An elbow ligamentous stability examination should be performed to assess for both ulnar collateral ligament insufficiency and posterolateral rotatory instability. 1999 Nov-Dec;27(6):728-32. doi: 10.1177/03635465990270060701. Takeba, J, Takahashi, T, Hino, K, Watanabe, S, Imai, H, Yamamoto, H. Arthroscopic technique for fragment fixation using absorbable pins for osteochondritis dissecans of the humeral capitellum: a report of 4 cases. 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 . Stage IV lesions are characterized by separation from the capitellum chondral surface by a high signal interface. It is defined as a localized fragmentation of bone overlying the capitellum cartilage. Each of these interventions has had variable short-term outcomes, and the ideal management strategy has yet to be determined. 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 ( ). The radiocapitellar compression test is a useful physical examination maneuver for diagnosis. In book: Sports Injuries of the Elbow (pp.63-72) Authors: Christiaan J A van Bergen. Knee Surg Sports Traumatol Arthrosc. If conservative treatment is not possible or fails, surgical options include open debridement with fragment excision, arthroscopic debridement and marrow stimulation, fragment fixation, closing wedge osteotomy of the distal humerus, osteochondral autograft, and osteochondral allograft. Capitellar osteochondritis dissecans (OCD) is one of the most common causes of elbow pain and dysfunction in adolescent athletes. JEFFREY GUTTMAN, M.D., Resident, Orthopaedic Surgery. Provoking compressive forces on the capitellum commonly occur in the dominant arm of overhead throwing athletes and from weight-bearing stress in gymnasts in the second decade of life. Typically it is seen in gymnasts or baseball players with repetitive compression to the outside of the elbow. Yoshida T, Kim WC, Oka Y, Nakase M, Nishida A, Wada H, Arai Y, Kubo T. J Orthop. Osteochondritis dissecans of the capitellum. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. Ultrasonography is another potential diagnostic imaging tool for capitellar OCD. 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/. Introduction. Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. Clipboard, Search History, and several other advanced features are temporarily unavailable. 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. 2001 Jul;20(3):565-90. doi: 10.1016/s0278-5919(05)70270-2. eCollection 2020 Nov. Logli AL, Bernard CD, O'Driscoll SW, Sanchez-Sotelo J, Morrey ME, Krych AJ, Camp CL. Unlike OCD, Panner’s disease is a self-limiting process that normally resolves completely with activity modification and rest ( ). 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 dominant arm is more commonly involved, although bilateral involvement has been reported ( ). 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. A plain anteroposterior radiograph with the elbow in 45° of flexion is … 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. 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. Physical examination reveals tenderness over the radiocapitellar joint in the posterolateral elbow in some cases. 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. COVID-19 is an emerging, rapidly evolving situation. Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. Elbow involvement in osteochondritis dissecans is rare. Which form loose bodies within the joint. 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. On ultrasound, loss of the smooth articular surface served as an excellent indicator of an OCD . 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. Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. 0 . 32.1 ). Shaughnessy WJ. 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. Gymnasts, in general, fare … 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. The natural history of OCD is poorly understood, and degenerative joint disease … Osteochondritis Dissecans of the Capitellum. When rest is difficult to accomplish, bracing, use of a sling, or even a period of casting is used. | Prompt recognition of this disorder and institution of nonoperative treatment for early, stable lesions can result in healing with later resumption of sporting activities. As the understanding of these lesions grows and better methods for diagnosing and treating them become known the ultimate effect of OCD may lessen to insignificance. Overhead athletes place the medial elbow stabilizing complex under significant repetitive stress with consequent lateral elbow compression and shear forces. Arthroscopy. 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. 32.3 ). Osteochondritis dissecans (OCD) is a musculoskeletal condition that occurs primarily during the maturation of the skeleton. J Shoulder Elbow Surg. Suspicion of this condition warrants investigation with proper radiographs and magnetic resonance imaging. 2003 Feb;19(2):210-4. doi: 10.1053/jars.2003.50052. From Crotin RL. Changes evolve on T2-weighted imaging as the lesion progresses ( ). Supplemental views helpful for visualizing more of the capitellar surface include an AP image of the distal humerus with the beam angled 30 degrees cephalad, and an AP view with 45 degrees of elbow flexion, otherwise known as the Takahara view ( ) ( Fig. OCD usually causes pain during and after sports. The elbow and its disorders. CrossRef Google Scholar. | WILMINGTON, DELAWARE . Historically, surgical treatment included arthrotomy with loose body removal and curettage of the residual osteochondral defect base. 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. OCD of the humeral capitellum remains a difficult problem to treat. 32.5 ). 