Osteochondritis Dissecans of the Capitellum

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. It  usually occurs in baseball players, but can occasionally happen in other athletes that  throw overhead. It can be distinguished from the more benign Panner’s disease, as  Panner’s is self-limiting, requires minimal treatment, and occurs in a younger age  group.

OCD happens when the repetitive trauma results in a blood supply injury to the  capitellum and the bone either fails to develop from the cartilage a child was born  with, or the maturing bone dies and therefore softens and collapses. It can resolve  without treatment, but often requires some intervention and occurs in an older age  group (age 8 to 18).

Symptoms

Symptoms of OCD at the capitellum include:

  • Elbow pain, particularly on the outer side.
  • Pain that worsens with activity and improves with rest.
  • Limitation in elbow motion (inability to straighten the elbow completely).

Diagnosis

The affected elbow will have specific pain on examination, and the amount of motion  may be different than the other (non-affected) elbow. X-rays will demonstrate the  OCD in the capitellum.It may be important to obtain an MRI of the elbow to assess
whether or not the OCD fragment has broken off from the arm bone or if there are  any other problems.

Treatment

Rest from sports involving use of the elbow is the recommended treatment. Casting  may be necessary. If there is no improvement after three months of rest, surgery is  a good option. This would likely entail drilling the lesion with a small pin that can stimulate the OCD to heal. This process occasionally needs to be repeated. If the MRI  suggests that the OCD is not attached, surgery should be done to attempt to put the  OCD fragment back in place. If it is not fixable, removing the fragment is a  reasonable choice to stop the pain.

Both X-rays and an MRI need to be done to assess the healing. A return to throwing  sports should not be done until imaging studies show that the OCD is completely  healed (even if there is no pain and motion has been fully restored). If it is not fully
healed, the fragment can eventually break loose (often in young adulthood) and  result in early arthritis of the elbow joint. The healing process can be as short as four  months, or as long as two years.