When Radiographs Aren't Enough: Why CT Is Changing the Way We Diagnose Canine Elbow and Shoulder Disease
Radiographs remain our first choice when evaluating forelimb lameness in canine patients; and for good reason. Taking x-rays is common practice in virtually all veterinary clinics. It is cost-effective and often provides enough information to diagnose fractures, arthritis, and a smattering of other orthopedic conditions.
However, sometimes our clinical signs do not match the radiographs, or when elbow dysplasia or shoulder pathology is suspected, computed tomography (CT) can usually yield better answers.
Unlike radiographs, which compress a three-dimensional joint into a two-dimensional image, CT eliminates superimposition by producing detailed cross-sectional images of bone. This allows the clinician to identify subtle lesions that may be difficult (or sometimes impossible) to appreciate in rads.
The Evidence for Canine Elbows
The strongest research supporting CT comes from studies of canine elbow disease.
A landmark study published in BMC Veterinary Research compared radiographs, CT, and arthroscopy in 180 canine elbows affected by medial coronoid disease. Using arthroscopy as the gold standard, CT demonstrated 100% sensitivity and 93% specificity, leading the authors to conclude that CT should be considered the preferred non-invasive imaging modality for evaluating medial coronoid disease.
More recently, a 2025 study evaluating 424 canine elbows found that routine screening radiographs detected only 65% of affected joints, while CT consistently identified substantially more clinically significant disease. The authors concluded that CT should be the preferred screening modality whenever available for suspected medial coronoid disease.
What About the Shoulder?
Although fewer comparative studies exist for the shoulder, CT has become increasingly valuable for evaluating osteochondritis dissecans (OCD), subtle fractures, mineralized joint mice, and other complex osseous lesions.
The ability to visualize the humeral head and glenoid in multiple planes allows surgeons to better define lesion size, assess subchondral bone changes, and plan surgical treatment with greater confidence than radiographs alone.
Better Imaging Leads to Better Decisions
CT can provide significant advantages when evaluating:
Fragmented medial coronoid process (FMCP)
Elbow incongruity
Elbow osteochondrosis
Shoulder OCD lesions
Small osteophytes and subchondral sclerosis
Surgical planning for orthopedic procedures
In many cases, CT identifies pathology before secondary arthritic changes become obvious on radiographs, allowing for earlier diagnosis and more informed treatment decisions.
The Bottom Line
Radiographs remain an essential first step in orthopedic imaging. However, when elbow dysplasia, medial coronoid disease, shoulder OCD, or other complex osseous pathology is suspected, CT provides a level of diagnostic confidence that conventional radiography simply cannot match.
At Veterinary Intelligence, we believe better imaging leads to better diagnoses and better diagnoses lead to better patient outcomes. Knowing when to advance from radiographs to CT can make a meaningful difference for both clinicians and the patients they serve.
-Robert Whitaker
Further Reading
Villamonte-Chevalier A, et al. Assessment of medial coronoid disease in 180 canine lame elbow joints: a sensitivity and specificity comparison of radiographic, computed tomographic and arthroscopic findings. BMC Veterinary Research (2015). Open-access article
Cook CR, Cook JL. Diagnostic Imaging of Canine Elbow Dysplasia: A Review. Veterinary Surgery (2009). PubMed abstract
Cross-Modality Diagnostic Agreement in Canine Medial Coronoid Disease in a Screening Population: Radiographs vs. CT in 424 Elbow Joints. (2025). Open-access article
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