Osteochondritis Dissecans

• Osteochondritis Dissecans:

  • an acquired lesion of subchondral bone with varying degrees of reabsorption, fragmentation and sclerosis with potential involvement of the overlying cartilage but not the result of an acute osteochondral fracture
• Osteochondritis Dissecans:

  • what
  • an acquired lesion to subchondral bone
  • +/- involvement of the overlying cartilage
  • NOT from an acute osteochondral fracture
  • where
  • capitulum (common)
  • radial head, olecranon and trochlea (very rare)
  • how
  • multifactorial
  • repetitive trauma e.g. overhead activities and weight lifting
  • biomechanical mismatch: radial head and capitellum
  • vascular: blood flow disruption
  • who
  • peak incidence in males, 11 to 17 year old
  • involved in overhead sports
• Osteochondritis Dissecans - Subjective Features:

  • pain on aggravating activities e.g. overhead activities, weightlifting
  • stiffness through range
  • mechanical symptoms e.g. catching/locking, crepitus
  • pain at rest and at night - if damage to bony surface continues
• Osteochondritis Dissecans - Objective Features:

  • observations
  • holding arm in flexion as it hurts to go into extension or because they physically cant go into extension
  • palpation/tests
  • tenderness over radiohumeral joint line
  • pain with axial compression
  • ROM
  • lacking 15 - 30 degrees of elbow extension
  • crepitus with pronation/supination
  • Investigations
  • 3 view plain xray (only detects 66% of OCD)
  • MRI - gold standard
• Osteochondritis Dissecans - Stable Lesions Management:

  • features:
  • localised flattening or radiolucency on xray
  • good elbow range of motion
  • open capitellar physis
  • respond well to non operative treatment
  • immediate cessation of aggravating activities
  • hinged elbow brace for 1 - 6 weeks
  • ROM exercises
  • only start strength exercises once symptoms resolved
  • graded return to activity
  • gentle graded overhead throwing/activity at 3 to 4 months
  • return to sport at 6 months
• Osteochondritis Dissecans - Unstable Lesions Management:

  • features:
  • fragmentation on xray
  • ROM lacking more than 20 degrees extension
  • closed capitellar physis
  • Better outcome with operative treatment
  • surgery is dependent on many factors
  • lesion size, loose bodies etc
  • post operation rehab is similar to conservative rehabilitation