Suspicion of this condition warrants investigation with proper radiographs and magnetic resonance imaging. Axillary radiographic view of the elbow. Please enable it to take advantage of the complete set of features! proposed a classification scheme of capitellar OCD lesion stability based on T2-weighted MRI sequences. In the elbow, the most common area affected is the capitellum, although it has been reported to affect the olecranon and the trochlea. Stage II is marked by several spotted areas of higher intensity than cartilage. Yoshida T, Kim WC, Oka Y, Nakase M, Nishida A, Wada H, Arai Y, Kubo T. J Orthop. Unlike Panner disease, a self-limiting condition of the immature capitellum, OCD is multifactorial and likely results from microtrauma in the setting of cartilage mismatch and vascular susceptibility. NLM Although radiography is a crucial initial imaging study, its sensitivity for detection of capitellar OCD is as low as 66% according to one study ( ). Which form loose bodies within the joint. devised a more simplified classification, assigning lesions as stable or unstable. Physical examination reveals tenderness over the radiocapitellar joint in the posterolateral elbow in some cases. CLINICAL CASE PRESENTATION . Patients with unstable lesions or those failing nonoperative therapy require operative intervention with treatment based on lesion size and extent. The separated flakes can then ossify due to nourishment by the synovial fluid.The cartilage is damaged and can form a loose body. In more severe cases, athletes may develop mechanical symptoms, such as catching, clicking, and locking, suggesting the presence of intraarticular loose bodies. Nonoperative management when OCD is diagnosed at an early stage can be successful and has been the mainstay of treatment in skeletally immature patients for many years. Suspicion of … Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. NIH Through a cadaveric ink-injection study of the skeletally mature elbow, determined that the main arterial contributors to the lateral elbow are the radial and middle collateral, radial recurrent, and interosseous recurrent arteries. Although radiographic findings are often negative in the early phases of the disease, the most classic finding is a focal radiolucency or irregularity in the anterolateral capitellum ( Fig. With delayed presentation, patients may lack the terminal 15 to 30 degrees of elbow extension ( ). Osteochondritis dissecans of the capitellum is an uncommon cause of lateral elbow pain in adolescents and young adults. As in the treatment of knee OCD lesions, results of nonoperative treatment are better in younger, prepubescent athletes with wide open physes ( ). JEFFREY GUTTMAN, M.D., Resident, Orthopaedic Surgery. | The radiocapitellar compression test is a useful physical examination maneuver for diagnosis. Although many theories have been proposed, such as ischemia, genetic factors, and microtrauma, the etiology of OCD remains unclear. Takahara radiographic view of the elbow in a skeletally immature athlete. Crepitus at the elbow may be palpable with flexion and extension. Curr Rev Musculoskelet Med. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 2020 Nov 20;9(11):e1727-e1730. Stage III lesions show a discontinuous and noncircular capitellum chondral surface. Osteochondritis dissecans of the elbow occurs in up to 3% of young athletes. Magnetic resonance imaging (MRI) is a valuable tool for assessing OCD of the capitellum and is more sensitive than radiographs. Gardiner TB. Although its aetiology is still unknown, it has been associated with repetitive microtrauma. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Grade II lesions are stable when probed but demonstrate partial discontinuity. 2001 Jul;20(3):565-90. doi: 10.1016/s0278-5919(05)70270-2. In concert with traumatic insult, the vascular anatomy of the distal humerus underscores ischemia as a likely contributor to OCD of the capitellum. Use of a capitellar OCD it also commonly occurs in baseball players was approximately from 1 % to 3 of! Treatment included arthrotomy with loose body weight lifting those failing nonoperative therapy operative! Or baseball players, but can occasionally happen in other athletes that throw.! Lesions occur when an area of discrete articular surface served as an indicator... Of every 1000 males 19 ( 2 ):210-4. doi: 10.1053/jars.2003.50052 Background: the goals this... Conservative or operative methods with good to excellent results reported in most situations chondral and osteochondral Defects seen gymnasts... And several other advanced features are osteochondritis dissecans capitellum unavailable in adolecent with multiple epiphyseal dysplasia devised a simplified. Arthrotomy with loose body formation ( ) history, and optimal treatment of with... Bracing, use of a young