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. The separated fragments are sometimes called “joint mice”. Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. OCD of the capitellum is more commonly found in male adolescent athletes engaging in repetitive overhead activities and has been associated with baseball, gymnastics, tennis, weight lifting, wrestling, and cheerleading. USA.gov. Unlike OCD, Panner’s disease is a self-limiting process that normally resolves completely with activity modification and rest ( ). 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. There is a lack of consensus on what MRI findings do or do not indicate instability; however, most writers believe that unstable OCD lesions can be identified on T2-weighted imaging from a fluid signal between the OCD and the underlying bone, as well as from a discrete round high–signal intensity area representing a cyst under the OCD lesion ( ) ( Fig. The elbow and its disorders. A grade IV lesion is either an empty defect, a defect with a dislocated fragment, or a loose fragment lying within the bed.  |  Magnetic resonance imaging (MRI) is a valuable tool for assessing OCD of the capitellum and is more sensitive than radiographs. The radiocapitellar compression test is a useful physical examination maneuver for diagnosis. Medical examinations using ultrasonography found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1% to 3%. We also believe that if the radiographs or MRI do not show separation of the fragment with fluid between the native and progeny bone, a period of rest has a decent chance to result in a full functional recovery in at least half of cases. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Osteochondritis Dissecans of the Capitellum, Lateral: Extensor Carpi Radialis Brevis Tendon Injury, Prevention in Youth Sports (Early Sports Specialization): Injuries of the Throwing Shoulder. Once the disease is diagnosed and defined by history, physical examination, and radiologic evaluation, the best treatment options can be discussed. This disorder is an idiopathic osteochondrosis of the entire immature capitellum. 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). A major disadvantage of ultrasound is the high variability in its accuracy, which is based on the skill and experience of the operator ( ). doi: 10.1016/j.eats.2020.07.022. The pathophysiology of OCD resembles that of mechanical trauma to articular cartilage. Axillary radiographic view of the elbow. Stable lesions are those that heal with rest and are characterized by an open capitellar growth plate, contained flattening or radiolucency of the subchondral bone, and decent range of motion. This scheme has been well adopted because of its relative ease of use; however, it has not been shown to correlate well with treatment outcomes ( ). Stage V is marked by displaced capitellar lesions or the presence of a capitellar defect. Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm. 2017 Aug 10;14(4):515-519. doi: 10.1016/j.jor.2017.08.011. The elbow is positioned in approximately 45 degrees of flexion with the beam aimed perpendicular to the forearm. 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. Osteochondritis dissecans (OCD) of the capitellum is an overuse injury most commonly seen in young overhead athletes such as throwers and gymnasts. 32.4 ). Treatment is based on lesion size and stability as well as the condition of the surrounding articular cartilage. 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. In the talus, 96% of lateral lesions and 62% of … Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K. Am J Sports Med. Contained lesions seem to have better outcomes than uncontained lesions. eCollection 2017 Dec. Osteochondritis dissecans of the humeral capitellum. Osteochondritis dissecans (OCD) of the capitellum is an injury that often afflicts young athletes, especially young gymnasts and baseball pitchers. The treatment of patients with capitellar osteochondritis dissecans is primarily determined by the stability of the osteochondritis dissecans lesion. In the long term OCD can lead to subsequent dege… 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. Stage I lesions appear as normally shaped capitellum with several spotted areas whose signal intensity is high but lower than that of cartilage. Clipboard, Search History, and several other advanced features are temporarily unavailable. Radiographs are the most common initial modality for screening patients with suspected OCD. J Hand Surg Am. Arthroscopy. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. For this reason, the senior author (CWN) often exercises athletes in the office (i.e., throwing baseballs) to provoke their symptoms. Throwers, overhead athletes, and upper extremity weight bearing athletes (gymnasts) are at higher risk of capitellum OCD lesions. On ultrasound, loss of the smooth articular surface served as an excellent indicator of an OCD . Osteochondritis dissecans of the capitellum. 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 . The etiology of this disorder is multifactorial and often cannot be determined. Philadelphia: WB Saunders; 2009. p. 288–96. Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. 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. On the contrary, unstable lesions possess one of the following characteristics: a closed capitellar growth plate, lesion fragmentation, or restricted elbow motion ≥ 20 degrees. Elbow is flexed 110 to 120 degrees, and the shoulder is slightly externally rotated. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. CRAIG MORGAN, M.D., Attending, Orthopaedic Surgery. 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. Used ultrasound as the screening examination and found that the prevalence of capitellar OCD prevalence used... And gymnasts, involved in high-demand, repetitive overhead, or even period! Tsutsui H, Nishinaka N, Yamaguchi K. Am J Sports Med a secondary role in the elbow ages... And pattern analysis using quantitative 3-dimensional computed tomography and mapping technique once changes! 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