Humeral Capitellum Osteochondritis Dissecans 

  • Author: Shital Patel, MD; Chief Editor: Sherwin SW Ho, MD   more...
 
Updated: Aug 2, 2011
 

Background

In 1889, Francis Konig described osteochondritis dissecans as a subchondral inflammatory process of the knee resulting in a loose fragment of cartilage from the femoral condyle. Although no inflammatory cells have been identified on histologic sections of excised fragments, the term osteochondritis dissecans has persisted and since been broadened to describe a similar process occurring in many other joints, including the knee, hip, ankle, elbow, and metatarsophalangeal joints.[1, 2, 3, 4, 5, 6]

Humeral capitellum osteochondritis dissecans occurs after the capitellum has ossified and is the result of "injury" to the subchondral bone. The initial histologic appearance is consistent with avascular necrosis. The avascular necrosis of subchondral bone leads to loss of support for adjacent cartilaginous structures. The natural history of some osteochondritis dissecans lesions is the separation of these structures from the capitellum, leading to the development of an osteochondral fragment of articular cartilage on the underlying bone at the superficial surface of the diarthrodial joint.[7, 8, 9, 10]

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Epidemiology

Frequency

United States

Humeral capitellum osteochondritis dissecans comprises 6% of all osteochondritis dissecans cases.

In the United States, humeral capitellum osteochondritis dissecans most commonly occurs in the second decade of life and is rare in individuals younger than 10 years or older than 50 years. Humeral capitellum osteochondritis dissecans is primarily observed in children aged 10-15 years.

Approximately 85% of osteochondritis dissecans cases involve males, with a large proportion of these being Little League pitchers. Humeral capitellum osteochondritis dissecans is believed to affect 4.1 of every 1000 males. Among male relatives of affected males, the prevalence rate is 14.6%. Osteochondritis dissecans also occurs in females, most notably gymnasts. Finally, it also commonly occurs in persons who participate in racquet sports and in weight lifting.

Humeral capitellum osteochondritis dissecans usually occurs in the dominant arm. In up to 20% of cases, it occurs bilaterally.

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Functional Anatomy

While the trochlea of the distal humerus articulates with the sigmoid fossa of the proximal ulna, the capitellum of the distal humerus articulates with the head of the radius. These articulations, in conjunction with the radioulnar articulation, compose the elbow joint. The articulation of the radial head and humeral capitellum provides mobility for a wide range of supination and pronation, as well as flexion and extension. This area is thus particularly susceptible to the rotary, compressive, axial, and angular forces associated with activities such as throwing.

The radiocapitellar articulation is supported laterally by the radiocollateral, the accessory collateral, the lateral ulnar collateral, and the annular ligaments. These ligaments function to stabilize the elbow throughout the motions of pronation, supination, flexion, and extension.

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Sport-Specific Biomechanics

The exact etiology of osteochondritis dissecans is unclear.[1, 4, 5, 11, 12, 13] In overhead throwing, articular forces at the radiocapitellar articulation are significant. Progressive pronation, compression, and rotation occur on the anteromedial radial head and the inferior and medial aspects of the capitellum as the elbow is extended.

These forces are believed to lead to fibrillation on the articular surface and subchondral osseous changes, with the possible production of osteocartilaginous fragments and the development of humeral capitellum osteochondritis dissecans. The valgus orientation of the elbow contributes to these compressive loads. Excessive axial loading to the elbow is also believed to be the primary cause of injury in gymnasts and weight lifters.[14, 15]

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Contributor Information and Disclosures
Author

Shital Patel, MD  Staff Physician, Bryn Mawr Rehabilitation Hospital

Shital Patel, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Chester County Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Guy W Fried, MD  Assistant Professor, Department of Rehabilitation Medicine, Thomas Jefferson University; Outpatient Medical Director, Medical Director of Incontinence and Respiratory Care Programs, Magee Rehabilitation Hospital

Guy W Fried, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Phillip J Marone, MD, MSPH  Clinical Professor, Department of Orthopedic Surgery, Jefferson Medical College

Phillip J Marone, MD, MSPH is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, American Orthopaedic Society for Sports Medicine, and Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Leslie Milne, MD  Assistant Clinical Instructor, Department of Emergency Medicine, Harvard University School of Medicine

Leslie Milne, MD is a member of the following medical societies: American College of Sports Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD  Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Herodicus Society

Disclosure: Breg, Inc. Consulting fee Consulting; Biomet, Inc. Consulting fee Consulting; GMV, Inc. Arthroscopy Simulator Evaluation and teaching; Smith and Nephew Grant/research funds Fellowship funding; DJ Ortho Grant/research funds Course funding; Athletico Physical Therapy Grant/research funds Course, research funding

References

  1. Shaughnessy WJ. Osteochondritis dissecans. In: Morrey BF, ed. The Elbow and Its Disorders. Philadelphia, Pa: WB Saunders Co; 2000:255-60. [Full Text].

