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What is Osteochondritis Dissecans (OCD) of the Capitellum?

OCD of the capitellum is a localized fragmentation and separation of subchondral bone - meaning the bone below the cartilage - in your elbow. It is basically a stress fracture of the joint. This condition occurs almost exclusively in teenagers and pre-teenagers who are involved in sports. In this age group, the blood supply may be temporarily insufficient to heal minor stress injuries to the bone incurred by daily activities and sports, leading to a cracking and separation of the bone and cartilage. In severe cases the fragmented bone and cartilage may float freely in the joint, causing locking, clicking, pain and loss of motion.

Symptoms

  • Pain in the elbow, particularly on the outer aspect or lateral side
  • Pain that decreases with rest but increases with activity
  • Reduced range of motion in the elbow or difficulty, especially with extension (straightening) of the elbow

Diagnosis

The diagnosis will begin with a detailed physical examination of the affected elbow which involves comparing it to the non-affected elbow.

The condition is then confirmed by imaging, for example with X-ray, CT scan or MRI.

Treatment

Various options are available to treat OCD of the capitellum. However, a specific type of treatment will be chosen depending on the stage and nature of the condition.

If the OCD of the capitellum is in its early stage and stable, conservative treatment involving rest and modification of activities, possibly even application of a cast may suffice. This includes rest from sports until the pain is resolved. Surgery may be considered if there is an unstable OCD lesion, with a loose free-floating bone fragment. The surgical treatment most often involves arthroscopy of the joint allowing a minimally invasive removal of the offending loose fragment. The site of injury can be drilled to stimulate bone marrow regeneration of the missing bone and cartilage.

Post-Surgery Care and Recovery

After the surgery, you will be advised not to return to any overhead throwing sports or activities until the injury is completely healed, even if motion is restored and pain is absent.

For example it will usually take a minimum of 4 months for a pitcher to return to competitive throwing, or a gymnast to return to competition following surgery.

  • NASS
  • Newton-Wellesley Hospital
  • AOSSM
  • AAOS
  • American Association of Hip and Knee Surgeons (AAHKS)
  • Tufts University School of Medicine
  • Newton-Wellesley Hospital