Young gymnasts and overhand athletes, particularly baseball pitchers and racket-sport players, are prone to an odd and troubling elbow condition. The forceful and repeated actions of these sports can strain the immature surface of the outer part of the elbow joint. The bone under the joint surface weakens and becomes injured, which damages the blood vessels going to the bone. Without blood flow, the small section of bone dies. The injured bone cracks. It may actually break off. This condition is called osteochondritis dissecans (OCD).
In the past, this condition was called Little Leaguer’s elbow. It got its name because it was so common in baseball pitchers between the ages of 12 and 20. Now it is known that other sports, including gymnastics, weight lifting, and racket sports, put similar forces on the elbow. These sports can also lead to elbow OCD in adolescent athletes.
Elbow OCD affects the articular cartilage in the capitellum. The capitellum is a knob on the end of the humerus (your upper arm bone). The capitellum fits into the cup-shaped end of the radius (one of the two bones in the forearm that connects to the humerus).
The capitellum transmits two-thirds of all compressive forces across the elbow. Throwing athletes with an increased angle at the elbow (called valgus) put even more force and load through the capitellum. Overworked, poorly conditioned, and skeletally immature elbows are at increased risk for this condition.
OCD also affects the layer of bone just below the cartilage, which is called the subchondral bone. In advanced stages of OCD, the upper end of the radius, particularly the head of the radius, is also involved.
When the head of the radius spins on the capitellum, the forearm rotates so that the palm faces up toward the ceiling (supination) or down toward the floor (pronation). The joint also hinges as the elbow bends and straightens. The lesion caused by OCD can cause elbow pain, loss of motion, and even lock the joint and keep it from moving if a loose fragment gets lodged in the joint.
For small defects that don’t involve loose fragments, conservative (nonoperative) care may be successful. The child or teen is advised to modify his or her activity and avoid putting strain and load on the joint. Activity reduction and modification may be required for several months or more.
If this treatment approach isn’t successful or if there is a large lesion with loose fragments, then surgery may be required. The goals of surgery are usually to decrease pain, increase motion, and return the athlete to a preinjury level of activity.
Surgeons have at their disposal several techniques that can be used. The simplest method is called debridement. The surgeon gently shaves away any jagged edges and smooths down the bone. If there are any loose pieces of cartilage or bone, these can be removed during the procedure. Large pieces of bone can be reattached with pins, wires, or screws. The surgeon can also drill tiny holes into the affected area to help stimulate a healing response.
The best surgical approach for this condition has not been identified. That’s where this study comes in. The 13 elbows treated in this study were surgically repaired arthroscopically. Half the group were involved in baseball, one third in gymnastics, and the rest in football. The patients ranged in age from 10 to 15 years old. Each one was evaluated before and after surgery by measuring elbow motion and function.
Imaging studies using X-rays, CT scans, and MRIs helped document the location and severity of the lesion. Not all lesions were the same so treatment varied. There were nine elbows that required drilling and five that needed removal of loose fragments. Only two cases were sufficiently treated with debridement.
Results showed favorable outcomes. The children all experienced pain relief and decreased joint swelling. Elbow motion was improved and locking or catching of the elbow was eliminated for 83 per cent of the group. The remainder reported only occasional locking or catching. Half the group returned to their full preinjury level of activity. Everyone was able to return to their sporting activity at some level. In one case, the child switched to throwing with the other arm.
The authors were satisfied that their treatment was safe and effective with no complications. They agree with other experts who suggest that the best results come with early treatment for this condition. Without some intervention, it will only get worse and can become a chronic degenerative problem. Athletes with osteochondritis dissecans of the elbow may not be able to return to the sport or activity that caused the problem in the first place. They should be warned that this might be the case to avoid any surprises after surgery.