In this feature, AAOS Now publishes a series of images, challenging readers to diagnose the condition depicted.
The images for this month’s challenge were submitted by Craig Denlinger, MD, a resident at the University of Tennessee–Campbell Clinic, who provided the following information:
The patient is a 15-year-old female with a 1-week history of right elbow pain. Her medical history includes a diagnosis of multiple epiphyseal dysplasia. Physical examination finds a 30-degree lack of full extension; pain begins to be felt at 30 degrees of elbow flexion and continues through 100 degrees of elbow flexion. She has full, but painful, pronation and supination of the forearm. What’s your diagnosis?
Find the answer to this month’s challenge below
According to Craig Denlinger, MD, who submitted the case, thie initial diagnosis was osteochondrosis of the capitellum—until the MRIs were obtained. Then, the final diagnosis of osteochondritis dissecans of the capitellum was made.
Osteochondritis dissecans of the capitellum often affects the dominant arm of gymnasts and adolescents involved in overhead athletics. Its exact etiology is unknown, but trauma and ischemia are believed to play a role. Patients typically present with lateral elbow pain associated with increased activity and relieved with rest. Mechanical symptoms, such as locking and catching, often develop late.
Treatment is based primarily on the integrity of the articular surface and stability of the lesion. Early, stable lesions generally can be treated with rest; surgery should be considered for unstable lesions and may include débridement with marrow stimulation, fragment fixation, osteotomy, or osteochondral autograft transplantation.
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