Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Clipboard, Search History, and several other advanced features are temporarily unavailable. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. 2009 Feb;37(2):298-304. doi: 10.1177/0363546508324970. The blood supply to the capitellum arises primarily from posterior perforating vessels that traverse the epiphyseal articular cartilage without metaphyseal collateral circulation ( ). Genetic factors are thought to play a secondary role in the pathogenesis. 2003 Feb;19(2):210-4. doi: 10.1053/jars.2003.50052. This site needs JavaScript to work properly. Clin Sports Med. Although its aetiology is still unknown, it has been associated with repetitive microtrauma. Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. Investigators have found high sensitivity (89% to 100%) of MRI for detecting unstable lesions when all four of the following Kijowski criteria are present: (1) a rim of high signal on T2-weighted images, (2) surrounding cysts, (3) a fluid-filled osteochondral defect, and (4) a thin high-intensity fracture line on T2-weighted images ( ). Like osteochondritis dissecans of the knee, osteochondritis dissecans of the capitellum, or OCD, involves a similar lesion in the elbow of young athletes. Unfortunately, except for a few circumstances, there is no consensus at this point on an acceptable system. 4th ed. J Hand Surg Am. OSTEOCHONDRITIS DISSECANS OF THE CAPITELLUM . 2017 Sep;26(9):1629-1635. doi: 10.1016/j.jse.2017.03.010. Once the disease is diagnosed and defined by history, physical examination, and radiologic evaluation, the best treatment options can be discussed. Unlike OCD, Panner’s disease is a self-limiting process that normally resolves completely with activity modification and rest ( ). Crepitus at the elbow may be palpable with flexion and extension. Stage III lesions show a discontinuous and noncircular capitellum chondral surface. In the evaluation for suspected osteochondritis dissecans of the capitellum, standard elbow radiographs, including anteroposterior (AP), oblique radial head, and lateral views, should be obtained ( Fig. However, its etiology remains unknown. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. On ultrasound, loss of the smooth articular surface served as an excellent indicator of an OCD . In early-stage lesions, the T1-weighted MR image demonstrates uniform low-intensity changes in the superficial capitellum, although the T2-weighted imaging findings remain normal. In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. Osteochondritis dissecans (OCD or OD) is a joint disorder primarily of the subchondral bone in which cracks form in the articular cartilage and the underlying subchondral bone. Osteochondritis dissecans. Osteochondritis dissecans (OCD) of the humeral capitellum is a sports-related disorder in young athletes, especially baseball players and gymnasts. Arthroscopy. Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. Osteochondritis dissecans also occurs in females, most notably gymnasts. Furthermore, patients’ lesions often heal their and patients return to full activities despite the lack of full radiographic healing. Although radiography is a crucial initial imaging study, its sensitivity for detection of capitellar OCD is as low as 66% according to one study ( ). This point is defined as early acceleration with the shoulder near its point of maximal external rotation. Shaughnessy WJ.  |  However, we are very careful with this treatment arm of the algorithm because the elbow loses functional range of motion faster than most joints in the body when it is immobilized. The natural history of OCD is poorly understood, and degenerative joint disease … Arthroscopic treatment of osteochondritis dissecans of the capitellum: Report of 5 female athletes. As in the treatment of knee OCD lesions, results of nonoperative treatment are better in younger, prepubescent athletes with wide open physes ( ). OCD of the humeral capitellum remains a difficult problem to treat. Although intravenous gadolinium contrast enhancement of the lesion may suggest vascularity and thus viability of a fragment, MR arthrography has not been shown to provide any added benefit in assessing for the presence or stability of OCD lesions ( ). Hence, this compromise of the subchondral support structure promotes articular cartilage fragmentation and loose body formation ( ). Ultimately the decision on how to treat a particular lesion is determined both by the extent of the lesion and by the athlete’s desire to participate in the chosen sport. Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. 