Primary and concomitant flexor enthesopathy of the canine elbow

To report the characteristics of two types of flexor enthesopathy, primary and concomitant, based on different diagnostic techniques.

Over a period of three years a prospective study was performed on dogs admitted for the complaint of elbow lameness. Based on the radiographic findings a selection of dogs underwent a complete series of different imaging modalities. With each technique, pathology of the medial epicondyle and the presence of other elbow disorders were recorded. All joints with signs of flexor pathology apparent with at least three techniques were selected. A distinction was made between primary and concomitant flexor enthesopathy based on the absence or presence of other elbow disorders.

Primary flexor enthesopathy was diagnosed in 23 joints and concomitant flexor enthesopathy in 20 joints. In 43% of the joints with primary and in 75% of the joints with concomitant flexor enthesopathy, pathology at the medial epicondyle was demonstrated by all techniques. All joints with concomitant flexor enthesopathy had a diagnosis of medial coronoid disease, osteochondritis dissecans, or both.

Pathology at the medial epicondyle is a sign of flexor enthesopathy. It may be present as the only sign in a joint with primary flexor enthesopathy or concomitant with other elbow pathology. In both groups flexor lesions can be demonstrated with different imaging techniques. The distinction between the primary and concomitant form is based on the presence or absence of other elbow pathology, mainly medial coronoid disease. Recognizing both types is important for a correct treatment decision.