Topic

OCD of the capitellum

Topic Progress:

Osteochondritis dissecans (OCD) is typically seen in athletes between the ages of 11 and 16 years. It is most commonly seen in weight-bearing sports like gymnastics and is very not common in football.

It is thought that OCD is the result of repeated compressive forces (generally throwing) causing microtrauma and changes in the subchondral blood supply that results in osteochondral injury. The developing elbow may be more at risk as the expanding capitellar epiphysis has a relatively tenuous blood supply.14 It is reasonable to suspect that goalkeepers may be at an increased risk compared with field players, but definitive data is lacking.

 

History

Patients will present with a deep aching pain made worse by throwing. The pain is often felt laterally and is usually in the dominant arm. Patients may report a catching or locking feeling and also report swelling and reduced range of motion.

 

Examination

Examination findings are generally non-specific. The player may have a loss of elbow movement, localised tenderness, and elbow swelling. The ‘active radio-capitellar test’15 involves forearm pronation and supination with the elbow extended. This test aims to reproduce the athlete’s symptoms.

 

Investigations

Radiographs and MRI are the imaging modalities of choice and can help stage the lesion.

Click on the following images to view examples of OCD affecting the elbow.

  • X-ray loose bodies

    Multiple loose bodies see in this (now skeletally mature) athlete.

  • Coronal T1 MRI loose bodies

    The loose bodies and associated osteochondral injury involving the capitellum are seen on this T1 image.

Treatment

The natural history of this condition is difficult to predict and no clear prognostic factors exist. If healing is going to happen, it generally occurs before the physes close. Generally, non-operative treatment is indicated if there is no loose body and no mechanical symptoms. It is important to limit throwing or weight-bearing activity while the athlete is symptomatic. Careful follow-up is needed. If there is evidence of subchondral detachment, arthroscopic debridement has less morbidity and faster return to sports than open procedures. In the long term, osteoarthritis and inability to return to same level are potential outcomes.

Learn more about osteochondritis dissecans in the ‘Youth Player’ module.

André Pedrinelli

Orthopaedic – Prosthetics / Sports Medicine