Abstract
Osteochondritis dissecans is thought to be the result of continual microtrauma to the articular cartilage of the elbow. Studies suggest that this repetitive microtrauma causes an ischemic insult to the cartilage and supporting structures that results in the characteristic localized separation of the articular cartilage and subchondral bone. Osteochondritis dissecans most often affects the elbow of the dominant upper extremity in young male athletes, with bilateral findings occurring in approximately 5% of those affected. Sports most often associated with the development of osteochondritis dissecans include racquetball, baseball, weight lifting, cheerleading, and competitive gymnastics. Pain on use of the affected elbow is universally present in patients suffering with osteochondritis dissecans and eases at rest. The pain is often deep, dull, and poorly defined. Loose bodies of the joint are common. Bilateral disease has been reported. The pain of osteochondritis dissecans is generally the patient’s first indication of an elbow problem. The pain is poorly localized, and the patient often rubs his or her elbow when trying to describe it. If joint mice are present, the patient may complain of grating or popping sensations with flexion and extension of the affected elbow. Sleep disturbance is common.
Keywords
osteochondritis dissecans, elbow pain, joint mouse, radiocapitellar joint, active radiocapitellar compression test, intra-articular injection elbow, ultrasound guided injection, sports injury, diagnostic ultrasonography
ICD-10 CODE M93.20
Keywords
osteochondritis dissecans, elbow pain, joint mouse, radiocapitellar joint, active radiocapitellar compression test, intra-articular injection elbow, ultrasound guided injection, sports injury, diagnostic ultrasonography
ICD-10 CODE M93.20
The Clinical Syndrome
Although osteochondritis dissecans was first described in the late 1800s, its exact etiology remains unknown. Current thinking is that osteochondritis dissecans is the result of continual microtrauma to the articular cartilage of the elbow. Studies suggest that this repetitive microtrauma causes an ischemic insult to the cartilage and supporting structures that results in the characteristic localized separation of the articular cartilage and subchondral bone. Osteochondritis dissecans most often affects the elbow of the dominant upper extremity in young male athletes, with bilateral findings occurring in approximately 5% of those affected. Sports most often associated with the development of osteochondritis dissecans include racquetball, baseball, weight lifting, cheerleading, and competitive gymnastics ( Fig. 47.1 ). Pain on use of the affected elbow is universally present in patients suffering with osteochondritis dissecans and eases at rest. The pain is often deep, dull, and poorly defined. Loose bodies of the joint are common. Bilateral disease has been reported.
Signs and Symptoms
The pain of osteochondritis dissecans is generally the patient’s first indication of an elbow problem. The pain is poorly localized, and the patient often rubs his or her elbow when trying to describe it. If joint mice are present, the patient may complain of grating or popping sensations with flexion and extension of the affected elbow. Sleep disturbance is common. Patients suffering from osteochondritis dissecans may exhibit a decreased ability to extend the affected elbow fully. Active compression across the radiocapitellar joint from muscular forces may reproduce the patient’s pain, as will an active radiocapitellar compression test, which is performed by having the patient pronate and supinate the forearm while flexing and extending the elbow ( Fig. 47.2A and B ). Physical examination may also reveal tenderness to palpation of the elbow. If the patient has an associated acute injury to the elbow, swelling and ecchymosis may be present. Flexion contracture, which may also be present, results in a loss of full elbow extension (see Fig. 41.3 ). In some high-performing athletes, these range-of-motion abnormalities represent adaptive changes and are not often the sole cause of the patient’s pain symptoms. As with thrower’s elbow, patients suffering from osteochondritis dissecans often suffer from other coexisting disorders of the elbow including tendinitis, ligamentous injury, myofascial pain syndromes, nerve entrapments, and bursitis.