13. It typically occurs in gymnasts and overhead throwers and presents along a wide spectrum of severity. Epub 2008 Dec 4. Unfortunately, the prognosis for advanced lesions remains more guarded, but short-term results after newer reconstruction techniques are promising. This occurs primarily during the late cocking phase of the throwing cycle as the radiocapitellar articulation, a prime secondary stabilizer to valgus stress, experiences as much as 60% of the axial compression force across the elbow ( Fig. 0 . CLINICAL CASE PRESENTATION . With this maneuver, passive forearm pronation and supination with the elbow in midrange flexion and extension during application of an axial load recreates pain at the radiocapitellar joint. When rest is difficult to accomplish, bracing, use of a sling, or even a period of casting is used. The elbow and its disorders. proposed a classification scheme of capitellar OCD lesion stability based on T2-weighted MRI sequences. In: Morrey BF, Sanchez-Sotelo J, editors. In the elbow, the most common area affected is the capitellum, although it has been reported to affect the olecranon and the trochlea. Treatment is based on lesion size and stability as well as the condition of the surrounding articular cartilage. Currently, the key to successful treatment is early detection. OCD can mean one or more flakes of articular cartilage have become separated. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. 2001 Jan;20(1):1-9. doi: 10.1016/s0278-5919(05)70243-x. 4 . Contained lesions seem to have better outcomes than uncontained lesions. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). The elbow is positioned in approximately 45 degrees of flexion with the beam aimed perpendicular to the forearm. A capitellar OCD prevalence study used ultrasound as the screening examination and found that it had a 100% positive predictive value. Repetitive stress to and compression of this tenuous blood supply may cause ischemia of the subchondral bone within the capitellum and the characteristic osteonecrosis observed in OCD. Grade II lesions are stable when probed but demonstrate partial discontinuity. An axillary view of the bent elbow, taken in the style of a knee Merchant view, may also provide better visualization of the capitellum as well as the posteromedial aspect of the elbow, where loose bodies are often found ( ) ( Fig. 1. repetitive throwing / valgus stress and gymnastics / weight bearing on upper extremity 1.1. valgus stress / compressive force on the vulnerable chondroepiphysis of the radiocapitellar joint in skeletally immature patients is supported as the etiology for OCD of the capitellum 8 2. ankle sprain/instability 2.1. Elbow is flexed 110 to 120 degrees, and the shoulder is slightly externally rotated. 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. The pathophysiology of OCD resembles that of mechanical trauma to articular cartilage. 1999 Nov-Dec;27(6):728-32. doi: 10.1177/03635465990270060701. 2. Curr Rev Musculoskelet Med. Arthrosc Tech. Stage II is marked by several spotted areas of higher intensity than cartilage. OCD lesions occur when an area of discrete articular surface begins to separate from the damaged underlying subchondral bone. Keywords: elbow, osteochondritis dissecans, baseball INTRODUCTION Osteochondritis dissecans (OCD) of the capitellum is a leading cause of elbow disability in adolescent athletes and generally af-fects those, such as baseball players and gymnasts, who engage in repetitive overhead or weight-bearing activities involving the upper extremities. Modyfied wedge osteotomy for osteoarthritis of elbow secondary to osteochondritis dissecans in adolecent with multiple epiphyseal dysplasia. Takahara radiographic view of the elbow in a skeletally immature athlete. 32.1 ). Overhead athletes place the medial elbow stabilizing complex under significant repetitive stress with consequent lateral elbow compression and shear forces. Osteochondritis dissecans (OCD) of the elbow is increasing in prevalence in American pediatric populations. Osteochondritis dissecans of the capitellum: lesion size and pattern analysis using quantitative 3-dimensional computed tomography and mapping technique. The radiocapitellar compression test is a useful physical examination maneuver for diagnosis. In the long term OCD can lead to subsequent dege… NIH eCollection 2017 Dec. Osteochondritis dissecans of the humeral capitellum. The progression of capitellar OCD may result in significant pain, loss of motion, inability to perform weight-bearing or overhead activities, and radiocapitellar degenerative change in approximately 50% of patients ( ). Osteochondritis dissecans (OCD) of the humeral capitellum is a disorder affecting mainly boys between the ages of 12 and 15 years. Humeral capitellum osteochondritis dissecans is believed to affect 4.1 of every 1000 males. devised a more simplified classification, assigning lesions as stable or unstable. Elbow involvement in osteochondritis dissecans is rare. 