- See:
Injuries of the Throwing Elbow
- Discussion:
- OCD is a localized fragmentation of the bone and overlying cartilage of the capitellum;
- it frequently progresses to loose body formation, and sometimes progresses to posttraumatic arthritis;
- laxity of the
MCL may accentuate the loading on the capitellum;
- osteochondritis dissecans of the capitellum tends to occur in patients 10-16 years of age;
- it is commonly found in young (10 yr old) baseball pitchers;
- during the acceleration phase, the elbow assumes a valgus position which loads the capitellum;
- it should be distinguished from
Panner's Disease:
- Clinical Findings:
- poorly localized lateral elbow pain, w/ catching and locking;
- swelling and flexion contractures are common;
-
MCL may show laxity;
- palpate the entire capitellum by flexing and extending the elbow;
- Radiographs:
- see
radiology of pediatric elbow
- localized area in capetellum w/ rareification and crater formation;
- in some cases, typical AP radiograph will be normal, but an AP with the elbow in 45 deg
of flexion will show irregularities, flattening and/or fragmentation c/w OCD;
- MRI and CT-arthrogram: may be helpful in some cases:
- on MRI, early osteochondritis dissecans will show a discrete area of low signal intensity on
T1 images;
- early on, T2 images may show no abnormalities;
- Treatment: based on degree of degree of lesion displacement;
-
non-displaced lesions:
- treated w/ rest and gentle ROM exercises
- throwing activities are strictly not allowed until symptoms subside and full range of motion is restored;
-
displaced lesions:
- if reduction of activities and physical therapy do not improve symptoms, then arthroscopic debridement should be considered;
- specific indications for arthroscopy include: frequent locking, persistent flexion contracture, pain, despite participating in physical therapy;
- theoretically would benefit from arthroscopic pinning or fragment excision;
Osteochondritis Dissecans of the Elbow. CORR 284: 156-160, 1992.
The Surgical Treatment of Osteochondritis of the Capitellum. Am J Sports Med 13(l): 11-21, 1985.
Osteochondritis in the female gymnast's elbow. Jackson DW et al. Arthroscopy Vol 5. p 129-136. 1989.
Early detection of osteochondritis dissecans of the capitellum in young baseball players. Report of three cases.
M. Takahara MD. et al. JBJS. Vol 80-A. No 6. Jun 1998. p 892.