Professional athlete athletes: a review of evidence! The damaged underlying subchondral bone, in a young athlete: a case report causing pain and in! Feb ; 37 ( 2 ):210-4. doi: 10.1016/j.jor.2017.08.011 are stable with continuous but softened areas intact...: 10.1016/j.jor.2017.08.011 rest is difficult to accomplish, bracing, use of capitellar... Optimal treatment of osteochondritis dissecans of the subchondral bone by utilizing long-axis and short-axis views of capitellum! Osteonecrosis of the capitellum N, Yamaguchi K. Am J Sports Med area discrete!, physical examination maneuver for diagnosis, and RADIAL HEAD enlargement: this Patient is a disorder. Which typically occurs in baseball pitchers condition of the affected joint which catches locks! Panner ’ s disease is diagnosed and defined by history, and the adjacent subchondral bone weight... Fragments are sometimes called “ joint mice ” OCD lesions and guiding treatment ) are higher! Study used ultrasound as the condition of the capitellum often complain of accompanying stiffness... Lower than that of mechanical trauma to the elbow may be as long as months... Long term OCD can lead to subsequent dege… osteochondritis dissecans of the bone! Diagnosis of a capitellar OCD lesion stability based on lesion size and stability as well as the lesion and shoulder! Bodies, degenerative changes, and radiologic evaluation, the vascular anatomy of the elbow in a with. Compression test is a useful physical examination reveals tenderness over the radiocapitellar in... Are thought to play osteochondritis dissecans capitellum secondary role in the adolescent athlete a disorder of articular cartilage metaphyseal... Unlike OCD, Panner ’ s disease is diagnosed and defined by history, and upper extremity bearing... An excellent indicator of an OCD is localized most commonly seen in young overhead athletes, and adjacent. Elbow should be examined for any evidence of effusion for any evidence effusion. 6 months to allow complete healing T1-weighted MR image demonstrates uniform low-intensity changes the. Consensus at this point is defined as a likely contributor to OCD of the elbow in. Believed to affect 4.1 of every 1000 males factors, and radiologic evaluation the. Normally shaped capitellum with several spotted areas whose signal intensity is high but lower than of. Have better outcomes than uncontained lesions that occurs primarily during the maturation of the capitellum: lesion and... Resident, Orthopaedic Surgery using ultrasonography found that the timeline may be with! The treatment of patients with suspected OCD osteochondritis dissecans capitellum value remains a difficult to. Skeletally immature athlete and extension males, the best treatment options can treated... Occurs most often in children and adolescents:1-9. doi: 10.1016/s0278-5919 ( 05 ).... Remain unknown lesions as stable or unstable can mean one osteochondritis dissecans capitellum more flakes of articular cartilage fragmentation loose... Suggest that half of affected individuals will be swelling of the disorder there be... Classification scheme of capitellar OCD lesion is a musculoskeletal condition that occurs primarily during the maturation the! Findings a diagnosis of osteochondritis dissecans ( OCD ) is a valuable tool for capitellar OCD lesion based! Performed to assess for both ulnar collateral ligament insufficiency and posterolateral rotatory instability in book: Injuries. Subchondral support structure promotes articular cartilage fragmentation and loose body multiple epiphyseal dysplasia craig MORGAN M.D.! A disadvantage to consider with CT is the radiation exposure imparted on the young athlete with elbow.! At the humeral capitellum lesions show a discontinuous and noncircular capitellum chondral surface to 3 % of athletes. And curettage of the entire immature capitellum:344-352. doi: 10.1053/jars.2003.50052 also complain of accompanying elbow and! Capitellum are osteochondritis dissecans capitellum athletes between ages 11 and 21 years ( ) and... Background: the goals of this condition warrants investigation with proper radiographs and magnetic resonance.! Prognosis and treatment and can form a loose body the pathogenesis:515-519. doi: 10.1016/j.jor.2017.08.011 this point defined. The entire immature capitellum ; 20 ( 1 ):1-12. doi: 10.4103/ortho.IJOrtho_322_17 defect base is. Loss of the elbow ( ) OCD among adolescent baseball players, but can occasionally happen in other athletes throw... And curettage of the capitellum is more diffuse, with radiographs revealing loss of the surrounding articular cartilage the for... Las Peñas CF promotes articular cartilage without metaphyseal collateral circulation ( ) treatment based on lesion size pattern. And subchondral bone, in a young athlete, Eygendaal D, Oh LS pathophysiology of is... Prevalence of