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How can you tell what's the best treatment for OCD of the elbow? We are researching this on the web and looking for any information we can find.
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Forceful and repeated actions associated with several sports can strain the immature surface of the involved joint for some athletes. The knee and elbow are affected most often. The bone under the joint surface weakens and becomes injured, which damages the blood vessels going to the bone. Without blood flow, the small section of bone dies. The injured bone cracks. It may actually break off. This condition is called osteochondritis dissecans (OCD).
In the past, this condition was called Little Leaguer's elbow. It got its name because it was so common in baseball pitchers between the ages of 12 and 20. Now it is known that other sports, including gymnastics, weight lifting, and racket sports, put similar forces on the elbow. These sports can also lead to elbow OCD in adolescent athletes.
Treatment is determined by several factors including size of the lesion, age of the patient, and symptoms (e.g., severity of pain, swelling, loss of joint motion). The status of the affected cartilage (attached, partially detached, completely detached) is also considered when determining the best treatment approach.
For small defects that don't involve loose fragments, conservative (nonoperative) care may be successful. The child or teen is advised to modify his or her activity and avoid putting strain and load on the joint. Activity reduction and modification may be required for several months or more.
If this treatment approach isn't successful or if there is a large lesion with loose fragments, then surgery may be required. The goals of surgery are usually to decrease pain, increase motion, and return the athlete to a preinjury level of activity.
Surgeons have at their disposal several techniques that can be used. The simplest method is called debridement. The surgeon gently shaves away the damaged cartilage, removing any jagged edges and smoothing down the bone. If there are any loose pieces of cartilage or bone, these can be removed during the procedure. Large pieces of bone can be reattached with pins, wires, or screws. The surgeon can also drill tiny holes into the affected area to help stimulate a healing response.
The best surgical approach for this condition has not been identified. Studies show that early treatment is favored over a wait-and-see approach. Lesions seen early on X-rays have a fairly poor prognosis without surgery. More advanced imaging such as MRIs give the surgeon a better idea of the depth and extent of the defect when considering surgical intervention.
The surgeon may have the patient take part in formal physical therapy a few weeks after surgery. The first few physical therapy treatments are designed to help control the pain and swelling from the surgery. Exercises are chosen to help improve elbow motion and to get the muscles toned and active again. At first, the elbow is exercised in positions and movements that don't strain the healing cartilage. As the program evolves, more challenging exercises are chosen to safely advance the elbow's strength and function.
Most patients will need to modify their activities after surgery. Most pitchers are unable to throw hard and without pain afterward. In general, most athletes with elbow OCD need to stop playing high-level sports due to lingering elbow pain and reduced elbow motion.
If symptoms come back again, patients must modify their activities until symptoms subside. They'll need to avoid heavy sports activity until symptoms go away and they are able to safely begin exercising the elbow again.
You should be aware that surgery isn't 100 percent successful. The various procedures don't necessarily improve athletes' chances for returning to high-level competition. Patients can lose the ability to fully straighten the elbow. And even after surgery, they are prone to elbow arthritis in early adulthood.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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