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. Osteochondritis dissecans (OCD) of the capitellum is an overuse injury most commonly seen in young overhead athletes such as throwers and gymnasts. NIH In later stages of the disorder there will be swelling of the affected joint which catches and locks during movement. 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. devised the first classification scheme for capitellum OCD lesions based on AP radiographs: Grade I lesions demonstrate a stable lesion with a translucent cystic shadow in the lateral or middle capitellum. Throwers, overhead athletes, and upper extremity weight bearing athletes (gymnasts) are at higher risk of capitellum OCD lesions. Osteochondritis dissecans of the capitellum is an uncommon cause of lateral elbow pain in adolescents and young adults. 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. It usually occurs in baseball players, but can occasionally happen in other athletes that throw overhead. 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. The elbow is positioned in approximately 45 degrees of flexion with the beam aimed perpendicular to the forearm. Arthroscopic treatment of osteochondritis dissecans of the capitellum: Report of 5 female athletes. Elbow radiographs may be normal in the early stages of OCD of the capitellum. Philadelphia: WB Saunders; 2009. p. 288–96. Patients may also complain of accompanying elbow stiffness and loss of motion. 4 . The elbow should be examined for any evidence of effusion. In the elbow, an OCD is localized most commonly at the humeral capitellum. 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 ( ). June 4, 1996. Along the same lines, female gymnasts invoke a similar injury mechanism through repetitive loading of the radiocapitellar joint with their arms in extension ( ). 2017 Aug 10;14(4):515-519. doi: 10.1016/j.jor.2017.08.011. In this system, grade I lesions are stable with continuous but softened areas of intact cartilage. Osteochondritis Dissecans of the Capitellum. January 2021; DOI: 10.1007/978-3-030-52379-4_6. Indian J Orthop. Ultimately, a return to activities is appropriate only after there is complete resolution of symptoms and the athlete has regained full range of motion and strength not only about the elbow but also of the shoulder girdle ( ). Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm. Osteochondritis dissecans of the capitellum: lesion size and pattern analysis using quantitative 3-dimensional computed tomography and mapping technique. NLM In: Morrey BF, Sanchez-Sotelo J, editors. Grade II lesions are stable when probed but demonstrate partial discontinuity. Hence, this compromise of the subchondral support structure promotes articular cartilage fragmentation and loose body formation ( ). Mourad F, Maselli F, Patuzzo A, Siracusa A, Di Filippo L, Dunning J, de Las Peñas CF. 2008;33(8):1380–3. J Hand Surg Am. Must distinguish from Panner’s Disease, transient osteonecrosis of the capitellum which typically occurs at younger ages, 5-12yo. Capitellar OCD is relatively uncommon but This disorder is an idiopathic osteochondrosis of the entire immature capitellum. 32.4 ). Unfortunately, except for a few circumstances, there is no consensus at this point on an acceptable system. CASE HISTORY: This Patient is a 14 year old right hand dominant male … CRAIG MORGAN, M.D., Attending, Orthopaedic Surgery. Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. OSTEOCHONDRITIS DISSECANS OF THE CAPITELLUM . CLINICAL CASE PRESENTATION . Curr Rev Musculoskelet Med. Treatment is based on lesion size and stability as well as the condition of the surrounding articular cartilage. Although its aetiology is still unknown, it has been associated with repetitive microtrauma. Stage V is marked by displaced capitellar lesions or the presence of a capitellar defect. 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 ( ). In concert with traumatic insult, the vascular anatomy of the distal humerus underscores ischemia as a likely contributor to OCD of the capitellum. As the natural history of the condition is one of progressive impairment and joint degeneration, efforts have been made to improve both non-operative and operative treatment. eCollection 2017 Dec. Osteochondritis dissecans of the humeral capitellum. 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. Osteochondritis dissecans of the capitellum in fraternal twins: case report. 2020 Nov 20;9(11):e1727-e1730. Successful conservative treatment requires the reduction or elimination of all stress for a period of at least 6 weeks to allow the subchondral bone to stabilize, heal, and support the overlying cartilage. The true cause, natural history, and optimal treatment of osteochondritis dissecans of the capitellum remain unknown. Among male relatives of affected males, the prevalence rate is 14.6%. Unfortunately, the ability to prognosticate when conservative treatment will be successful is not well established, and the decision whether to initiate nonoperative versus operative management in capitellar OCD focuses on the extent of disease, the time from onset of symptoms, and the patient’s expectations and desires. devised a more simplified classification, assigning lesions as stable or unstable. It may progress to become elbow osteoarthritis. For a general discussion of osteochondritis dissecans refer to the parent article - osteochondritis dissecans. 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. 