June 4, 1996. When rest is difficult to accomplish, bracing, use of a sling, or even a period of casting is used. Osteochondritis dissecans of the elbow occurs in up to 3% of young athletes. Grade I Osteochondritis Dissecans in a Young Professional Athlete. A grade IV lesion is either an empty defect, a defect with a dislocated fragment, or a loose fragment lying within the bed. J Shoulder Elbow Surg. Patients with unstable lesions or those failing nonoperative therapy require operative intervention with treatment based on lesion size and extent. Osteochondritis dissecans in … Genetic factors are thought to play a secondary role in the pathogenesis. January 2021; DOI: 10.1007/978-3-030-52379-4_6. Mourad F, Maselli F, Patuzzo A, Siracusa A, Di Filippo L, Dunning J, de Las Peñas CF. Osteochondritis dissecans (OCD) of the elbow is increasing in prevalence in American pediatric populations.  |  For this reason, the senior author (CWN) often exercises athletes in the office (i.e., throwing baseballs) to provoke their symptoms. 32.2 ). CrossRef PubMed Google Scholar. Introduction. The most common early symptom of a capitellar OCD lesion is a gradual, progressive onset of lateral elbow pain. 0 . Unlike OCD, Panner’s disease is a self-limiting process that normally resolves completely with activity modification and rest ( ). It typically occurs in gymnasts and overhead throwers and presents along a wide spectrum of severity. Gardiner TB. 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. 2003 Feb;19(2):210-4. doi: 10.1053/jars.2003.50052. 2008;33(8):1380–3. 2017 Aug 10;14(4):515-519. doi: 10.1016/j.jor.2017.08.011. The presence of these OCD lesions is now better recognized, but their etiology is often not known and is certainly multifactorial in many instances. Nonoperative treatment for osteochondritis dissecans of the capitellum. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. 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. Osteochondritis dissecans (OCD) of the humeral capitellum is a critical elbow injury in adolescent overhead throwing athletes. Osteochondritis dissecans (OCD) of the capitellum is a localized disorder of the subchondral bone, in a region with limited healing capacity. Osteochondritis Dissecans of the Capitellum. Many classification systems have been proposed to help guide the diagnosis and management of capitellar OCD lesions. As in the treatment of knee OCD lesions, results of nonoperative treatment are better in younger, prepubescent athletes with wide open physes ( ). 32.4 ). 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. The natural history of OCD is poorly understood, and degenerative joint disease … 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. Prompt recognition of this disorder and institution of nonoperative treatment for early, stable lesions can result in healing with later resumption of sporting activities. Elbow pain seen in the at-risk athlete, such as a baseball player (in particular, a pitcher) or gymnast, should raise suspicion for OCD. 2017 Sep;26(9):1629-1635. doi: 10.1016/j.jse.2017.03.010. Once radiographic changes are obvious, long-term studies suggest that half of affected individuals will be symptomatic. It may progress to become elbow osteoarthritis. Osteochondritis dissecans of the capitellum. 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 ( ). 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. Stage V is marked by displaced capitellar lesions or the presence of a capitellar defect. Once the disease is diagnosed and defined by history, physical examination, and radiologic evaluation, the best treatment options can be discussed. 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. 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. 14. 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. 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. Many writers suggest that the timeline may be as long as 6 months to allow complete healing. Capitellar OCD is relatively uncommon but In the long term OCD can lead to subsequent dege… 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. Magnetic resonance imaging (MRI) is a valuable tool for assessing OCD of the capitellum and is more sensitive than radiographs. From Crotin RL. Ultrasonography is another potential diagnostic imaging tool for capitellar OCD. Unfortunately, the prognosis for advanced lesions remains more guarded, but short-term results after newer reconstruction techniques are promising. Radiographs are the most common initial modality for screening patients with suspected OCD. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. Osteochondritis dissecans (OCD) of the capitellum is an uncommon disorder seen primarily in the adolescent overhead athlete. Stage I lesions appear as normally shaped capitellum with several spotted areas whose signal intensity is high but lower than that of cartilage. This same phenomenon extends to OCD of the capitellum. Suspicion of … 32.6 ). 2020 Nov 20;9(11):e1727-e1730. Osteochondritis dissecans of the capitellum is a well-recognized cause of elbow pain and disability in the adolescent athlete. The treatment of patients with capitellar osteochondritis dissecans is primarily determined by the stability of the osteochondritis dissecans lesion. 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. Osteochondritis dissecans (OCD) is a musculoskeletal condition that occurs primarily during the maturation of the skeleton. Deciding when healing has occurred to an extent great enough to start a slow and planned progression back into daily functioning and, ultimately, athletic activities is difficult. 