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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