What is Osteochondritis Dissecans?
Osteochondritis Dissecans (OCD) is a focal injury where a small area of joint surface and the bone beneath loses its blood supply and may loosen or break away. In the elbow it targets the capitellum—the rounded outer part of the humerus that meets the radius.
Who gets it and why?
- Typical age: 12 – 20 years.
- Gender: Boys twice as often as girls.
- Sports: Baseball pitching, gymnastics, tennis, weight-lifting—anything that repeatedly loads the straightened elbow.
- Mechanism: Repetitive valgus compression damages the small end-arteries that feed the capitellum, causing avascular necrosis (loss of blood supply).
- Other factors: Genetics, early specialisation in a single sport, and high training volume.
Warning signs and symptoms
- Gradual, activity-related pain on the outer (lateral) elbow.
- Early loss of full straightening (extension).
- Catching, clicking, or locking—red flags for a loose fragment.
- Swelling or a feeling of “giving way” during throwing or handstands.
How is it diagnosed?
|
Test |
What it shows |
Strengths |
Limits |
|
X-ray (AP & Lat.) |
Flattening or a small dark (lucent) spot in the capitellum |
Cheap, first-line |
Misses up to 50 % of cases |
|
MRI |
Size, bone marrow oedema, intact versus breached cartilage |
Best for judging stability |
Cost, time |
|
CT |
Loose bodies, exact defect size |
Helpful when MRI unclear |
Radiation |
Stable lesion = cartilage intact, no fluid behind fragment.
Unstable lesion = cartilage breach or fluid line; often needs surgery.
Treatment options
– Non-operative (stable lesions)
- Rest & sport pause: 3 – 6 months.
- Hinged brace to unload the radiocapitellar joint.
- Physiotherapy—range first, then gradual strength.
- Return to throwing only when pain-free and full motion restored.
Success exceeds 90 % in skeletally immature athletes with small, early lesions.
– Operative (unstable or failed non-operative)
|
Technique |
Best for |
Key points |
Return-to-sport rate |
|
Arthroscopic drilling (microfracture) |
Stable but stubborn lesions |
Stimulates blood flow; minimal morbidity |
~70 % |
|
Fixation with screws/pins |
Large, salvageable fragment |
Keeps native cartilage; hardware may need removal |
60 – 90 % |
|
Loose-body removal & debridement |
Small, unsalvageable pieces |
Relieves mechanical symptoms; may combine with microfracture |
55 – 75 % |
|
Osteochondral autograft (OATS/mosaicplasty) |
Wide defects or failed prior op |
Healthy plugs from knee; excellent surface match, donor-site risk |
up to 94 % |
Rehabilitation milestones
|
Phase |
Focus |
Typical duration* |
|
Protection |
Sling/hinged brace, gentle motion |
0 – 2 weeks |
|
Mobility |
Active-assisted ROM, isometrics |
2 – 6 weeks |
|
Strength |
Progressive resistance, core & scapular work |
6 – 12 weeks |
|
Return-to-play |
Graduated throwing or load programme |
4 – 6 months |
*Times vary by procedure and surgeon.
Outlook and prevention
- Better prognosis when the fragment is stable, small (< 1 cm²), and treated early.
- Even after successful care, up to one-third develop early osteoarthritis in later life.
- Prevention tips:
- Follow pitch-count limits and rest days.
- Cross-train; avoid single-sport specialisation before age 14.
- Build shoulder and core strength to share the load.
Clinical Pearls / Key Points
- Loss of elbow extension in a throwing teen = OCD until proved otherwise.
- MRI signs of fluid deep to the lesion or cartilage breach predict instability.
- Stable lesions heal best with conservative care; unstable ones need early surgery.
- OATS offers the highest return-to-sport but risks knee donor-site discomfort.
- Long-term follow-up is essential—degenerative change can appear years later.
Patient FAQs
|
Question |
Short answer |
|
Is this the same as “Little Leaguer’s Elbow”? |
That term covers several growth-plate injuries; capitellar OCD is one possible component. |
|
Can I avoid surgery? |
Yes—if the fragment is stable and you strictly follow rest and rehab advice. |
|
Will my elbow be normal again? |
Pain and motion usually improve, but some athletes notice occasional ache on heavy use. |
|
How long before I can pitch or tumble again? |
After surgery, expect a structured 4- to 6-month pathway; your surgeon sets exact milestones. |
Call-to-Action
For a personalised assessment or a second opinion, please reach out to our elbow team at info@TheArmDoc.co.uk or call 020 3384 5588. Explore our exercise videos and injury-prevention guides at www.thearmdoc.co.uk
Disclaimer
This information is for general educational purposes only and should not be used as a substitute for consultation with a qualified healthcare professional. Every patient is unique; diagnosis and treatment decisions should be made in partnership with your medical team.