Elbow Osteochondritis Dissecans Repair Overview
What is osteochondritis dissecans of the elbow?
Osteochondritis Dissecans of the elbow, also known as OCD occurs when there is a loss of adequate blood supply to the cartilage and underlying bone within the elbow joint. A small section of bone dies without the required blood supply, crack and breaks off with the supportive cartilage. Often seen in young athletes between the ages of 12-20, and especially in young baseball pitchers, osteochondritis dissecans of the elbow used to be called “Little Leaguer’s Elbow.” Now, however, OCD has been found in a broader spectrum of athletes including gymnasts and those who play racket sports. Dr. Nikhil Verma, orthopedic elbow specialist serving Westchester, Oakbrook, Hinsdale and surrounding Chicago communities has extensive experience in treating patients with osteochondritis dissecans of the elbow.
What causes OCD of the elbow?
OCD is caused by the lack of blood in the subchondral bone. This loss of blood flow causes the subchondral bone to die in a process called avascular necrosis. The bone is then reabsorbed by the body, leaving the behind articular cartilage damage. OCD of the elbow often occurs due to a genetic anomaly. Other causes may include:
- Overuse of the elbow joint
- Repetitive throwing motions, creating a stress injury
- History of significant trauma
What are the symptoms of elbow osteochondritis dissecans?
- Pain and tenderness when moving the elbow
- Locking or difficulty moving the elbow
- Stiffness, popping or clicking
- Instability in the joint
How is elbow OCD diagnosed?
Dr. Verma will conduct a thorough medical history as well as physical examination of the patient’s elbow. Popping or clicking (known as crepitus) in the elbow is checked, as well as range of motion and level of pain. X-rays of the elbow are used to confirm the diagnosis and often an MRI scan is required to determine the amount of damage to surrounding soft tissues, cartilage and bone damage. Tears in the cartilage, called lesions, are classified as follows:
- Grade 1: Considered stable – Cartilage in intact, but there is an abnormality and a beginning thickening.
- Grade 2: Considered stable – Cartilage has been damaged and there is a crack or tear in the bone (a lesion).
- Grade 3: Considered unstable – Cartilage has been damaged and there are bone fragments with synovial fluid present.
- Grade 4: Considered unstable – Loose bodies with in the joint (often bone fragments).
How is OCD of the elbow treated?
For young athletes who are diagnosed with OCD of the elbow, discontinuation of the sporting activity that caused the elbow OCD needs to occur. In severe cases, patients may wear a sling or splint to immobilize the joint and facilitate healing. Dr. Verma may prescribe a non-steroidal anti-inflammatory medicine to help reduce pain and swelling within the joint. Physical therapy may be necessary after a period of rest to help with flexibility and range of motion. Dr. Verma’s team will then work with athletes to help improve their form so the strain on the elbow during sports can be reduced.
The type and extent of surgical treatment depends on the grade of the lesion. Dr. Verma typically performs this type of surgery either openly (where he opens the elbow to see the joint clearly) or arthroscopically with small incisions and using small surgical instruments. He may perform one or more of the following procedures:
- External Fixation
How long is the recovery after treatment for OCD of the elbow?
Recovery time varies and is dependent upon several factors. Age, health and the extent of injury all play a part in the recovery timeline. In general, treatment can often take 1-4 months, followed by physical therapy. Complete recovery can take up to a full year, depending on the severity of the osteochondritis dissecans.
For more information on osteochondritis dissecans of the elbow, or if your teen is suffering from elbow pain, please contact the office of Nikhil Verma, MD, orthopedic specialist, serving Westchester, Oakbrook, Hinsdale and the surrounding Chicago, IL communities.