Although these two conditions are considered separate problems, some experts view them as two stages of the same thing.
Both affect the capitellum bone of the elbow but Panner disease causes fragmentation of the entire capitellum. OCD is usually more of an isolated lesion that breaks away from the main bone causing a loose body to float inside the joint.
Here’s a quick review of elbow anatomy to help you picture the capitellum. The elbow is the connection of the humerus (upper arm bone) and the two bones of the forearm (the ulna and the radius).
The joint where the humerus meets the radius is called the humeroradial joint. This joint is formed by a knob and a shallow cup. The knob on the end of the humerus is called the capitellum. The capitellum fits into the cup-shaped end of the radius, also called the head of the radius.
Panner disease tends to develop in young boys between the ages of 5 and 10 who aren’t involved in repetitive motions that cause trauma to the joint. For unknown reasons, normal growth in the outer edge of the elbow is disrupted, which causes the small area of bone to flatten out.
Symptoms of diffuse elbow pain are common with both Panner disease and OCD. Diffuse means the pain feels like it is throughout the entire elbow. Pain can occur along the outside or lateral aspect of the elbow. The pain is present with activity and there’s a loss of extension. The child cannot straighten the elbow all the way. There may be stiffness, swelling, and when there is a loose body associated with OCD, clicking, catching, and/or locking of the elbow can occur.
How does the physician tell the difference between OCD and Panner disease? The child’s age and activity level help sort this out. X-rays, MRIs, and the most definitive method: arthroscopy shows the type, location, and severity of cartilage and subchondral damage. MRIs are especially good at showing early changes when X-rays appear otherwise normal.
Once the diagnosis has been made, then a plan of care is developed. One main difference between Panner disease and OCD is that Panner disease is self-limiting. That means it will go away with rest and doesn’t require additional treatment. Over a period of one to two years, the bone slowly rebuilds itself. During this time, symptoms gradually disappear, although the elbow may never fully straighten out.
OCD may respond to rest, which removes the compressive load and shear forces long enough to allow healing. The use of antiinflammatory medications and a physical therapy program of stretching and strengthening exercises are also recommended. OCD does not always improve with conservative care. With more advanced (more severe, unstable) lesions, surgery might be needed to help the cartilage heal.