The prevalence of medial coronoid process disease is high in lame large breed dogs and quantitative radiographic assessments contribute to the diagnosis

Medial coronoid process disease is a common leading cause of thoracic limb lameness in dogs. Computed tomography and arthroscopy are superior to radiography to diagnose medial coronoid process disease, however, radiography remains the most available diagnostic imaging modality in veterinary practice. Objectives of this retrospective observational study were to describe the prevalence of medial coronoid process disease in lame large breed dogs and apply a novel method for quantifying the radiographic changes associated with medial coronoid process and subtrochlear‐ulnar region in Labrador and Golden Retrievers with confirmed medial coronoid process disease. Purebred Labrador and Golden Retrievers (n = 143, 206 elbows) without and with confirmed medial coronoid process disease were included. The prevalence of medial coronoid process disease in lame large breed dogs was calculated. Mediolateral and craniocaudal radiographs of elbows were analyzed to assess the medial coronoid process length and morphology, and subtrochlear‐ulnar width. Mean grayscale value was calculated for radial and subtrochlear‐ulnar zones. The prevalence of medial coronoid process disease was 20.8%. Labrador and Golden Retrievers were the most affected purebred dogs (29.6%). Elbows with confirmed medial coronoid process disease had short (P < 0.0001) and deformed (～95%) medial coronoid process, with associated medial coronoid process osteophytosis (7.5%). Subtrochlear‐ulnar sclerosis was evidenced in ～96% of diseased elbows, with a significant increase (P < 0.0001) in subtrochlear‐ulnar width and standardized grayscale value. Radial grayscale value did not differ between groups. Periarticular osteophytosis was identified in 51.4% of elbows with medial coronoid process disease. Medial coronoid process length and morphology, and subtrochlear‐ulnar width and standardized grayscale value varied significantly in dogs with confirmed medial coronoid process disease compared to controls. Findings indicated that medial coronoid process disease has a high prevalence in lame large breed dogs and that quantitative radiographic assessments can contribute to the diagnosis.     

Treatment of fragmented coronoid process in young dogs by proximal ulnar osteotomy

Fragmented coronoid process in 13 elbows (10 dogs) was treated by medial elbow arthrotomy plus osteotomy of the proximal ulnar diaphysis. All the dogs were skeletally immature and had a lameness of at least four weeks' duration. An attempt was made to measure the disease-modifying effect of this procedure by estimating the development of osteophytosis. Complications were infrequent and never serious. Clinical outcome, overall, was good. This preliminary work indicates that proximal ulnar diaphyseal osteotomy may have a place in the management of fragmented coronoid process in young dogs.     

COMPUTED TOMOGRAPHIC FINDINGS OF DOGS WITH CUBITAL JOINT LAMENESS

The purpose of this study was to identify the incidence of abnormal computed tomography (CT) findings in dogs with lameness of one or both elbows. CT examinations of 102 elbows in 51 dogs were reviewed individually and by group consensus by 3 examiners and graded for various abnormalities. Frequently encountered abnormalities included abnormal shape and sclerosis of the medial coronoid process of the ulna, irregularity of the radial incisure of the ulna, and ulnar trochlear notch sclerosis. Other abnormalities included distinct/separate or fissure/in situ fragmentation of the medial coronoid; lucency of the radial incisure; ununited anconeal process; sclerosis, lucency, or flattening of the medial aspect of the humeral condyle; osteophyte formation; and joint incongruity. In conclusion, CT of the canine cubital joint is useful in identification of various lesions beyond simple fragmentation of the medial coronoid process of the ulna.     

Evaluation of elbow incongruency using reconstructed CT in dogs suffering fragmented coronoid process

OBJECTIVES: A retrospective study was undertaken to evaluate elbow joint congruency in dogs suffering fragmented coronoid process (FCP). METHODS: Based on clinical, radiographic and computed tomographic (CT) examinations, elbows were divided into control and FCP groups. Standardised CT reconstructions were formatted in the frontal and sagittal planes. Humeroradial and humeroulnar joint space measurements were obtained from the Images and incongruencies were calculated by comparing the two measurements. RESULTS: Forty-two FCP and 29 control elbows were identified. No incongruencies were noted at the coronoid base. At the level of the coronoid apex, FCP elbows exhibited a significant radioulnar incongruency compared with controls (P < 0.0001), though incongruency was not identified in all cases. Comparing FCP and control elbows at the level of the apex, the humeroradial joint space was increased in FCP elbows (P = 0.0006) whereas no difference was noted in the humeroulnar space. CLINICAL SIGNIFICANCE: This study supports the hypothesis that joint incongruency is associated with FCP in dogs, though is not present in every case at the time of diagnosis. The precise mechanism of development of this incongruency cannot be determined from these data.     

