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Osteochondritis Dissecans (OCD)
Osteochondritis dissecans (OCD) of the elbow is an increasingly diagnosed condition in which a portion of articular cartilage, together with a layer of bone, becomes damaged. Osteo- refers to bone, chondro- refers to cartilage, and -itis describes inflammation. With OCD, the affected area of bone loses its blood supply. That portion of bone then dies, cracking and eventually breaking away from the main part of the bone. The fragment or fragments of bone and cartilage may then become stuck within the elbow joint, causing the more severe symptoms associated with this condition. Although OCD can occur in other joints of the body, this condition most commonly affects the elbow or knee.
Three bones articulate with each other to form the elbow: the humerus in the upper arm, and the radius and ulna in the lower arm. Together they allow the arm to move in a hinge-like manner, and also to turn the hand palm up or palm down. Between articulating surfaces are areas of cartilage, smooth, strong tissue that both cushions the ends of the bones and allows them to glide easily over each other. Bone fragments associated with OCD usually come from the capitulum of the humerus, a rounded part at the base of the bone that articulates with the head of the radius bone of the forearm.
Causes:
Although the exact cause of osteochondritis dissecans of the elbow is unknown, it is thought that the condition may result from disturbances of the normal growing process, or from relatively mild but recurrent injuries to the elbow. Weight-bearing stress placed repeatedly on the immature elbow, without allowing sufficient time for damaged tissues to heal, is believed to be one cause of OCD. Occasionally the damage may be the result of a sudden trauma, such as a heavy blow, to the elbow joint.
OCD occurs primarily in young people whose bones are still maturing. Patients are normally aged between 10 and 16 years old. Young athletes whose sports demand significant and repetitive upper arm movements, such as gymnasts, baseball or softball players, and javelin throwers, tend to be most at risk from OCD of the elbow.
There may be a genetic component to the development of OCD, as it is often found in members of the same family, or in subsequent generations.
Symptoms:
- Pain, often described as ‘aching’, felt within the elbow
- Stiffness of the joint
- Diminished ability to fully straighten or rotate the arm
- ‘Locking’ of the joint at a particular angle
- Possible ‘clicking’ heard or sensed in the elbow
- Possible tenderness at the site of injury
- Possible swelling due to synovial fluid leaking from the articular capsule around the elbow joint.
Diagnosis:
Your doctor will ask you questions about your medical history, including any previous injuries to your elbow. You will be asked about your lifestyle, occupation, and recreational and sporting activities. Your elbow will then be physically examined and compared with the unaffected arm.
Imaging tests such as X-rays and an MRI (magnetic resonance imaging) scan will probably be taken. The MRI is generally considered to be the best diagnostic tool for osteochondritis dissecans as it can clearly show the condition of the soft tissues and any developing or present detachment of an osteochondral fragment from the body of the bone. A CT (computerized tomography) scan or an arthrogram are other possible ways of diagnosing OCD. The arthrogram procedure consists of injecting dye into the elbow joint and then using a special form of X-ray to view where the dye is within the joint.
Treatment:
Occasionally, particularly if the patient is young, osteochondritis can resolve itself. If the OCD has been diagnosed at an early stage conservative (non-surgical) treatment can be successful, particularly if an MRI has revealed no separation of the cartilage and bone. About 50% of these patients should recover full function of the elbow.
Conservative treatment consists of complete rest of the elbow, usually achieved with the use of a brace or sling to immobilize the joint. Ice, crushed in a bag and wrapped in a towel, can be applied to the elbow for as long as is comfortable, several times a day, to relieve swelling and pain. NSAIDs (non-steroidal anti-inflammatory drugs) can be taken according to directions. Examples of NSAIDs are ibuprofen (Advil), naproxen (Aleve) and aspirin. Only when no more symptoms are present can a gradual return to activity begin, and a program of stretching and strengthening exercises for the elbow and shoulder initiated.
Often, a surgical procedure is necessary to reattach or remove loose pieces of cartilage and bone in the elbow that are restricting elbow movement or causing pain, or if conservative measures have failed to resolve the condition. Surgery is carried out arthroscopically if possible, but open surgery is sometimes necessary in order to properly fix the fragment.
Prognosis:
The chance of a good recovery from OCD depends on the age of the patient, and the severity and location of the damage. Younger patients tend to heal more successfully. Surgical repair can have a successful outcome, particularly if the fragment has been fixed and allowed to properly heal, although some residual stiffness may be present.
Early development of arthritis is a condition associated with severe cases of adolescent osteochondritis dissecans.
Exercises:
Exercises should not be performed without medical approval. Returning to activity before OCD has completely healed increases the risk of permanent damage. Your physical therapist will design an exercise program for you, but the following can help you begin to regain flexibility and strength in your elbow.
Pendulum:
Standing, bend over at the waist and let your arm hang down at your side. You can hold onto a support with the other hand. Allow your arm to swing from side to side and back and forth, then in small circles. Keep the distances short. Repeat this exercise for 3-7 days then add a small weight (1-2 lbs). Gradually increase the range of motion.
Elbow Flex and Extend:
Standing, simply bend and straighten your elbow as far as it will go without force. You should not feel any pain. Repeat 10 times.
Rotations:
With your elbow by your side and bent to 90 degrees, carefully rotate your palm up and down as far as it will go without force. Repeat 10 times.
Ball Squeeze:
Hold a soft ball, about the size of a tennis ball, in your hand. Squeeze the ball as hard as possible with causing yourself pain. Hold for 5 seconds. Repeat 10 times.
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