What is osteochondritis dissecans of the elbow?

Osteochondritis dissecans (OCD) of the elbow is a condition that can affect young athletes who participate in sports that require repeated overhead motion – like gymnastics, baseball, softball, tennis and weightlifting. When the elbow joint undergoes repetitive stress during activities, it can result in injury to the bones and overlying cartilage in the elbow joint. 

If left untreated, these regions of weak bone can cause significant pain, limit activity, and may become unstable as the cartilage and underlying bone may break off and become loose bodies floating in the elbow. 

Here is some information to help you understand OCD of the elbow. The elbow joint is made up of three bones – the upper arm (humerus bone) and forearm (ulna and radius bones). At the bottom of the upper arm bone (humerus) there are two smooth surfaces – one on the inside of the elbow (trochlea) and one on the outside (capitellum). Osteochondritis dissecans of the elbow most commonly affects the outside of the elbow, or capitellum, and due to repetitive stress or impact loading may cause a part of the cartilage in this region to soften, crack or separate from the bone. This area is more commonly predisposed to this condition due to underlying blood flow in the area. Damage to the cartilage and bone causes pain and may restrict range of motion.

OCD of the elbow is a rare condition that can affect boys and girls at any age but is more often diagnosed in boys aged 8 to 19. 

While OCD of the elbow can resolve without treatment in some pediatric and adolescent athletes, in most cases intervention is needed. An evaluation by a skilled pediatric orthopedic or sports medicine physician is recommended to ensure the bones and cartilage in the elbow do not become unstable and lead to diminished elbow function and arthritis. 

Because OCD of the elbow is an injury that strictly affects youth, pediatric specialists are recommended over adult providers. Pediatric sports physicians have the experience, training and expertise to treat OCD of the elbow.

Osteochondritis dissecans can also affect the bones in the knee, hip and ankle.

Causes and risk factors of OCD of the elbow 

While the exact cause of OCD is still unknown, there are many factors that may contribute to a temporary, compromised blood supply to the elbow in a growing and active youth, including:

• Overuse or repetitive impact to the joint
• Involvement in high-impact sports
• Repetitive stress of the elbow joint, in sports like baseball, gymnastics, tennis and weightlifting
• Specialization in one sport such as baseball or gymnastics from an early age
• Year-round sports training that requires repetitive elbow movement
• Personal or family history of OCD
• Prior injury or trauma to the elbow

Signs and symptoms of osteochondritis dissecans of the elbow

The most common symptom of OCD of the elbow is pain, which typically occurs on the outside and back of the elbow and tends to worsen after certain activities like throwing, weight-lifting and strenuous arm movement. 

Other symptoms may include:

• Swelling of the elbow and arm
• Popping, clicking, catching or locking at the elbow joint
• Stiffness in the elbow joint and/or arm
• Decreased range of movement (i.e., inability to fully straighten or bend the elbow)
• Fluid inside the joint
• Weakness at the elbow joint

OCD symptoms can mimic other joint and muscle injuries, and in some cases, there may be no symptoms at all. It’s crucial for children and teens to be evaluated by a trained pediatric orthopedic doctor to be properly diagnosed and determine treatment needs. 

If OCD is left untreated, the condition generally worsens and may require surgery.

Testing and diagnosis for elbow OCD

To diagnose OCD of the elbow, an orthopedic physician will perform a physical exam, take a detailed medical history and order imaging tests. In most cases, OCD can be seen on X-ray, but at CHOP, an MRI is always performed when OCD of the elbow is suspected. MRI allows clinicians to better visualize and assess the joint, not just to determine the severity of the injury, but to guide treatment decisions including whether surgery is needed.

Treatment for osteochondritis dissecans of the elbow

Treatment for OCD of the elbow depends on the severity of the condition. In some cases, non-surgical treatment may be recommended. Surgery may be needed if part of the bone and/or overlying cartilage has broken off or is unstable, or if non-surgical treatments don’t relieve pain.

Non-surgical treatment options for elbow OCD 

Non-surgical treatment for osteochondritis dissecans of the elbow includes complete rest of the joint, followed by physical therapy. Anti-inflammatory medications and other over-the-counter pain relievers may be recommended. Hot or cold therapy (heat or ice packs) may be suggested. Cold therapy may be recommended to address swelling after activity. Heat therapy may be recommended to warm up muscles before activity.

Rest from sports or impact activities will likely be recommended. Other non-surgical treatments may include:

• A splint or cast to hold the joint in place and reduce movement in the initial phase following diagnosis
• Exercises to improve flexibility and strength

Many youth athletes with OCD of the elbow can benefit from continued training activities while resting their elbows. Activities such as jogging, using a stationary bike, swimming and core strengthening may continue as long as the affected joint remains uninvolved. Competitive sports, throwing, handstands, push-ups and upper-body weightlifting should be avoided during this time.

Surgery may be needed if:

• Non-surgical treatment is not successful in addressing pain
• Symptoms and signs worsen even with non-surgical treatment
• The OCD fragment/overlying cartilage becomes loose in the elbow joint
• There is concern for impending OCD instability
• Imaging shows the condition is getting worse

It’s important to note that OCD of the elbow primarily affects children and adolescents and should be evaluated by specially trained pediatric specialists. Pediatric orthopedic doctors and pediatric sports medicine physicians can best diagnose these conditions, determine their severity, then plan treatment and follow up care.

Surgical treatment options for OCD of the elbow 

If non-surgical treatments for your child’s OCD of the elbow are unsuccessful or are not recommended, surgery may be needed. The choice of surgical procedure will depend on the condition of OCD lesion and tissues at the time of surgery. Surgery can often be performed minimally invasively with small incisions. In some cases, a larger incision and open surgery may be needed. 

Depending on the specific OCD lesion and degree of stability, the procedure may involve:

• Drilling small holes into the bone to stimulate healing by increasing blood flow and new growth of healthy cells
• Removing loose bone and/or cartilage fragments
• Reattaching loose bone and/or cartilage fragments by inserting a screw, suture, or other device to secure loose tissue and keep the bones in proper positioning while healing
• Replacing the injured bone or cartilage with healthy tissue from other parts of the body (called an “autograft”) or from a donor (called an “allograft”)

For certain types of injuries, osteochondral autologous transplantation surgery (OATS) may be recommended. In this procedure, surgeons will replace injured bone and cartilage in the elbow with healthy tissue from another part of the body, such as near the knee. Osteochondral allograft transplantation (OCA), where the tissue is provided by a donor, is also a possibility in some cases. Both procedures are rarely “first line” treatment, but if grafting is recommended, this is a decision that will be made with the patient’s family and the trained orthopedic sports surgeon.

At CHOP, our orthopedic surgeons and sports medicine physicians are experts at treating OCD of the elbow and can guide your family through what to expect at every stage of treatment and recovery.