Radiographic diagnosis and surgical management of fragmented medial coronoid process in dogs

The diagnosis of fragmented (ununited) medial coronoid process was made in 21 dogs, with 10 dogs having bilateral lesions. Ten of these dogs were presented to surgery. The diagnosis of fragmented medial coronoid process was made in young and middle-aged large- and giant-breed dogs with a history of intermittent or persistent lameness. Diagnosis was based on history as well as results of clinical examination and radiographic study of both elbows. Concomitant elbow lesions seen with fragmented medial coronoid processes were ununited anconeal process and osteochondritis dissecans of the medial humeral condyle. Avulsion of the medial epicondyle and posteromedial supracondylar ridge of the humerus were thought not to have occurred in these cases. Instead, dystrophic ossification of the synovial membrane and periosteal proliferation on the medial epicondyle and posteromedial supracondylar ridge had taken place. It was concluded that, with a questionable radiographic diagnosis of fragmented medial coronoid process, exploratory arthrotomy may be necessary to confirm the diagnosis. Without surgery, the eventual outcome of fragmented coronoid process is degenerative joint disease. Even with degenerative joint disease, however, clinical improvement was seen following removal of the fragment of the medial coronoid process.     

BONE SCINTIGRAPHY FOR THE DIAGNOSIS OF AN ABNORMAL MEDIAL CORONOID PROCESS IN DOGS

Few reports have been published regarding the use of scintigraphy in the diagnosis of elbow joint lameness in dogs. Some authors have speculated about the potential use of bone scintigraphy and its suspected high sensitivity for the early diagnosis of abnormalities of the medial coronoid process (MCP) in dogs. Scintigraphy is used routinely in our institution in dogs presented for thoracic limb lameness and/or suspected of abnormalities of the MCP when radiographic findings were equivocal. Radiographic, scintigraphic, and surgical findings of the elbow joints of 17 dogs with elbow joint lameness were compared with radiographic, scintigraphic, and necropsy findings of the elbow joints of 12 clinically healthy Labrador Retrievers. Quantitative evaluation of scintigraphic images was performed to determine relative radiopharmaceutical uptake in the region of the MCP. Maximum relative uptake of the coronoid process in the normal dogs was taken as a threshold value to classify elbows as positive or negative for an abnormal MCP after all 24 elbows of the 12 healthy dogs were confirmed as being normal at necropsy. All 17 elbows from lame dogs were positive on scintigraphy and confirmed as having chondromalacia, a fissure, or fragmentation of the MCP. Based on our results, bone scintigraphy may be a valuable diagnostic tool for the diagnosis of abnormalities of the MCP in dogs, and particularly in older dogs where clinical and radiographic changes may be ambiguous.     

Computed tomographic evaluation of canine radioulnar incongruence in vivo

OBJECTIVE: To compare radioulnar incongruence (RUI) of normal canine elbows and elbows with arthroscopically confirmed medial compartment disease in vivo using systematic computed tomography (CT) measurements. STUDY DESIGN: Prospective comparison of RUI measurements in normal and dysplastic canine elbows. SAMPLE POPULATION: Right elbows of 25 medium-large breed, adult dogs with medial compartment disease and 9 medium-large breed, adult dogs with no elbow disease. METHODS: Transverse CT images of proximal radioulnar articulation were reformatted to dorsal and sagittal planes. RUI in 3 locations of the forelimb's medial coronoid was measured. Arthroscopy confirmed diagnosis of medial compartment disease in the diseased group. RUI measurements of the diseased and normal elbows were compared. RESULTS: Cumulative statistical analysis of RUI in all planes revealed no significant difference between the normal and abnormal elbows (P = .61). The abnormal elbows had negative mean RUI at the mid (P = .56) and cranial (P = .24) coronoid regions that were not significantly different from normal elbows and mean positive RUI at the base coronoid that was significantly greater than in normal elbows (P = .00082). CONCLUSION: Canine elbows with established medial compartment disease do not have significant RUI at the medial coronoid region at the time of diagnosis when compared with normal elbows. CLINICAL RELEVANCE: If RUI is a significant factor in the pathophysiology of medial compartment elbow disease in the dog, it does not appear to be present at the time of diagnosis of disease. Ulnar or radial osteotomies do not appear to be indicated for restoration of normal radioulnar articular surface alignment.     

