What can you tell me about osteochondritis dissecans (OCD) of the elbow in terms of how it is diagnosed and what happens over time with this condition? I understand what OCD is, but I don't know what to expect 2 years from now or even 10 years later.
Osteochondritis dissecans (OCD) is a condition in which a piece of cartilage and the underlying bone have been damaged. In some cases, the damaged fragment separates from the bone and floats freely within the joint.
Shear stresses from repeated motions probably start the problem. Poor mechanics and fatigue of the muscles and ligaments are added to the shear load. Combined together, these forces cause the cartilage to separate from the bone, taking a piece of the underlying layer of bone with it.
OCD is not self-limiting condition. In other words, it doesn't get better on its own. But other than that bit of information, the natural history (what happens over time) and the best way to treat this condition isn't known. There are some studies that show over time, OCD lesions can lead to further degenerative changes in the elbow.
How can the orthopedic surgeon tell if someone has osteochondritis dissecans? Of course, the patient history helps -- for one, participation in overhead throwing sports or activities that repeatedly compress the elbow joint (gymnastics, weight lifting, tennis, cheerleading) is a red flag.
The symptoms reported are usually pain along the outside of the elbow that gets better with rest. Stiffness, locking, catching, and loss of full elbow extension complete the picture.
To confirm the diagnosis, the physician relies on X-rays, MRIs, and sometimes CT scans. Once it has been determined where the damage is located, how severe the lesion is, and how stable (or unstable) the elbow is, then a management plan can be formed.
In many cases, the final diagnosis is made when the surgeon performs an arthroscopic exam. By inserting a scope inside the joint, the surgeon can take a look around and see what's going on. For the elbow, it may be necessary to enter the joint from several different portals (insertion sites for the scope) in order to examine all locations.
The final outcome of this condition may depend on the age at diagnosis, the activity level during healing and recovery, the treatment (conservative care versus surgery), and whether there are any complications after surgery. More study is definitely needed to better understand the natural history of osteochondritis dissecans.
David E. Ruchelsman, MD et al. Osteochondritis Dissecans of the Capitellum: Current Concepts. In Journal of the American Academy of Orthopaedic Surgeons. September 2010. Vol. 18. No. 9. Pp. 557-567.
*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.