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... 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