The diagnostic puzzle of canine forelimb lameness

In this follow-up interview on a lecture presented at the 2026 Veterinary Meeting & Expo, Leilani Alvarez, DVM, DACVSMR, CVA, CCRT, head of the Integrative and Rehabilitative Medicine Department at the Schwarzman Animal Medical Center in New York, NY, discusses the unique challenges of diagnosing forelimb lameness in dogs. According to Alvarez, because dogs carry approximately 60% of their body weight on their front legs, these structures endure significantly higher mechanical loads and greater soft-tissue stress compared to the hind limbs.

She breaks down the anatomical complexities of the forelimb, explains the difficulty in differentiating between shoulder and elbow pain, and shares how the shoulder’s lack of bony attachments makes it particularly susceptible to intricate soft-tissue injuries.

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.

Forelimb lameness is a much more challenging part of the body to diagnose lameness as compared to the pelvic limb. One reason is that the primary weight-bearing forces in a dog are on the forelimb, so 60% of a dog's body weight is on the forelimbs.

That means that we have a much higher mechanical load on those front legs compared to the hind legs and it means that the joints, as well as the soft tissue structures, are experiencing a lot greater stress as compared to the pelvic limb.

Because the shoulder joint is not attached to the body by any bony [structure]—there's no pelvis, dogs don't have a clavicle—it's all a soft tissue structure, there's a lot more susceptibility to soft tissue injuries that are more complex, because the shoulder is a more complex joint compared to the knee, because, again, it's just muscular attachments to the trunk.

And then the types of diseases we see in the elbow compared to the shoulder are very different, and that adds to the complexity. A lot of people will call it the “shelbow” because it's very difficult to differentiate between elbow and shoulder, whereas in the pelvic limb it's pretty easy to differentiate between hip and knee. But it is a lot more complicated in the forelimb, and part of it is that the dog is relying on a lot of their body weight on that front leg, and it makes it more difficult to figure out what the difference is.