  2. Bennet JB, Mehloff TL. Articular injuries in the athlete. In: Morrey BF, ed. The Elbow and Its Disorders. Philadelphia, Pa: WB Saunders Co; 2000.

  3. Pappas AM, Cummings NM. Sports injuries in the skeletally immature. In: Pappas AM, ed. Upper Extremity Injuries in the Athlete. New York, NY: Churchill Livingstone; 1995:132.

  4. Clanton TO, DeLee JC. Osteochondritis dissecans. History, pathophysiology and current treatment concepts. Clin Orthop Relat Res. Jul 1982;167:50-64. [Medline].

  5. Pappas AM. Osteochondrosis dissecans. Clin Orthop Relat Res. Jul-Aug 1981;158:59-69. [Medline].

  6. Naguro S. The so-called osteochondritis dissecans of Konig. Clin Orthop Relat Res. 1960;18:100-22.

  7. Alley RM, Pappas AM. Acute and chronic performance-related injuries of the elbow. In: Pappas AM, ed. Upper Extremity Injuries in the Athlete. New York, NY: Churchill Livingstone; 1995:350-1, 361-2.

  8. Pettrone FA, ed. American Academy of Orthopaedic Surgeons Symposium on Upper Extremity Injuries in Athletes. St. Louis, Mo: CV Mosby; 1986:193-232.

  9. Brown R, Blazina ME, Kerlan RK, et al. Osteochondritis of the capitellum. J Sports Med. Jan-Feb 1974;2(1):27-46. [Medline].

  10. Woodward AH, Bianco AJ Jr. Osteochondritis dissecans of the elbow. Clin Orthop Relat Res. Jul-Aug 1975;110:35-41. [Medline].

  11. Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. Surgical technique. J Bone Joint Surg Am. Mar 2008;90 suppl 2:47-62. [Medline].

  12. Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am. Jun 2007;89(6):1205-14. [Medline].

  13. Stubbs MJ, Field LD, Savoie FH 3rd. Osteochondritis dissecans of the elbow. Clin Sports Med. Jan 2001;20(1):1-9. [Medline].

  14. Bradley JP, Petrie RS. Osteochondritis dissecans of the humeral capitellum. Diagnosis and treatment. Clin Sports Med. Jul 2001;20(3):565-90. [Medline].

  15. Singer KM, Roy SP. Osteochondrosis of the humeral capitellum. Am J Sports Med. Sep-Oct 1984;12(5):351-60. [Medline].

  16. Krabak BJ, Alexander E, Henning T. Shoulder and elbow injuries in the adolescent athlete. Phys Med Rehabil Clin N Am. May 2008;19(2):271-85, viii. [Medline].

  17. Kobayashi K, Burton KJ, Rodner C, Smith B, Caputo AE. Lateral compression injuries in the pediatric elbow: Panner's disease and osteochondritis dissecans of the capitellum. J Am Acad Orthop Surg. Jul-Aug 2004;12(4):246-54. [Medline].

  18. DaSilva MF, Williams JS, Fadale PD, Hulstyn MJ, Ehrlich MG. Pediatric throwing injuries about the elbow. Am J Orthop. Feb 1998;27(2):90-6. [Medline].

  19. Takahara M, Ogino T, Tsuchida H, et al. Sonographic assessment of osteochondritis dissecans of the humeral capitellum. AJR Am J Roentgenol. Feb 2000;174(2):411-5. [Medline]. [Full Text].

  20. Matsuura T, Kashiwaguchi S, Iwase T, Takeda Y, Yasui N. Conservative treatment for osteochondrosis of the humeral capitellum. Am J Sports Med. May 2008;36(5):868-72. [Medline].

  21. Arai Y, Hara K, Fujiwara H, et al. A new arthroscopic-assisted drilling method through the radius in a distal-to-proximal direction for osteochondritis dissecans of the elbow. Arthroscopy. Feb 2008;24(2):237.e1-4. [Medline].

  22. Nobuta S, Ogawa K, Sato K, et al. Clinical outcome of fragment fixation for osteochondritis dissecans of the elbow. Ups J Med Sci. 2008;113(2):201-8. [Medline].

  23. Bauer M, Jonsson K, Josefsson PO, Lindén B. Osteochondritis dissecans of the elbow. A long-term follow-up study. Clin Orthop Relat Res. Nov 1992;284:156-60. [Medline].

  24. Lindholm TS, Osterman K, Vankka E. Osteochondritis dissecans of elbow, ankle and hip: a comparison survey. Clin Orthop Relat Res. May 1980;148:245-53. [Medline].

  25. Medical Economics Staff. Physicians' Desk Reference. 54th ed. Montvale, NJ: Medical Economics Co; 2000.

  26. Mitsunaga MM, Adishian DA, Bianco AJ Jr. Osteochondritis dissecans of the capitellum. J Trauma. Jan 1982;22(1):53-5. [Medline].

  27. Roberts N, Hughes R. Osteochondritis dissecans of the elbow joint; a clinical study. J Bone Joint Surg Br. Aug 1950;32-B(3):348-60. [Medline]. [Full Text].

 
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