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Humeral Capitellum Osteochondritis Dissecans

  • Author: Shital Patel, MD; Chief Editor: Sherwin SW Ho, MD  more...
 
Updated: Oct 25, 2015
 

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.[11]

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.[12] 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, 13, 14, 15] 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.[16, 17]

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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, Chester County Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Guy W Fried, MD Professor, Department of Rehabilitation Medicine, Jefferson Medical College of Thomas Jefferson University; Chief Medical Officer, 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, Phi Beta Kappa

Disclosure: Nothing to disclose.

Phillip J Marone, MD, MSPH Clinical Professor, Department of Orthopedic Surgery and Department of Rehabilitation Medicine, Jefferson Medical College of Thomas Jefferson University

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, Philadelphia County Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American Orthopaedic Society for Sports Medicine

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 Division of the Biological Sciences, The Pritzker School of Medicine

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

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

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.

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