COMPUTED TOMOGRAPHIC FINDINGS IN CANINE ELBOWS ARTHROSCOPICALLY DIAGNOSED WITH EROSION OF THE MEDIAL COMPARTMENT: AN ANALYTICAL METHOD COMPARISON STUDY

Medial compartment erosion is an advanced stage of medial coronoid disease, an important cause of elbow lameness in dogs, with treatment and the expected prognosis depending on the extent of the cartilage lesions. The identification of specific computed tomographic (CT) findings might facilitate the nonsurgical diagnosis and add to treatment decision making. Aims of this retrospective, analytical, method comparison study were to describe CT findings in elbows of dogs arthroscopically diagnosed with medial compartment erosion and to compare CT vs. arthroscopic findings. A total of 56 elbows met inclusion criteria. Elbows with focal (n = 13), diffuse (n = 11), and complete (n = 32) erosion were compared. Prevalence findings for CT lesions were as follows: periarticular osteophytosis (100%), abnormal shape of the medial coronoid process of the ulna (96.4%), and subchondral bone defect of the medial part of the humeral condyle (MHC; 96.4%). The three groups significantly differed for presence of medial coronoid process fragmentation, radial head subchondral bone sclerosis, and widening of the humeroulnar joint space. No significant agreement was found between CT and arthroscopy for presence of a subchondral bone defect of the MHC. A significant agreement was found between CT and arthroscopy for presence of fragmentation of the medial coronoid process. However, some of the calcified body/fragment(s) visualized on CT in the region of the medial coronoid process could not be identified via arthroscopy. Findings indicated that an accurate estimation of the extent of the elbow cartilage lesions still requires arthroscopic joint inspection.     

COMPUTED TOMOGRAPHIC IDENTIFICATION OF DYSPLASIA AND PROGRESSION OF OSTEOARTHRITIS IN DOG ELBOWS PREVIOUSLY ASSIGNED OFA GRADES 0 AND 1

Elbow dysplasia is a heritable disease that is a common cause of lameness and progressive elbow osteoarthritis in young large breed dogs. The Orthopedic Foundation for Animals (OFA) screens elbow radiographs, and assigns grades 0–3 based on presence and severity of bony proliferation on the anconeal process. Grade 1 is assigned when less than 3 mm is present and considered positive for dysplasia. We investigated the incidence of elbow dysplasia and progression of osteoarthritis in elbows with grades 0 and 1 in 46 elbows screened at least 1 year previously, using CT as a gold standard and with the addition of CT absorptiometry. The incidence of dysplasia based on CT was 62% in grade 0, and 75% in grade 1 elbows, all of which had medial coronoid disease. Progressive osteoarthritis at recheck was consistent with elbow dysplasia. The sensitivity and specificity of the OFA grade for elbow dysplasia compared to CT findings was 75% and 38%, respectively. Increased bone mineral density of the medial coronoid process as characterized by osteoabsorptiometry warrants further investigation with respect to elbow dysplasia. Proliferation on the anconeal process without CT evidence of dysplasia or osteoarthritis was present in 20% of the elbows, and is theorized to be an anatomic variant or enthesopathy of the olecranon ligament/synovium. Results of our study suggest that the “anconeal bump” used for elbow screening by the OFA is a relatively insensitive characteristic, and support the use of CT for identifying additional characteristics of elbow dysplasia.     

Fragmentation of the medial coronoid process of the ulna in dogs: A study of 109 cases

The results of a combined retrospective and prospective study of 130 cases of fragmented coronoid process (FCP) in 109 dogs are presented. Sixty-eight cases were treated surgically by medial elbow arthrotomy and 62 were treated medically (rest and anti-inflammatories). Case records were searched with the emphasis on the severity of lameness, physical abnormalities and in surgical cases, the appearance of the coronoid process lesion. Long term follow-up was obtained by a telephone survey. Analysis of case histories and physical data revealed no correlation between severity of lameness before treatment, severity of radiographic changes in the elbow joint and the type of lesion found at surgery. Surgical treatment did not decrease the incidence of post treatment lameness, but the surgically treated dogs were more active and less severely lame than those treated without surgery. It was concluded that young dogs with mild lameness due to FCP in the elbow probably do not benefit from surgical treatment but dogs with chronic, moderate to severe lameness have a better prognosis if treated surgically.     

