History
The typical presentation is that of a young adolescent reporting elbow pain. [3, 18, 19, 20] The pain is usually characterized as dull and poorly localized. The patient reports aggravation with use (particularly throwing) and good relief with rest. Pain can also result from other activities, such as wrestling, football, tennis, basketball, golf, shot-putting, and gymnastics. In extreme cases, the elbow flexion contracture may be 15° or more, related to the possible presence of a loose body, overuse, or pain related to the osteochondritis dissecans lesion. Presence of a loose body may also result in catching and locking sensation at the elbow.
Related Medscape topics:
Resource CenterAdolescent Medicine
Resource CenterExercise and Sports Medicine
Resource CenterJoint Disorders
Specialty SiteOrthopaedics
Specialty SitePediatrics
Causes
Ischemic
Repetitive valgus loading may injure the limited vascular supply to the distal humerus, thus leading to avascularity in the region.
Activities such as pitching are often associated with repetitive overuse that leads to valgus compressive forces being generated across the radiocapitellar joint and, thus, induce changes in the distal humerus that cause osteochondritis dissecans.
A similar mechanism is noted in gymnasts. Gymnasts bear their entire body weight on their arms and expose the elbows to repetitive compressive forces.
Trauma
This is usually the result of repetitive microtrauma, as described above or, less frequently, the result of single traumatic insult.
Genetic predisposition
Osteochondritis dissecans is often seen in several generations of the same family.
Osteochondritis dissecans frequently occurs within multiple joints in a given patient.
Physical Examination
Early findings
Early findings include the following:
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Local tenderness over the lateral aspect of the elbow, most typically in the dominant arm
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Swelling
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Intermittent limitations with range of motion (ROM) that are worse with activity
Late findings
Late findings include the following:
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Joint effusion
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More progressive limitation of elbow movement (loss of extension, usually 5-10°)
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Crepitus with motion
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Muscle atrophy
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Catching and locking of the elbow (usually observed with separation of osseous/cartilaginous fragments)