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. A major disadvantage of ultrasound is the high variability in its accuracy, which is based on the skill and experience of the operator ( ). Stage I lesions appear as normally shaped capitellum with several spotted areas whose signal intensity is high but lower than that of cartilage. Ultrasonography is another potential diagnostic imaging tool for capitellar OCD. 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. Rest and antiinflammatory medications are typically effective in relieving the pain, features that may contribute to the delayed presentation that often occurs with this pathology. Osteochondritis dissecans (OCD) of the capitellum is a localized disorder of the subchondral bone, in a region with limited healing capacity. 22 Abstract Background: The goals of this study were to … Onset is between childhood and middle age, with the majority of patients being between 10 and 40 years of age, with approximately a 2:1 male to female ratio 3. 2018 Aug;13(4):726-736. Seen primarily in young overhead athletes such as baseball players, the condition is thought to be secondary to repetitive compressive and shearing forces that are exerted by the radial head on the humeral capitellum during the throwing motion. 32.2 ). CrossRef Google Scholar. Grade III lesions are associated with loose bodies. Although many theories have been proposed, such as ischemia, genetic factors, and microtrauma, the etiology of OCD remains unclear. Mourad F, Maselli F, Patuzzo A, Siracusa A, Di Filippo L, Dunning J, de Las Peñas CF. Osteochondral Autograft Transfer for Capitellar Chondral and Osteochondral Defects. Diagnosis and treatment. JEFFREY GUTTMAN, M.D., Resident, Orthopaedic Surgery. Throwers, overhead athletes, and upper extremity weight bearing athletes (gymnasts) are at higher risk of capitellum OCD lesions. 32.5 ). 2001 Jul;20(3):565-90. doi: 10.1016/s0278-5919(05)70270-2. Grade III lesions show complete discontinuity but have not dislocated. described a method to visualize the articular surface and subchondral bone by utilizing long-axis and short-axis views of the anterior and posterior capitellum. For this reason, the senior author (CWN) often exercises athletes in the office (i.e., throwing baseballs) to provoke their symptoms. Patients may also complain of accompanying elbow stiffness and loss of motion. 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. Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. In book: Sports Injuries of the Elbow (pp.63-72) Authors: Christiaan J A van Bergen. Each of these interventions has had variable short-term outcomes, and the ideal management strategy has yet to be determined. In the elbow, supplemental views such as 45 degrees flexion or oblique views may help to demonstrate the lesion. Osteochondritis dissecans (OCD) of the outer elbow side of the arm bone, or capitellum, is a condition that results from repetitive trauma to the capitellum. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. For a general discussion of osteochondritis dissecans refer to the parent article - osteochondritis dissecans. An elbow ligamentous stability examination should be performed to assess for both ulnar collateral ligament insufficiency and posterolateral rotatory instability. 2018 Jul-Aug;52(4):344-352. doi: 10.4103/ortho.IJOrtho_322_17. Stage V is marked by displaced capitellar lesions or the presence of a capitellar defect. Osteochondritis dissecans of the capitellum. A collaborative approach to prevent medial elbow injuries in baseball pitchers. 2020 Nov 20;9(11):e1727-e1730. The stability of OCD lesions has a significant impact on prognosis and treatment and can be predicted on MRI in some cases. Panner’s disease must be considered in the differential diagnosis of a young athlete with elbow pain. However, once an athlete complains of clicking or locking, regardless of the timeliness of diagnosis and the patient’s age, the likelihood that conservative management will be successful decreases. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. CASE HISTORY: This Patient is a 14 year old right hand dominant male … The most common early symptom of a capitellar OCD lesion is a gradual, progressive onset of lateral elbow pain. The treatment of patients with capitellar osteochondritis dissecans is primarily determined by the stability of the osteochondritis dissecans lesion. Osteochondritis dissecans of the capitellum is an uncommon cause of lateral elbow pain in adolescents and young adults. Mihara K, Tsutsui H, Nishinaka N, Yamaguchi K. Am J Sports Med. 32.6 ). It can be distinguished from the more benign Panner’s disease, as Panner’s is self-limiting, requires minimal … eCollection 2020 Nov. Logli AL, Bernard CD, O'Driscoll SW, Sanchez-Sotelo J, Morrey ME, Krych AJ, Camp CL. Osteochondritis dissecans of the capitellum in fraternal twins: case report. Patients with unstable lesions or those failing nonoperative therapy require operative intervention with treatment based on lesion size and extent. This same phenomenon extends to OCD of the capitellum. Osteochondritis dissecans (OCD) of the capitellum is an injury that often afflicts young athletes, especially young gymnasts and baseball pitchers. A disadvantage to consider with CT is the radiation exposure imparted on the young athlete. Many classification systems have been proposed to help guide the diagnosis and management of capitellar OCD lesions. It is defined as a localized fragmentation of bone overlying the capitellum cartilage. Athletes often present to the physician’s office after a period of rest, lowering the diagnostic yield of physical examination. Suspicion of this condition warrants investigation with proper radiographs and magnetic resonance imaging. With time, the overlying articular cartilage begins to break down and is increasingly vulnerable to shear stress because of inadequate subchondral osseous support, leading to separation, fragmentation, and loose body formation ( ). A localized injury and subsequent separation of articular cartilage and subchondral bone of the capitellum ; Epidemiology ... - Osteochondritis Dissecans of Elbow B 6/7/2020 262 . Must distinguish from Panner’s Disease, transient osteonecrosis of the capitellum which typically occurs at younger ages, 5-12yo. Osteochondritis dissecans in … With delayed presentation, patients may lack the terminal 15 to 30 degrees of elbow extension ( ). Once radiographic changes are obvious, long-term studies suggest that half of affected individuals will be symptomatic. Elbow pain seen in the at-risk athlete, such as a baseball player (in particular, a pitcher) or gymnast, should raise suspicion for OCD. In this system, grade I lesions are stable with continuous but softened areas of intact cartilage. Indian J Orthop. Capitellar OCD is relatively uncommon but Osteochondritis dissecans (OCD) of the capitellum is a condition of the lateral elbow that often affects skeletally immature athletes, especially those who repeatedly subject the radiocapitellar joint to compressive forces. Osteochondritis dissecans (OCD) is a musculoskeletal condition that occurs primarily during the maturation of the skeleton. Athletes with OCD of the capitellum often complain of diffuse, nonspecific pain with activity. Use of repeated imaging, although intuitively a good idea, is not established as a viable method to determine the appropriate timing of return to activities. Osteochondritis Dissecans of the Capitellum. Magnetic resonance imaging (MRI) is a valuable tool for assessing OCD of the capitellum and is more sensitive than radiographs. In more severe cases, athletes may develop mechanical symptoms, such as catching, clicking, and locking, suggesting the presence of intraarticular loose bodies. The introduction of elbow arthroscopy in the treatment of osteochondritis dissecans of the capitellum permits a thorough lesion assessment and evaluation of the entire elbow joint with the ability to treat the lesion and coexistent pathology in a minimally invasive fashion.  |  Historically, surgical treatment included arthrotomy with loose body removal and curettage of the residual osteochondral defect base. In later stages, the capitellar surface may flatten and the lesion is often surrounded by a rim of sclerotic bone ( ). doi: 10.1016/j.eats.2020.07.022. The lesions can be treated by either conservative or operative methods with good to excellent results reported in most situations. Medical examinations using ultrasonography found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1% to 3%. Side view of a pitcher at the point of maximal shoulder and elbow stress. Computed tomography (CT) may be used to better define the osseous anatomy and subchondral bone, and CT arthrography can more accurately assess for loose bodies ( ). A young athlete ; 20 ( 3 ):565-90. doi: 10.1053/jars.2003.50052 useful for better characterizing lesions. Ages, 5-12yo show a discontinuous and noncircular capitellum chondral surface by a high signal interface separated... 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