the ulna, along with a slight irregularity of the joint space. These findings are consistent with early elbow dysplasia, specifically a disease process affecting the medial coronoid process (FCP), particularly within the medial compartment.
Imaging provided an important piece of the puzzle, but structural changes alone don’t always explain the full extent of functional impairment. This is exactly where objective gait analysis came in.
Functional Gait Analysis with LupoGait
The subsequent motion analysis using the 12-sensor LupoGait system confirmed and quantified the clinical impressions. Stance phase duration was significantly shortened on the right and markedly asymmetric across the humerus and radius compared to the left forelimb. Range of motion (ROM) in the right elbow was also clearly reduced relative to the left. In addition, a slightly reduced vertical acceleration/peak force was noted in the right elbow.
Together with the shortened stance phase, this provided a clear, objectively measurable indication of functional off-loading of the affected limb, a finding that reinforced the subjective clinical impression with reproducible data.
Nerve Block and Re-Evaluation
To further differentiate the source of pain, a targeted diagnostic nerve block was performed. The radial nerve, ulnar nerve, and medial antebrachial cutaneous nerve were locally anesthetized. Thirty minutes after injection, the gait was re-assessed both visually and kinematically.
The difference was clinically striking: Enzo moved in a more relaxed and even manner, the previously observed head nod was no longer detectable, his sitting position was symmetrical, and both extension and flexion of the left limb had visibly improved.
The kinematic measurements confirmed this clinical impression. Stance phase durations of the humerus and radius on the left became noticeably more even relative to the right side, driven by a prolonged stance phase on the right forelimb. ROM, particularly in the radius, also improved. Interestingly, the marked improvement on the left side also pointed to a previously unnoticed compensation pattern in the left forelimb – an effect that would likely have gone undetected without the before-and-after measurement. Peak vertical force increased in the forelimbs, while the hindlimbs bore less force than before, a further sign of compensation within the musculoskeletal system.
Interpretation and Clinical Assessment
The combination of clinical examination, diagnostic imaging, and objective gait analysis supports a diagnosis of right-sided elbow dysplasia with a source of pain in the medial joint compartment. The immediate improvement following local anesthesia suggests an inflammatory component or a possible structural lesion, such as an early FCP (fragmented medial coronoid process).
The persistence of a slight difference in peak vertical force also suggests that, alongside the pain component, functional or already chronic structural changes may be playing a role.
Next Steps
A further CT examination was recommended for structural work-up. In parallel, a rehabilitation-focused exercise program was initiated to restore muscular balance and joint function. Follow-up LupoGait measurements are planned to objectively monitor treatment progress.
Conclusion
Enzo’s case illustrates the value of combining classic orthopedic assessment with objective gait analysis in daily practice: while palpation and radiographs point toward a structural lesion, kinematic measurement reveals the functional consequences – and provides reproducible reference values for diagnosis, treatment decisions, and later follow-up. Especially in subtle, intermittent lameness cases like Enzo’s, this kind of objectification can make the crucial difference in detecting early elbow dysplasia and treating it in a targeted way.
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