What do we know these days about osteochondritis dissecans of the elbow in young athletes? What causes this condition? Can it be cured? These are some of the questions answered in this review article written by sports medicine orthopedic surgeons from Rush University in Chicago, Illinois.
Osteochondritis dissecans (OCD) is a problem encountered most often by male adolescents (teens) involved in repetitive overhead throwing activities. Young girls participating in gymnastics are the second group affected most often. Gymnasts can spend quite a bit of time engaged in activities that require repeated weight-bearing on the arms leading to OCD.
What is OCD and what causes it? In this condition, repetitive microtrauma from repeated motions of the elbow causes the articular cartilage that lines the elbow joint to separate and break into pieces. When the cartilage pulls away from the joint, it takes a layer of subchondral bone with it. Subchondral just means "under the cartilage," which describes the first layer of bone next to the articular cartilage.
Any bone within the elbow can be affected. But the most commonly involved bone is the capitellum. Here's a quick review of elbow anatomy to help you picture the capitellum. The elbow is the connection of the humerus (upper arm bone) and the two bones of the forearm (the ulna and the radius).
The joint where the humerus meets the radius is called the humeroradial joint. This joint is formed by a knob and a shallow cup. The knob on the end of the humerus is called the capitellum. The capitellum fits into the cup-shaped end of the radius, also called the head of the radius.
When the head of the radius spins on the capitellum, the forearm rotates so that the palm faces up toward the ceiling (supination) or down toward the floor (pronation). The joint also hinges as the elbow bends and straightens.
When making the diagnosis, the orthopedic surgeon must distinguish between OCD and another problem called Panner disease. Although these two conditions are considered separate problems, some experts view them as two stages of the same thing.
Both affect the capitellum but Panner disease causes fragmentation of the entire capitellum. OCD is usually more of an isolated lesion that breaks away from the main bone causing a loose body to float inside the joint.
Panner disease tends to develop in young boys between the ages of 5 and 10 who aren't involved in repetitive motions that cause trauma to the joint. For unknown reasons, normal growth in the outer edge of the elbow is disrupted, which causes the small area of bone to flatten out.
Symptoms of diffuse elbow pain are common with both Panner disease and OCD. Diffuse means throughout the entire elbow. Pain can occur along the outside or lateral aspect of the elbow. The pain is present with activity and there's a loss of extension. The child cannot straighten the elbow all the way. There may be stiffness, swelling...