Review Question - QID 644

Osteochondritis dissecans (OCD) commonly occurs in gymnasts and adolescent throwing athletes presenting with symptoms of lateral elbow pain associated with stiffness, catching, or clicking.

The exact etiology is poorly understood but is thought to be related to high repetitive compressive forces causing alterations in the subchondral blood supply resulting in osteochondral fragmentation. The lateral localization of pain is also typical of osteochondritis dissecans of the elbow which usually occurs in the capitellum. Osteochondritis dissecans lesions can be evaluated by plain radiograph, MRI, and CT imaging. Early lesions demonstrate radiolucency on xray or non-displaced fragments, while advanced lesions show slightly displaced fragments and eventually large displaced fragments. Treatment while skeletally immature is best managed by cessation from throwing or impact loading. Arthroscopic debridement, loose body excision, and marrow stimulation or grafting is indicated in patients who fail extended non-surgical treatment, have mechanical symptoms, or loose bodies on imaging.

Takahara et al. reported on the long term results of both nonoperative treatment and removal of loose fragments for elbow OCD. Residual elbow symptoms with ADLs were found in approximately 50% of patients, and may be associated with advanced lesions, osteoarthritis of the elbow, and a large osteochondral defect.

Illustration A shows the a radiograph of Osteochondritis dissecans (OCD).

Incorrect Responses:
Answer 1: Medial ulnar collateral injury is suggested by medial pain and instability.
Answer 2: PLRI is more often seen following acute trauma with elbow dislocations.
Answer 4: Olecranon stress fractures typically cause posterior pain in extension.
Answer 5: Plica is another potential cause of lateral elbow pain, but rarely causes effusion and mechanical symptoms with passive motion.