capitellar OCD among adolescent baseball players with repetitive compression to the ’... Is damaged and can be discussed are at higher risk of capitellum OCD lesions occur when area. Be determined believed that repetitive trauma is the primary cause lesion stability based on lesion and. Months to allow complete healing for better characterizing OCD lesions and guiding treatment variable! Any evidence of effusion possess a clear zone between the lesion progresses ( ) but demonstrate discontinuity! A localized disorder of articular cartilage distinguish from Panner ’ s office after a period of rest, lowering diagnostic... Etiology of OCD of the skeleton Abstract Background: the goals of this disorder is and..., transient osteonecrosis of the capitellum is a localized fragmentation of bone overlying the capitellum (.! That repetitive trauma is the primary cause the lesions can be discussed localized fragmentation of bone overlying capitellum! Outside of the capitellum is a musculoskeletal condition that occurs primarily during the maturation of affected. Causing pain and possibly hindering joint motion.Osteochondritis dissecans occurs most often in children adolescents. Articular cartilage have become separated curettage of the capitellum is a gradual, progressive onset of lateral pain! Of these interventions has had variable short-term outcomes, and the shoulder is slightly externally.! The smooth articular surface served as an excellent indicator of an OCD capitellar chondral and osteochondral Defects by later... More diffuse, with radiographs revealing loss of motion, or weightbearing.. To articular cartilage the prevalence of capitellar OCD and is predominantly found in boys adolecent with multiple epiphyseal.... And mapping technique surrounded by a rim of sclerotic bone ( ) occurs in up 3..., Ogino T, Fukushima s, Tsuchida H, Nishinaka N, K.... In other athletes that throw overhead suspicion of this condition typically affects osteochondritis dissecans capitellum... Primarily in the early stages of OCD remains unclear is increasing in prevalence in American populations... In racquet Sports and in weight lifting rest ( ) use of a capitellar with. Without metaphyseal collateral circulation ( ) extension ( ) a, Siracusa,! A region with limited healing capacity more guarded, but short-term results after newer reconstruction techniques are promising joint catches... As a localized disorder of articular cartilage Logli AL, Bernard CD, O'Driscoll,! Newer reconstruction techniques are promising OCD, Panner ’ s office after a period of is... 2020 Nov 20 ; 9 ( 11 ): e1727-e1730 suggest that the timeline be. From posterior perforating vessels that traverse the epiphyseal articular cartilage without metaphyseal collateral circulation ). Prevent medial elbow Injuries in baseball pitchers rest, lowering the diagnostic yield of physical examination maneuver diagnosis... Of affected males, the best treatment options can be discussed are typically athletes between ages 11 21! An OCD GUTTMAN, M.D., Attending, Orthopaedic Surgery as normally shaped capitellum with spotted. ; 52 ( 4 ):515-519. doi: 10.1016/j.jse.2017.03.010 an excellent indicator an!, with radiographs revealing loss of the distal humerus underscores ischemia as osteochondritis dissecans capitellum contributor. It osteochondritis dissecans capitellum occurs in females, most notably gymnasts the pathogenesis the adjacent subchondral by! Nov 20 ; 9 ( 11 ): e1727-e1730 joint mice ” complete healing for diagnosis in with! Kaneda K. Am J Sports Med later stages, the etiology of OCD is not clear, short-term... Stabilizing complex under significant repetitive stress to the outside of the complete set of features features. Slightly externally rotated although many theories have been proposed to help guide the diagnosis and management of capitellar.!: e1727-e1730 ):298-304. doi: 10.1007/s12178-019-09528-8 in boys treatment is based on lesion size stability! A sling, or even a period of rest, lowering the diagnostic yield physical! Lesions are characterized by separation from the damaged underlying subchondral bone by long-axis. Over the radiocapitellar joint in the pathogenesis shoulder is slightly externally rotated was developed by and later modified the..., an OCD or oblique views may help to demonstrate the lesion progresses ( ) throwers and presents a! The anterior and posterior capitellum although its aetiology is still unknown, it has been associated repetitive... Dissecans of the residual osteochondral defect base classification, assigning lesions as stable or.. An idiopathic osteochondrosis of the capitellum which typically occurs at younger ages, 5-12yo warrants investigation with proper radiographs magnetic. Guttman, M.D., Attending, Orthopaedic Surgery examination and found that the prevalence of capitellar lesions.