Spectrum of computed tomographic findings in 58 canine elbows with fragmentation of the medial coronoid process

O bjective : To describe in detail the computed tomographic findings in elbows of dogs with fragmentation of the medial coronoid process of the ulna.
M ethods : Retrospective review of computed tomographic images of 58 elbows that had displaced medial coronoid process fragment(s), non-displaced medial coronoid process fragment or a stable fissure in the articular cartilage of the medial coronoid process at arthroscopy.
R esults : Bone fragments were observed in 85 per cent elbows with a displaced fragment at arthroscopy, in 18 per cent elbows with a non-displaced fragment and in 29 per cent elbows with a stable fissure. Fissures in the subchondral bone were observed in computed tomographic images of 43 per cent elbows that had a stable fissure at arthroscopy. Abnormal shape, sclerosis and lucency affecting the medial coronoid process, subchondral sclerosis of the ulna and humerus, irregular radial incisure of the ulna and periarticular osteophytes were observed in a similar proportion in dogs regardless of the arthroscopic findings. Kissing lesions affecting the medial aspect of the humeral condyle were mainly associated with displaced fragments. Signs of joint incongruity were observed in dorsal and sagittal reconstructed computed tomographic images in 24 per cent elbows.
C linical S ignificance : A wide range of abnormalities may be observed in computed tomographic images of dogs with fragmented medial coronoid process. Computed tomographic is moderately sensitive for detection of fragments.     

RADIOGRAPHIC AND COMPUTED TOMOGRAPHY FINDINGS IN BELGIAN SHEPHERD DOGS WITH MILD ELBOW DYSPLASIA

We compared computed tomography (CT) and radiographic findings of Belgian shepherds with grade 1 or borderline elbow dysplasia to determine whether the radiopaque area dorsal to the anconeal process and seen in mediolateral 45° flexed radiographs is formed by osteophytes, or whether it is an anatomic variation. Eighteen dogs with screening results 0/1, 1/0, or one or both elbows graded as borderline were studied. The radiographs were evaluated according to International Elbow Working Group guidelines and compared with CT images. A fragmented medial coronoid process was seen in five joints, and remaining 31 joints were considered free of dysplasia based on CT images. In radiographs, height of the radiopaque area on the anconeal process was 0–2.7 mm in dysplastic and 0–3.0 mm in other joints. Sensitivity of this sign as dysplasia indicator was 40% and specificity 29%. All dysplastic joints and three of the other joints had blurring of the cranial edge of the medial coronoid process. Subtrochlear sclerosis was seen in four dysplastic joints and in three other joints. Both changes were significant indicators of dysplasia ( P <0.001). Sensitivity and specificity of these phenomena as dysplasia indicators were 80% and 90%, respectively. We conclude that the radiopaque area on the anconeal process might not always be osteophyte formation in Belgian shepherds and should not be used as the sole criterion for dysplasia. Blurring of the medial coronoid process cranial edge and ulnar trochlear notch sclerosis are reliable signs of elbow dysplasia and may be beneficial in screening protocols.     

Bone scintigraphy in the investigation of occult lameness in the dog

99mTechnetium methylene diphosphonate (99mTc-MDP) scintigraphy was performed in 14 dogs of different breeds after clinical lameness examination, radiography and synovial fluid analysis failed to localise lameness to a specific area of pain. The scintigraphic protocol included an intravenous injection of 17 MBq 99mTc-MDP/kg bodyweight and vascular, soft tissue and bone phase scans in standardised positions with a low-energy all-purpose collimator. Confirmation of diagnosis was achieved in nine dogs by arthroscopy, repeated lesion-orientated radiography, computed tomography and response to treatment. In seven cases, bone phase scans showed single elbow uptakes, in two cases unilateral limb uptake, and in one case each a single shoulder and tibia uptake; in three cases there was no increased uptake. Vascular and soft tissue phase images did not reveal additional information. Diagnosis of humeral condyle fissures, a fragmented medial coronoid process, panosteitis and arthropathy was possible in nine cases. Skeletal pathology was ruled out in three normal scintigrams. In two dogs with unilateral uptake of multiple joints, no diagnostic benefit was gained from scintigraphy. The highly sensitive and relatively specific uptake allowed localisation and characterisation or exclusion of skeletal lesions in most dogs.     

