Simple visual clues to differentiate forelimb lameness issues in dogs

Although diagnosing forelimb lameness in dogs can be challenging, especially when the shoulder and elbow are involved, just watching how the patient moves can help veterinarians identify where the problem might be. At the 2026 Veterinary Meeting & Expo, Leilani Alvarez, DVM, DACVSMR, CVA, CCRT, service head of the Integrative and Rehabilitative Medicine Department at the Schwarzman Animal Medical Center in New York, New York, led a session on practical tips and clinical pearls for evaluating and treating forelimb lameness.

In this follow-up interview with dvm360, Alvarez shares simple, observation-based cues that can help veterinary teams distinguish shoulder, elbow, carpal, and digital sources of pain by watching how a dog stands, walks, and transitions.

Below is the video transcript, lightly edited for clarity.

Alvarez: Hi, I'm Dr Leilani Alvarez. I'm the head of integrative and rehabilitative medicine at the Schwarzman Animal Medical Center in New York City.

The main takeaways that I wanted to present [to] the audience [are] that forelimb lameness, [although] it is a lot more complex than hind limb lameness…if you follow a systematic approach, it's actually quite easy to differentiate.

The big one that is hard to differentiate is [the] shoulder and [the] elbow.

Here [are] just a couple of quick snippets that I gave in my lecture that can be really helpful. Your eyes are really great tools. Observing how a dog walks and…stand[s] can give you a lot of information, [as well as] how they transition.

Shoulder lamenesses, because they're avoiding extension for the most part, [is] going to give you a shorter stride when they're walking. And [with] elbow lamenesses, especially if they're advanced, they'll tend to externally rotate their elbow when they're standing. And when they're transitioning, they'll avoid flexion of the elbow. So, when a dog is going into a down position in which they should be completely flexed and have their elbow back, they'll keep it in a slightly more extended position.

These are just a couple of helpful, really easy things that you can just use your eyes for to help you identify where the problem might be.

For [the] carpus, the primary injury we see is a hyperextension injury or a jump-down injury. And if you're not sure [whether] they're hyperextended, a simple thing you can do is just lift up the other leg. That'll generally make them collapse more, and you'll see that hyperextension more clearly.

Also, for the metacarpophalangeal joints—that's the knuckles—if you just look at them, they'll look raised when there's osteoarthritis there. It's just a really simple thing.

Again, you just use your eyes, and it can be very helpful to differentiate.