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. In concert with traumatic insult, the vascular anatomy of the distal humerus underscores ischemia as a likely contributor to OCD of the capitellum. 22 Abstract Background: The goals of this study were to … These lesions, although often asymptomatic, can cause a significant interruption in a young athlete’s sports participation and in his or her day-to-day lives when the disease goes undiagnosed or is allowed to progress until significant symptoms occur. This point is defined as early acceleration with the shoulder near its point of maximal external rotation. However, its etiology remains unknown. Stage IV lesions are characterized by separation from the capitellum chondral surface by a high signal interface. 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. Late findings include the presence of loose bodies, degenerative changes, and radial head enlargement. OCD lesions occur when an area of discrete articular surface begins to separate from the damaged underlying subchondral bone. It occurs in a younger age group (4–12 years) than capitellar OCD and is predominantly found in boys. J Hand Surg Am. In book: Sports Injuries of the Elbow (pp.63-72) Authors: Christiaan J A van Bergen. The dominant arm is more commonly involved, although bilateral involvement has been reported ( ). Suspicion of this condition warrants investigation with proper radiographs and magnetic resonance imaging. 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 ( ). Osteochondritis dissecans of the capitellum in fraternal twins: case report. Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm. Osteochondritis dissecans (OCD) of the humeral capitellum is a sports-related disorder in young athletes, especially baseball players and gymnasts. Typically it is seen in gymnasts or baseball players with repetitive compression to the outside of the elbow. It can be distinguished from the more benign Panner’s disease, as Panner’s is self-limiting, requires minimal … WILMINGTON, DELAWARE . With delayed presentation, patients may lack the terminal 15 to 30 degrees of elbow extension ( ). The elbow and its disorders. 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 disadvantage to consider with CT is the radiation exposure imparted on the young athlete. Osteochondral Autograft Transfer for Capitellar Chondral and Osteochondral Defects. Osteochondritis Dissecans of the Elbow. HHS Osteochondritis dissecans of the capitellum is an uncommon cause of lateral elbow pain in adolescents and young adults. This condition typically affects young athletes, such as throwers and gymnasts, involved in high-demand, repetitive overhead, or weightbearing activities. Like osteochondritis dissecans of the knee, osteochondritis dissecans of the capitellum, or OCD, involves a similar lesion in the elbow of young athletes. The stability of OCD lesions has a significant impact on prognosis and treatment and can be predicted on MRI in some cases. It is defined as a localized fragmentation of bone overlying the capitellum cartilage. 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. 2019 Mar;12(1):1-12. doi: 10.1007/s12178-019-09528-8. Physical examination reveals tenderness over the radiocapitellar joint in the posterolateral elbow in some cases. Despite the uncertainty of its etiology, symptomatic OCD of the capitellum arises primarily from repetitive stress to the elbow ( ). 2001 Jul;20(3):565-90. doi: 10.1016/s0278-5919(05)70270-2. Grade II lesions possess a clear zone between the lesion and the adjacent 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. 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. Athletes with OCD of the capitellum often complain of diffuse, nonspecific pain with activity. 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.  |  Nonoperative treatment of osteochondritis dissecans of the humeral 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 . 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 OF THE RADIAL HEAD IN A YOUNG ATHLETE: A CASE REPORT. Side view of a pitcher at the point of maximal shoulder and elbow stress. Among male relatives of affected males, the prevalence rate is 14.6%. Osteochondritis Dissecans OCD of the capitellum is character-ized by noninflammatory degenera-tion of subchondral bone occurring in the context of repetitive loading to the lateralcompartmentoftheelbow.Pan-ner disease and OCD may represent two different stages of the same disor-der, but they differ in the patient’s age 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. 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. Classic radiography finding of capitellar OCD with radiolucency of the anterolateral capitellum. Shaughnessy WJ. Athletes often present to the physician’s office after a period of rest, lowering the diagnostic yield of physical examination. 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. In this system, grade I lesions are stable with continuous but softened areas of intact cartilage. 2018 Jul-Aug;52(4):344-352. doi: 10.4103/ortho.IJOrtho_322_17. Grade III lesions are associated with loose bodies. 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. 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. USA.gov. 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. 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 ( ). 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. Hence, this compromise of the subchondral support structure promotes articular cartilage fragmentation and loose body formation ( ). 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