Clinical evaluation and long-term follow-up of dogs having coronoidectomy for elbow incongruity

A retrospective study was performed describing the clinical presentations, radiographic findings, and surgical outcomes of 17 dogs (18 elbows) following medial coronoidectomy for the treatment of elbow joint incongruity as a sole disease entity. Complete resolution of lameness was achieved in 100% of the cases. The mean radiographic arthrosis grade progressed in 70% of the cases. Results of this study indicate that resolution of clinical lameness may be achieved with medial coronoidectomy in dogs with elbow incongruity; however, progression of degenerative joint disease with unknown, long-term clinical significance can be expected after surgery.     

Radiographic findings of the medial humeral epicondyle in 200 canine elbow joints

Objectives: To determine the frequency and radiographic aspect of medial humeral epicondylar lesions as a primary or concomitant finding and to evaluate the association with osteoarthritis. Methods: Medical records of dogs diagnosed with elbow lameness were reviewed. Inclusion criteria for this study were a complete clinical examination, a complete set of digital radiographs and a final diagnosis made by computed tomography or magnetic resonance imaging and arthroscopy. Changes of the medial humeral epicondyle were recorded and correlated with the radiographic osteoarthritis and final diagnosis. Results: Eighty of the 200 elbows showed changes of the medial humeral epicondyle. In 12 of these 80 elbows, changes of the medial epicondyle were the only findings within the joint, and these elbows were diagnosed with primary flexor enthesopathy. In the remaining 68 elbows, other concomitant elbow pathologies were found. In those cases of concomitant epicondylar changes, high grades of osteoarthritis were recorded, while most elbows with primary flexor enthesopathy showed a low grade of osteoarthritis. Clinical significance: Changes of the medial humeral epicondyle are often considered clinically unimportant and are regarded as an expression of osteoarthritis. This study showed the relatively frequent presence of epicondylar changes of which the majority were considered concomitant to a primary elbow problem. If changes of the medial humeral epicondyle are the only pathologic finding (primary flexor enthesopathy) they should be considered as the cause of lameness and not as a sign of osteoarthritis.     

Computed tomographic features of incomplete ossification of the canine humeral condyle

Objectives— To describe computed tomographic (CT) features of canine elbows with incomplete ossification of the humeral condyle (IOHC) and investigate co-existing incongruence in the elbow joint.
Study Design— Case control study.
Animals— Dogs with IOHC (n=20; 38 elbows) and 25 normal elbows.
Methods— Elbows with IOHC and normal elbows were assessed by CT. Standardized dorsal and sagittal reconstructions were created at 3 levels using image analysis software to obtain single measurements of the humero-radial and humero-ulnar joint spaces. On dorsal plane reconstructions, joint space measurements were obtained at the center point of the humero-radial and humero-ulnar articulations. Joint incongruity was defined as the difference between the humero-radial and the humero-ulnar joint spaces.
Results— Nineteen dogs (95%), all Spaniel breeds, had either bilateral IOHC demonstrable as a saw-toothed intercondylar complete or incomplete hypoattenuating defect with hyperattenuating margins, or IOHC with contralateral humeral condylar fracture (HCF). Joint incongruity values for IOHC were compared with those of normal elbows. Significant differences were noted at the levels of the medial coronoid apex ( P <.0001) and base ( P <.004) indicative of humero-ulnar incongruence. Evidence of medial coronoid disease in 10 elbows (26%) and degenerative joint disease in 30 elbows (79%) was also found.
Conclusions— Presence of elbow incongruence may be an underlying factor in failure of ossification centers to fuse leading to IOHC.
Clinical Relevance— IOHC is clearly defined by CT, and it should be considered in larger Spaniel breeds, with a chronic forelimb lameness or HCF.     

