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Wheeless' Textbook of Orthopaedics

Osteochondritis of the 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; (see: Injuries of the Throwing Elbow)
    - 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. A long-term follow-up study.

The Surgical Treatment of Osteochondritis of the Capitellum.    

Osteochondritis in the female gymnast's elbow.    

Early detection of osteochondritis dissecans of the capitellum in young baseball players. Report of three cases



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, May 30, 2012 1:07 pm