Case of the month: German Shepherd with lameness in the right front

Signalment and anamnesis

• German Shepherd
• 1y old, male
• lameness right front

For further clarification, the follwing radiographs were taken:

Radiographic description

• There are faint increased medullary soft tissue opacities identified on the lateral projections centered on the right proximal ulna diaphysis, extending distally up the level of the distal diaphysis
• There are rough and solid periosteal reactions surrounding the proximal radius, most pronounced cranially
• The included elbow joints are normal, the anconeal process of the ulna is fused on both sides
• The medial coronoid processes of the ulna are well marginated with normal shape and opacity
• There is no subchondral bone sclerosis on the trochlear notch
• The included carpal joints are normal

Diagnosis

The increased medullary opacities in the right proximal humerus and signalment of the patient are consistent with panosteitis as a cause of the reported right front lameness

Zoomed section of the right ulnar diaphysis; the medullary cavity is focally increased in opacity and periosteal reactions are visible (arrows)

Sagittal view of the right proximal ulnar diaphysis on CT; the medullary cavity is increased in attenuation (oval)

Transverse view of the right proximal ulnar diaphysis. The surrounding cortical bone shows periosteal reactions (arrows)

Outcome

• Lameness stopped few weeks later and dog fully recovered

Discussion

• Panosteitis is typically a self-limiting condition and can manifest in multiple bones/limbs
• German shepherd dogs are predisposed
• Radiographic monitoring can be considered the clinical signs worsen
• If clinically indicated, a specialized orthopedic consult including advanced cross-sectional imaging like CT/MRI can be considered for further work up and evaluation of the chronic lameness
• In advanced disease, bone biopsy could be considered to rule out osteomyelitis or bone neoplasia

This case is available via the following link: https://www.veheri.com/cases/1386780725 

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Many thanks to Dr. DECVDI Thorsten Rick for this interesting case report

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