The Hip: Preservation, Replacement and Revision

Panner's Disease / Osteochondrosis

- Discussion:
    - disease involving capitulum of distal humerus that produced changes similar to those observed in Legg Calve Perthes disease;
          - it should be distinguished from osteochondritis dissecans (which occurs in the older child or adolescent - older than age 13 years);
    - pathologic process is believed to be caused by an interferrence in blood supply to growing epiphysis, which results in resorption & eventual repair
          and replacement of the ossification center;
          - in patients under 20 years of age, capitellum is only supplied by end arteries entering posteriorly;
    - Panner's disease almost always occurs in the dominant elbow in boys between 5 and 12 years of age;
    - inciting causes:
          - chronic repetitive trauma, congenital and hereditary factors, embolism (fat), and endocrine disturbances;

- Diff Dx:
    - Panner's disease should not be confused w/ more common osteochondritis dessicans of capitulum seen in adolescent boys, which is related to throwing activities;
    - throwing injuries:
          - although initial x-ray appearance of two conditions may be similar, the progression of the changes differs;

- Clinical manifestations:

    - patients report intermittent pain and stiffness in the affected elbow that lasts for several months;
    - symptoms are relieved by rest and aggravated by activity;
    - on PE local tenderness over capitulum, slight effusion, & synovial thicknening of the elbow joint are found;
    - limited extension is typical, lacking 20 to 30 deg of full extension;
    - there may be slight loss of pronation and supination w/ tenderness;

- Radiographic changes:
    - radiology of pediatric elbow
    - initially the capitulum appears irregular with areas of radioluceny (indicating resorption), particularly adjacent to
         the articular surface, and sclerosis;
    - in 3-5 months, radiographs show larger radiolucent areas followed by reconstruction of the bony epiphysis;
    - in 1 to 2 years, the epiphysis returns to its normal configuration w/ no flattening, presumably becausethe elbow is not wt bearing joint;
    - in about 50% of pts, adjacent radial head shows early maturation compared with the univolved elbow;

- Treatment:
    - symptomatic treatment for Panner's disease is sufficient because epiphysis becomes revascularized & develops normal configuration;
    - reducing elbow activities, particularly those that strain the joint, usually relieves pain and allows gradual return of elbow motion;
         - however, the use of a long arm cast or splint for 3 to 4 weeks may be necessary until pain, swelling, and local tenderness subside;
    - long term outlook is execellent, but a slight loss of elbow extension may persist in some patients;
    - of note, as with Perthes disease, the radiographic reovery may lag behind  the clinical resolution of symptoms

Arthroscopic Treatment of Panner's Disease.

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

Last updated by Data Trace Staff on Thursday, April 12, 2012 2:10 pm