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Osteochondral Defects



Transcript:

Hi, my name is Charles Goldfarb. I'm an Orthopedic Surgeon at Washington University in St. Louis. I see patients at the Orthopedic Center of Chesterfield, St. Louis Children's Hospital and the Shriner's Hospital for Children.

Kids born with hand and upper extremity abnormalities often come to these sites to see me for evaluation and treatment. One common abnormality I see in the elbow is something called an OCD or an Osteochondral Defect. The other name that gets associated with this problem is Osteochondritis Dissecans. It is typically thought to be an overuse abnormality of the outside of the elbow or a part of the humerus bone called the capitulum.

We see it most commonly in gymnasts and also in baseball pitchers, although we can see it in any child in any sport. It can be in the dominant hand or the non-dominant hand and it typically causes pain but also can cause other problems which we call mechanical problems which include locking of the elbow, popping in the elbow and an inability to perform daily activities.

When I see a child with an OCD of the elbow, we initiate treatment by limiting activities and sometimes simply backing off on gymnastics or baseball may be enough to help control the symptoms and allow the elbow to heal. The basic problem is likely to be poor blood supply to the capitulum or that distal part of the humerus and taking away the activities that cause the problem can lead to restoration, healing of the problem itself. If that fails to lead to improvement or if there are mechanical symptoms, which is the locking or catching of the elbow, then we have to think more aggressively and typically that involves surgical intervention.

The good news is that surgery can be very helpful depending on the type of specific injury we have. If the lesion is not very far progressed, then surgery can be a cleanup type procedure. If surgery is further along, then sometimes we have to remove the offending part of the bone and stimulate healing of the cartilage surface. Surgery can get quite technical and sometimes we bring cartilage and bone from the knee up to the elbow to restore these lesions, but other times at that stage, it can be very straight forward with a simple elbow arthroscopy where through a couple of poke holes, we can evaluate the lesion and institute treatment.

Most kids do well when they have this problem although we typically encourage the families to avoid the offending activity so if this seen in a high level gymnast and the elbow doesn't heal fully, that patient may or may not be able to get back to gymnastics as they performed before.

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