Return to Play
In general, once a patient with humeral capitellum osteochondritis dissecans is healed, his or her activity level should be gradually advanced. If symptoms recur, then activity modifications and/or limitations must be made. With intact lesions, return to competitive sports is likely, although the prognosis for pitchers and gymnasts is more guarded. In lesions in which completely detached osteochondral fragments are identified, studies have shown tremendous variability in a patient's ability to return to competitive athletics.
Complications
If the patient reports a locking and catching sensation, the physician must evaluate with MRI or CT arthrography for partially attached or completely detached fragments, even if the initial workup (ie, plain radiography) suggested an intact lesion.
Patients can be left with decreased ROM at the elbow, particularly loss of full extension. Patients also report pain with effort, especially with heavy lifting. Many report mild weakness. Long-term sequelae also include traumatic arthritis, increased diameter of the radial head, and early physeal closure of the radial head.
Prevention
The best method of prevention of humeral capitellum osteochondritis dissecans is to avoid the repetitive compressive forces that are associated with athletics and heavy labor. Maintaining guidelines such as limiting a pitcher's innings and mandatory rest between pitching appearances is extremely important for injury prevention. Following recommendations for maintenance therapy is also important upon return to activity.
Prognosis
Prognosis is largely dependent on the patient's age and the size and extent of the lesion. Individuals diagnosed at a younger age tend to have more favorable outcomes. [25] Lesions with large fragments that require surgery and those discovered in late adolescence are more prone to the development of traumatic arthritis. In cases in which the diagnosis is made early, the elbow can usually be returned to a functional level.
Education
Advising parents and children about the potential pitfalls of overuse is important. They must be taught to use good judgment and to take appropriate precautions, such as limiting the pitch count of Little League pitchers (see the 2004 USA Baseball Medical & Safety Advisory Committee recommendations for youth pitch counts).
Related Medscape Reference topics:
Elbow and Forearm Overuse Injuries
Related Medscape resources:
Resource CenterAdolescent Medicine
Resource CenterExercise and Sports Medicine
Resource CenterJoint Disorders
Specialty SiteOrthopaedics
Specialty SitePediatrics
