Osteochondritis Dissecans of the Elbow: Difference between revisions

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== Mechanism of Injury / Pathological Process<br>  ==
== Mechanism of Injury / Pathological Process<br>  ==


Ostechondrosis of the humeral capitellum is secondary to repetitive compressive forces between radial head and capitellum. This injury results in a loose body containing an osteochondral bone fragment that is detached from the articular surface.&nbsp; Causes of this pathology include injury or stress on the joint, lack of blood supply, and/or genetic makeup. <br>Repetitive high stress forces on the joint can result in a series of minor injuries on the elbow that can eventually lead to a fracture and ultimately detachment of the bony fragment from the bone.<br>Blockage of a small artery can also be a factor in this pathology. Lack of blood supply contributes to break down or death of bone tissue.&nbsp; Osteochondritis dissecans also has a genetic component allowing a predisposition to the pathology.<br>
Ostechondrosis of the humeral capitellum is secondary to repetitive compressive forces between radial head and capitellum. This injury results in a loose body containing an osteochondral bone fragment that is detached from the articular surface.&nbsp; Causes of this pathology include injury or stress on the joint, lack of blood supply, and/or genetic makeup. <br>Repetitive high stress forces on the joint can result in a series of minor injuries on the elbow that can eventually lead to a fracture and ultimately detachment of the bony fragment from the bone.<br>Blockage of a small artery can also be a factor in this pathology. Lack of blood supply contributes to break down or death of bone tissue.&nbsp; Osteochondritis dissecans also has a genetic component allowing a predisposition to the pathology.<br>
 
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Staging of osteochondritis dissecans is depicted in the chart below:<br>
 
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Staging of Osteochondritis Dissecans <br> <br>Stage&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Appearance on MRI&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Stability of Lesion<br> <br>I&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Thickening of cartilage and&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Stable<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; low signal changes <br> <br>II&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Articular cartilage interrupted,&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Stable<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; low signal rim behind fragment <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; showing that there is fibrous <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; attachment <br> <br>III&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Articular cartilage interuppted, &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Unstable<br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; high signal changes behind <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; fragment and underlying <br>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; subchondral bone <br> <br>IV&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Loose body &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; Unstable<br><br>


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Clinically Relevant Anatomy
[edit | edit source]

Involved anatomy of this disorder includes the radial head or the central and/or lateral aspect of the capitellum.

Mechanism of Injury / Pathological Process
[edit | edit source]

Ostechondrosis of the humeral capitellum is secondary to repetitive compressive forces between radial head and capitellum. This injury results in a loose body containing an osteochondral bone fragment that is detached from the articular surface.  Causes of this pathology include injury or stress on the joint, lack of blood supply, and/or genetic makeup.
Repetitive high stress forces on the joint can result in a series of minor injuries on the elbow that can eventually lead to a fracture and ultimately detachment of the bony fragment from the bone.
Blockage of a small artery can also be a factor in this pathology. Lack of blood supply contributes to break down or death of bone tissue.  Osteochondritis dissecans also has a genetic component allowing a predisposition to the pathology.


Staging of osteochondritis dissecans is depicted in the chart below:


Staging of Osteochondritis Dissecans

Stage                                      Appearance on MRI                        Stability of Lesion

I                                    Thickening of cartilage and                       Stable
                                     low signal changes

II                                  Articular cartilage interrupted,                    Stable
                                    low signal rim behind fragment
                                    showing that there is fibrous
                                    attachment

III                                 Articular cartilage interuppted,                   Unstable
                                   high signal changes behind
                                   fragment and underlying
                                   subchondral bone

IV                                Loose body                                             Unstable


Clinical Presentation[edit | edit source]

Presentation includes pain over the joint, stiffness, feeling of instability, and stiffness after resting.

Diagnostic Procedures[edit | edit source]

Radiographs can detect any abnormalities on the surface of the joint.


Magnetic Resonance Imaging (MRI) will show any accumulation of fluid in the area and can detect any loose fragments.


Computerized Tomography (CT) can detect any bony fragments, pinpoint their location and determine whether they have settled in the joint space.


Outcome Measures[edit | edit source]

An outcome measure appropriate for this injury is the DASH questionnaire which measures disabilities of the arm, shoulder and hand as they relate to everyday function. 

Management / Interventions
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add text here relating to management approaches to the condition

Differential Diagnosis
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If there is no radiologic confirmation of osteochondritis dissecans, other diagnoses may include inflammatory arthritides, osteoarthritis, bone cysts, and septic arthritis.

Key Evidence[edit | edit source]

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Resources
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add appropriate resources here

Case Studies[edit | edit source]

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[1][2]References[edit | edit source]

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  1. ↑ http://www.mayoclinic.com/health/osteochondritis-dissecans/DS00741
  2. ↑ O’Sullivan S, Siegelman R. National Physical Therapy Examination Review & Study Guide. Evanston, IL: International Educational Resources Ltd, 2006.
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