Osteochondral Defect (OCD) of Capitellum

The elbow joint is made up of the upper arm bone called the humerus and two forearm bones called the radius and the ulna. There are two cartilage-covered parts of the end on the humerus:

  1. The trochlea on the inside of the elbow
  2. The capitellum on the outside of the elbow

In the elbow, the capitellum and the radius touch to absorb some of the pressure transmitted from the wrist. In certain sports, like baseball and gymnastics, and in professions that require heavy lifting, more pressure than normal is transmitted to the outside of the elbow. This sometimes causes injury to the bone and cartilage of the capitellum called an osteochondral defect (osteo = bone, chondral = cartilage). Occasionally, for reasons that are not well understood, osteochondral defects arise without injury. Patients with this problem will often have pain on the outside of the elbow that is worse with throwing or lifting heavy objects. Occasionally, patients will complain of mechanical symptoms like something catching in the elbow or that the elbow locks up on them. We can often see this problem on an elbow x-ray; however, an MRI is more helpful to see the extent of the injury and to help determine what type of treatment is needed.

Treatment for an osteochondral defect depends on what the cartilage surface looks like on MRI. If the cartilage surface is intact, an extended period of rest may allow the bone under the cartilage to heal. If the cartilage surface is broken and fragmented, surgery may be needed to clean out the pieces, especially if the pieces are causing the elbow to lock up with motion. Surgery to treat this problem is usually done arthroscopically through a couple of small incisions. On occasion, if the bone is badly damaged, a piece of bone and cartilage from another part of the body may need to be transplanted into the defect. This can also be done arthroscopically but may require a bigger incision if the defect is large. Recovery after surgery depends on what is done in surgery.

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