Like osteochondritis dissecans of the knee, osteochondritis dissecans of the capitellum, or OCD, involves a similar lesion in the elbow of young athletes. Typically it is seen in gymnasts or baseball players with repetitive compression to the outside of the elbow. The disease process is exactly the same in that the bone under the articular cartilage starts to die for unknown reasons. Often the articular cartilage remains intact but occasionally it can fragment, creating a loose piece of bone and cartilage floating in the elbow.
Signs and symptoms of OCD of the capitellum
This process typically involves young athletes, both male and female. Often a young athlete will complain of dull pain or soreness and swelling. If the lesion has broken free in the joint, he or she might complain of catching, clicking, or locking.
In the office, the surgeon will perform a physical examination. Often there is no specific area of bony or soft tissue tenderness to palpation. Occasionally clicking can be felt if the fragment is loose or unstable, and the athlete might lack full range of motion as well. X-rays often show the lesion. An MRI, or even an MR arthrogram, is often ordered to look at the overlying cartilage and help plan treatment.
Surgery and non-surgical treatment options for osteochondritis dissecans of the capitellum
In young athletes with open growth plates, nonsurgical treatment can be attempted. It typically consists of completely stopping gymnastics or throwing until the lesion heals. Success rates for nonsurgical treatment in this population are reasonably good. If the osteochondritis dissecans lesion is free within the joint or felt to be unstable by radiographic studies, surgical treatment is usually indicated. The nature of the treatment depends on the nature of the lesion. Options range from arthroscopically debriding the lesion or removing it and drilling holes to try to stimulate fibrocartilage formation. Occasionally cylinders of bone and cartilage can be placed in the defect to try to recreate the normal contour of the joint.
Return to sports
Return to sports is variable depending on the nature of the lesion and a treatment. Usually surgeons will not allow patients to return to sports until the lesion is healed. Since the elbow is not a weightbearing joint, normal activities are usually allowed, but gymnastics or throwing is usually discouraged for anywhere from 6 weeks to 4 to 6 months depending on the surgical treatment needed.
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