We are trying to decide what’s the best treatment for an exchange student who is living with us. He has gotten involved in baseball and developed osteochondritis dissecans of the elbow. His parents have agreed to whatever we think is best. Would it be helpful to have a CT scan or MRIs done before deciding on the best course of action?

Athletes involved in overhead throwing sports are at risk for this problem at the elbow called osteochondritis dissecans (OCD). Baseball pitchers and racket-sport players are affected most often. Sometimes gymnasts who put weight through the arms develop this condition, too. It can be very disabling. Treatment that enables them to return to full participation in their sport is a challenge.

The forceful and repeated actions of these sports can strain the surface of the elbow. With repetitive shearing and compressive force on the elbow, the bone under the joint surface weakens and becomes injured. This, in turn, damages the blood vessels going to the bone. Without blood flow, a section of bone dies. The injured bone cracks. It may actually break off. The result is osteochondritis dissecans (OCD).

The diagnosis is usually made on the basis of the patient’s history and symptoms. The doctor begins by asking questions about the patient’s age and sports participation. In the physical exam, the sore elbow and healthy elbow will be compared. The doctor checks for tenderness by pressing on and around the elbow. The amount of movement in each elbow is measured. The doctor checks for pain and crepitus when the forearm is rotated and when the elbow is bent and straightened.

X-rays are needed to confirm the diagnosis. A front and a side view of the elbow are generally the most helpful. Early in the course of the problem, the X-rays may appear normal.

As the condition worsens, the X-ray image may show changes in the affected bone. The normal shape of the bone may appear irregular. In bad cases of elbow OCD, the capitellum (affected bone of the elbow) might even look like it has flattened out, suggesting that the bone has collapsed. The X-ray could show a crack in the capitellum or even a loose body.

A magnetic resonance imaging (MRI) scan may show more detail. The MRI can give an idea of the size of the affected area. It can show bone irregularities and also help detect swelling. Doctors may repeat the MRI test at various times to see if the area is healing.

The doctor might order a computed tomography (CT) scan. The CT scan helps confirm the diagnosis. A CT scan clearly shows bone tissue. The doctor can compare CT scans over a period of time to monitor changes in the bones of the elbow.