Panner disease is often caused by excessive throwing due to valgus stress. The disease causes pain and stiffness in the affected elbow and may limit extension; the affected elbow is usually on the dominant arm the child uses. The disease may be associated with pitching and athletic activity. Panner’s disease is caused by stress on the capitellum and the surrounding cartilage. The stress is usually from repeated motions in sports, such as throwing in baseball or tumbling in gymnastics. Osteochondritis dissecans (OCD) is a disorder of articular cartilage and subchondral bone. In the elbow, OCD is localized most commonly at the humeral capitellum. Teenagers engaged in sports that involve repetitive stress on the elbow are at risk.
Other Names
- Avascular Necrosis of the Capitellum
- Osteochondrosis of the Capitellum
- Juvenile osteochondrosis deformans of the capitulum humeri
Background
- This page describes Osteochondrosis of the capitellum of the Distal Humerus
- Should not be confused for an Osteochondral Defect of the capitellum where intra-articular loose bodies can exist
- Should not be confused for osteonecrosis of the elbow
- Fusion between the center of ossification of the capitellum and the adjacent centers occurs roughly at the age of 10 years in girls and at the age of 12 years in boys.
- Believed to be caused by an interference in blood supply to the growing epiphysis
- Subsequently, there is resorption & eventual repair and replacement of the ossification center
Causes
- Controversial
- In a review of 23 case reports, 13 reported a history of elbow trauma
- Thought to predominantly occur in boys due to delayed appearance and maturation of the secondary growth centers
- Abnormal valgus stress after the age of 5 years may be a factor
Risk Factors
- Sports
- Baseball
- Gymnastics
- Handball
Differential Diagnosis
- Fractures
- Adult
- Radial Head Fracture
- Olecranon Fracture
- Capitellum Fracture
- Coronoid Fracture
- Terrible Triad of Elbow
- Pediatric
- Nursemaids Elbow
- Supracondylar Fracture
- Lateral Condyle Fracture (Peds)
- Medial Condyle Fracture (Peds)
- Olecranon Fracture (Peds)
- Radial Head Fracture (Peds)
- Medial Epicondyle Fracture (Peds)
- Salter-Harris Fracture
- Adult
- Dislocations & Instability
- Elbow Dislocation
- Proximal Radioulnar Joint Instability
- Tendinopathies
- Lateral Epicondylitis
- Medial Epicondylitis
- Distal Biceps Tendon Injury
- Triceps Tendon Injury
- Bursopathies
- Olecranon Bursitis
- Ligament Injuries
- Lateral Collateral Ligament Injury (Elbow)
- Ulnar Collateral Ligament Injury
- Neuropathies
- Cubital Tunnel Syndrome
- Radial Tunnel Syndrome
- Arthropathies
- Elbow Arthritis
- Other
- Valgus Extension Overload
- Posteromedial Rotatory Instability
- Posterolateral Rotatory Instability
- Osteochondral Defect
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Diagnosis
- History
- Symptoms usually occur for several weeks to months prior to evaluation
- Patients will describe pain, swelling, and stiffness
- Often describe a history of valgus stress (i.e throwing or overhead sports)
- Physical: Physical Exam Elbow
- Loss of range of motion, usually 15-25° extension
- Possible effusion
- Slight loss of pronation and supination
- Warm elbow
- Special Tests
- Active Radiocapitellar Compression Test: With the elbow in extension, apply axial load and supinate/ pronate the forearm
- Plica Impingement Test: Flex elbow, move through an arc of motion while supinating/ pronating
Radiographs
- Standard Radiographs Elbow
- Typically sufficient to make the diagnosis
- Findings saw within the humeral capitellum[2]
- Irregularity of texture or destruction of epiphysis
- Increased density, Flattening
- Deossification[5]
- Lytic lesions, increased radio translucency
- Fragmentation, Sclerosis
Bone Scan
- Not routinely used
- One case report noted increased uptake in the capitellum
MRI
- Not necessary to make a diagnosis
- Findings
- The decreased signal intensity of the capitellum (T1).
- Joint effusion (T2)
Management
- Duration of symptoms varies from months up to 2 years
- Generally considered self-limited with an excellent long term prognosis
Nonoperative
- Initial management approach of choice[2]
- Relative rest
- Duration unclear
- Activity modification
- Avoid strenuous activity including lifting, throwing, etc
- Immobilization
- Consider Sling
- Modalities vary: Posterior Long Arm Splint, Long Arm Cast
- Duration varies: 4-11 weeks
- Consider NSAIDS
Operative
- Unclear indications for arthroscopy but generally considered non-surgical
Previous