CORRELATION OF RADIOGRAPHIC, NECROPSY AND HISTOLOGIC FINDINGS IN 8 DOGS WITH ELBOW DYSPLASIA

Elbow dysplasia is osteoarthrosis/degenerative joint disease due to abnormal development of the elbow joint. The abnormaldevelopment is the result of specific inherited etiologies alone or in combination. This paper attempts to clarify the diagnosis of elbow dysplasia based on the presence of degenerative joint disease by correlating rediographic necropsy, necropsy, and histopathologic results using elbows from 8 German Shepherd dogs. All elbows had radiographic changes consistent with osteoarthrosis/degenerativejoint disease which were identified best on the flexedmedial-lateral projection. Radiographically, a specific diagnosis was made inseven elbows; ununited anconeal process(6) and osteochondrosis (1). At necropsy these lesions were confirmed plus 14 elbows were identified that had fragmented medial coronoid process (6), abnormally shaped medial coronoid processes of fissures in the articualr cartilage of the medial coronoid process (8). additionally, histopathologically there was proliferative synovitis at the radial notch of the ulna and degenerative changes on the proximal, nonarticualr surface of the anconeal process at the site of insertion of the olecranon ligament and joint capsule.Therefore, for screening the elbow joint to identify elbow dysplasia, the recognition of osteoarthrosis/degenerative joint disease on an extreme flexed mediolateral rediograph appears to be sufficient.     

Clinical, radiographical and pathological aspects of ununited medial coronoid process of the elbow joint in dogs

An ununited medial coronoid process was found in the region of the medial ulnar articular rim of seven elbow joints in four Persian stray dogs in a survey of joint disease in dogs. The clinical, radiographical and pathological aspects of this condition are described and discussed.     

Digital analysis of ulnar trochlear notch sclerosis in Labrador retrievers

OBJECTIVES: To compare ulnar trochlear notch bone radiopacity in Labrador retrievers with and without fragmented medial coronoid process using quantitative analysis of film density on digitised radiographs. METHODS: Mediolateral view elbow radiographs from Labrador retrievers (n=34) aged between six and 18 months were obtained and digitised. Images from dogs with an arthroscopic diagnosis of fragmentation of the medial coronoid process (n=17) were compared with that of a control population (n=17), and this data subject to statistical analysis. RESULTS: A statistically significant relationship between the presence of increased trochlear notch radiopacity and a fragmented medial coronoid process was identified. Fractional analysis of this area shows the region of greatest difference in radiopacity between normal and fragmented medial coronoid process cohorts to be in the trochlear region of the medial coronoid process of the ulna. A decrease in radiopacity values in the dysplastic group versus the normal cohort was observed for the region of the proximo-caudal ulnar trochlear notch. CLINICAL SIGNIFICANCE: An increase in ulnar trochlear notch radiopacity is a finding associated with fragmentation of the medial coronoid process in Labrador retrievers.     

Prospective evaluation of techniques for differentiating shoulder pathology as a source of forelimb lameness in medium and large breed dogs

Objective— To assess lameness evaluation, shoulder abduction angles, radiography, and ultrasonography for determining presence, location, and severity of forelimb pathology. Study Design— Prospective cohort study. Animals— Dogs ≥20 kg (n=30). Methods— Each dog was assigned lameness scores. Shoulder abduction angles were determined. Radiographs of shoulders and elbows were subjectively graded for pathology. One investigator unaware of dog history (lameness, radiographic findings) performed ultrasonographic assessment of shoulders with subjective grading of pathology. Another investigator unaware of dog history (lameness, radiographic, ultrasonographic findings) performed arthroscopic assessment of shoulders with subjective grading of pathology. Elbows were disarticulated and evaluated for gross pathology. Histologic pathology scoring of shoulder tissues was performed. Data were compared for differences among groups, sensitivities, specificities, positive and negative predictive values, and positive and negative likelihood ratios were calculated. Results— Twenty‐seven forelimbs were considered clinically normal, 26 had shoulder pathology, 5 had elbow pathology, and 2 had pathology of both the shoulder and elbow. Dogs with shoulder pathology were twice as likely to be lame compared with dogs with elbow pathology. Limbs with medial shoulder instability had significantly higher abduction angles than normal limbs and those with elbow pathology. Radiographs were clinically useful for diagnosing elbow, but not shoulder, pathology. Ultrasonography was clinically useful for diagnosing shoulder pathology other than instability. Abduction angles, ultrasonographic evaluation, and arthroscopic assessments had strong, significant correlations with reference standards. Conclusions— Clinically relevant diagnostic techniques yielded characteristic, repeatable differences in objective and subjective assessments for distinguishing presence, location, and severity of forelimb lameness in dogs. Clinical Relevance— The diagnostic approach to forelimb lameness in dogs should include shoulder pathology as a differential with multiple assessments used to determine the clinical cause of lameness.