Osteochondritis (OCD) of the Capitellum
What is it: Osteochondritis (OCD) of the capitellum is a fragmentation of the cartilage and subchondral bone of the capitellum of the elbow.
How does it present: This condition usually presents in younger patients, ages 10-16, and is due to a repetitive lateral compression force on the elbow, such as with pitching. Young athletes may present with lateral elbow pain and swelling, pain with aggravating activities, such as throwing and pitching, or with a sense of locking or catching if there has been fragmentation of the underlying cartilage and bone causing loose bodies within the joint.
Common exam findings: On exam, the patient usually has lateral joint tenderness, and may have decreased range of motion or an effusion.
Tests and treatment: X-rays are helpful in making the diagnosis. Computer tomography (CT scan) or magnetic resonance imaging (MRI) arthrogram may be needed if x-rays are negative but there is a strong clinical suspicion, or in cases where further evaluation of amount of displacement of the fragments is needed. Treatment for cases of non-displaced OCD lesions may be considered for conservative management with rest, therapy for range of motion and strict avoidance of aggravating activity. Displaced OCD lesions should be referred to orthopedics for possible surgical management. OCD lesions of the capitellum should be differentiated from Panner's Disease which is irregularities and fragmentation of the bone of the capitellum due to avascular necrosis caused by a disruption in the blood supply to the epiphysis. A history of repetitive trauma to the elbow may be present with Panner's disease, but there are other hereditary or endocrine factors that may play a role in causality. In the majority of cases of Panner's disease, outcome is excellent with conservative measures.