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Osteochondritis Dissecans of Shoulders, Elbows, and Knees

Presentation

Magnetic resonance imaging indicated intra-articular loose bodies present. [healio.com]

Presentation Symptoms It usually presents in teenage years or the early 20s. It can affect younger children who are very active in sports. It may only become symptomatic in later life. [patient.info]

Evaluation of patients presenting with knee pain: Part II. Differential diagnosis. Am Fam Physician. 2003;68(5):917-22 Links: osteochondritis [gpnotebook.co.uk]

Ultimately, the link for most patients, if present, is probably minor. Pathophysiology Once a lesion is present, it typically progresses through 4 stages unless appropriately treated. [emedicine.medscape.com]

This incidence is most certainly rising and age at presentation is decreasing. [kneeocd.org]

Musculoskeletal

  • Knee Effusion

    On examination: there may be quadricep atrophy, focal bony tenderness, a mild knee effusion, palpable loose body and knee extension block (2,3) Wilson's signs may be positive - the knee flexed to 90 degrees with the tibia rotated medially while extending [gpnotebook.co.uk]

Workup

Diagnostic Workup Physical examination will often show tenderness over the radiocapitellar joint. Range of motion is typically decreased compared to the contralateral elbow, usually with a flexion contracture of 15-20 degrees. [cancertherapyadvisor.com]

Treatment

Non-operative Treatment Non-operative treatment when the OCD is diagnosed at an early stage can be successful. [kneeocd.org]

However, in addition to combining juvenile and adult patients, these studies did not provide consistent criteria for conservative treatment; they also did not consistently delineate what conservative treatment was provided. [emedicine.medscape.com]

BACKGROUND: Determination of appropriate treatment options for adult osteochondritis dissecans is difficult, as most published papers on surgical osteochondritis dissecans treatment report outcomes in a population consisting of both adult and juvenile [sportssurgerychicago.com]

Treatment Non-Surgical Treatment The different non-surgical treatment options are: Rest : Giving proper rest to the elbow is the first step towards recovery. [orthobangalore.com]

Treatment Options Non-operative Treatment Initial treatment of an OCD lesion follows the basic RICE formula: rest, ice, compression and elevation, combined with nonsteroidal anti-inflammatory medications for pain and activity modification (i.e., no running [northtownsorthopedics.com]

Prognosis

Prognosis Prognosis depends on the age of the patient, the affected joint and the stage of the lesion at presentation. [patient.info]

(1): Better prognosis: – Younger age – Open distal femoral physes (best predictor for non-op management) – Medial femoral condyle Worse prognosis: – Adult form – Lateral femoral condyle – Sclerosis on X-Ray – Synovial fluid behind lesion on MRI Author [sportmedschool.com]

The natural history and prognosis with different treatments vary depending on the age of the patient, the joint affected, and the stage of the lesion. [emedicine.medscape.com]

Prognosis is generally positive but can depend on the patient’s age, the stage of the lesion and the affected joint. [ctikneebraces.co.uk]

Etiology

During the past 120 years, many theories have been proposed for the etiology of osteochondritis dissecans; however, the precise etiology of this condition is yet to be determined. [healio.com]

Etiology The true etiology of osteochondritis dissecans has been the source of enthusiastic debate for decades. The etiology has been described as traumatic, ischemic, idiopathic, and hereditary. [emedicine.medscape.com]

[…] of OCD’s are suspected and often the true etiology is unknown. [kneeocd.org]

In osteochondritis dissecans (OCD) a small segment of articular cartilage and subjacent bone may separate - dissect - as an avascular segment. in majority the cause is idiopathic, other proposed etiological factors include trauma (either macrotrauma or [gpnotebook.co.uk]

The etiology of joint pain in these patients is often from osteochondrosis, although traumatic, inflammatory, or infectious origins should be ruled out as well. [aafp.org]

Epidemiology

STUDY DESIGN: Descriptive epidemiology study. METHODS: A retrospective chart review (2007-2011) was performed on OCD. Inclusion criteria included OCD of any joint and patients aged 2 to 19 years. [ncbi.nlm.nih.gov]

Epidemiology Prevalence OCD most often affects the knee. [ 2 ] The exact prevalence of OCD is unknown but prevalence figures of between 15 and 29 per 100,000 have been reported. [patient.info]

Most OCD lesions of the elbow involve the capitellum, typically the central or lateral portion, but also the radial head, the olecranon of the ulna and the trochlea humeri. [2] Epidemiology / Aetiology Ostechondritis of the humeral capitellum is secondary [physio-pedia.com]

Epidemiology Frequency Prevalence In the United States, the overall prevalence of osteochondritis dissecans is not known. However, in the femoral condyles, OCD has a prevalence of approximately 6 cases per 10,000 men and 3 cases per 10,000 women. [emedicine.medscape.com]

The epidemiology of Perthes' disease. Clin Orthop Relat Res. 1986;(209):89–94. 4. Nigrovic PA. Overview of hip pain in childhood. UpToDate Online. http://www.uptodate.com/online/content/topic.do?topicKey=gen_pedi/21233 [subscription required]. [aafp.org]

Pathophysiology

Pathophysiology(1)(2)(4): The underlying pathophysiology of OCD remains elusive to clinicians and researchers. The initial theory hypothesized the role of inflammation, however this has been unsupported by further research. [sportmedschool.com]

Pathophysiology The initial change takes place in the bone. A segment of the bone undergoes avascular necrosis. The changes in the overlying cartilage are secondary. [boneandspine.com]

Pathophysiology Once a lesion is present, it typically progresses through 4 stages unless appropriately treated. Stage I consists of a small area of compression of subchondral bone. Stage II consists of a partially detached osteochondral fragment. [emedicine.medscape.com]

Prevention

Exercise Techniques to Prevent Injury: Because osteochondritis dissecans often occurs spontaniously, there is not adequate form of prevention. [fitnesshealth101.com]

Is it possible to prevent osteochondritis dissecans? It is only possible to prevent osteochondritis dissecans by preventing trauma or injury to the affected joint. [medicinenet.com]

The continued micro-trauma from repetitive loading, ie: continued running on the already injured knee prevents the defect from healing and loosens the bone fragment. The loose fragment then can cause swelling and pain. [togct.com]

C 20 – 22 Medial epicondyle apophysitis is best treated with prevention. Parents, coaches, and players should adhere to the guidelines set forth by the Little League Association of America to maintain the health of young, throwing athletes. [aafp.org]

Can osteochondritis dissecans be prevented or avoided? Since the cause of osteochondritis dissecans is unknown, it can be hard to avoid it. Children who are very active in sports can be taught how to reduce their chance of being injured. [familydoctor.org]

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