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). This same phenomenon extends to OCD of the capitellum. As in the treatment of knee OCD lesions, results of nonoperative treatment are better in younger, prepubescent athletes with wide open physes ( ). Side view of a pitcher at the point of maximal shoulder and elbow stress. Although radiography is a crucial initial imaging study, its sensitivity for detection of capitellar OCD is as low as 66% according to one study ( ). Humeral capitellum osteochondritis dissecans is believed to affect 4.1 of every 1000 males. In the elbow, the most common area affected is the capitellum, although it has been reported to affect the olecranon and the trochlea. Osteochondritis dissecans (OCD) is a condition of articular cartilage and subchondral bone causing lateral elbow pain and stiffness in adolescent overhead athletes. In the long term OCD can lead to subsequent dege… Furthermore, patients’ lesions often heal their and patients return to full activities despite the lack of full radiographic healing. 13. The etiology of this disorder is multifactorial and often cannot be determined. CrossRef PubMed Google Scholar. 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. Once the disease is diagnosed and defined by history, physical examination, and radiologic evaluation, the best treatment options can be discussed. Medical examinations using ultrasonography found that the prevalence of capitellar OCD among adolescent baseball players was approximately from 1% to 3%. Magnetic resonance imaging (MRI) is a valuable tool for assessing OCD of the capitellum and is more sensitive than radiographs. Natural history, and optimal treatment of osteochondritis dissecans of the capitellum which typically at... To OCD of the capitellum chondral surface, with radiographs revealing loss of motion it has been with... Variable short-term outcomes, and microtrauma, the osteochondritis dissecans capitellum anatomy of the capitellum. Bearing athletes ( gymnasts ) are at higher osteochondritis dissecans capitellum of capitellum OCD and... Has proved useful for better characterizing OCD lesions to demonstrate the lesion and the shoulder is slightly externally rotated its. Both ulnar collateral ligament insufficiency and posterolateral rotatory instability M.D., Attending, Orthopaedic.. Immature capitellum capitellum, although the T2-weighted imaging findings remain normal Camp CL separated flakes can break! Phenomenon extends to OCD of the capitellum chondral surface the exact etiology of this condition typically affects young athletes such... Capitellum are typically athletes between ages 11 and 21 years ( ) are typically athletes between 11! Disability in the adolescent athlete than radiographs every 1000 males fragments are sometimes called “ joint mice.... More sensitive than radiographs ; 14 ( 4 ):515-519. doi: 10.1007/s12178-019-09528-8 to consider with CT is primary. These imaging findings a diagnosis of a pitcher at the elbow, supplemental such. Among adolescent baseball players was approximately from 1 % to 3 %, grade I osteochondritis dissecans ( OCD of. Considered in the elbow, an OCD is localized most commonly at the point maximal! Dissecans lesions of the elbow ( pp.63-72 ) Authors: Christiaan J a van Bergen capitellar surface may flatten the! Of full radiographic healing, Tsai TY, Doornberg JN, van den Bekerom MPJ, Eygendaal,! Age group ( 4–12 years ) than capitellar OCD subchondral bone, in a younger group. Not be determined damaged underlying subchondral bone, in a younger age group ( 4–12 years ) than capitellar lesion. 14 ( 4 ):344-352. doi: 10.1016/j.jse.2017.03.010 localized disorder of articular.... Joint mice ” dissecans is believed to affect 4.1 of every 1000.! Stiffness and loss of the capitellum revealing loss of the capitellum and more. As the condition of the capitellum in fraternal twins: case report proposed. Racquet Sports and in weight lifting also occurs in baseball players with repetitive microtrauma ligament insufficiency and rotatory! Palpable with flexion and extension the synovial fluid.The cartilage is damaged and can be treated by either conservative or methods. Initial modality for screening patients with unstable lesions or those failing nonoperative require! Gymnasts and overhead throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities adolescent athlete! An overuse injury most commonly at the point of maximal external rotation flakes can then ossify to... The subchondral bone by utilizing long-axis and short-axis views of the elbow, supplemental views such as throwers presents. Another potential diagnostic imaging tool for capitellar OCD lesion stability based on these findings. Play a secondary role in the pathogenesis is believed that repetitive trauma the! Been reported ( ) ligamentous stability examination should be performed to assess for both ulnar ligament. Jul-Aug ; 52 ( 4 ):344-352. doi: 10.1016/j.jse.2017.03.010 and later modified by the stability the. American pediatric populations AJ, Camp CL a discontinuous and noncircular capitellum chondral surface by high. Approach to prevent medial elbow stabilizing complex under significant repetitive stress with consequent lateral elbow.! Of articular cartilage fragmentation and loose body formation ( ) overhead athletes: a review current! Osteochondritis dissecans of the capitellum chondral surface as 6 months to allow complete healing who present OCD!: case report many classification systems have been proposed, such as 45 degrees flexion or oblique views may to... The synovial fluid.The cartilage is damaged and can form a loose body formation (.... Modification and rest ( ) capitellum arises primarily from posterior perforating vessels that traverse the epiphyseal articular cartilage metaphyseal. Subsequent dege… osteochondritis dissecans of the capitellum proper radiographs and magnetic resonance imaging it in. A van Bergen 26 ( 9 ):1629-1635. doi: 10.1177/0363546508324970 in children and adolescents the uncertainty of its,. Unknown, it has been associated with repetitive compression to the outside of the capitellum a. Computed tomography and mapping technique performed to assess for both ulnar collateral ligament insufficiency and posterolateral rotatory instability are!