Osteochondritis Dissecans (OCD) is a condition in which fragments of joint cartilage become separated from the bone. These fragments may peel from the bone and remain intact or completely separate from the bone, forming loose bodies that float in the joint. These fragments can originate from any part of the elbow joint.
It is currently thought that most OCD lesions occur as a result of a traumatic injury that occurred in the patient's past. They can also occur in the athlete as a result of overuse. Some lesions do not have an identifiable cause.
OCD causes pain at a specific area in the elbow. Patients will complain of clicking and locking in the elbow, particularly if the fragment has separated and is floating around the joint. Patients are often unable to fully flex and extend their elbow.
Your surgeon will perform a thorough history and physical exam, which typically includes X-rays. Your surgeon will evaluate the range of motion and strength. The origin of the fragment may be tender to the touch. X-rays may or may not identify OCD. MRI is standard for OCD diagnosis. Fluid seen behind the fragment on MRI is an indicator of OCD.
Stable OCD lesions, those not likely to displace, are treated with anti-inflammatory medication, cryotherapy, activity modification and observation.
Unstable OCD lesions are evaluated by a minimally-invasive arthroscopic procedure. Sometimes the fragment can be repaired with small screws/tacks if it is still attached to the bone. If the fragment has separated from the bone and cannot be repaired, it will be removed and a cartilage regeneration or replacement procedure may be performed in the lesion. A microfracture procedure can be performed in the lesion to allow blood to soak the lesion. A cartilage graft, typically from a donor, can then be placed at the site. Over time, new cartilage will be formed over the lesion. Alternatively, your surgeon may choose to take a piece of cartilage from a donor and place it into the defect (allograft cartilage procedure).
Arthritis is inflammation of a joint. Over time, the loss of the smooth covering on the ends of bones (aka - articular cartilage) causes pain and stiffness. This can lead to pain with motion or at rest, clicking or grinding and a loss of strength. When the cartilage is damaged or decreased, the bones rub together during joint motion, resulting in “bone-on-bone” arthritis. When arthritis becomes severe, inflammation occurs around the joint and extra bone is formed in an attempt to protect the joint, resulting in limited motion and strength. In the elbow, arthritis can develop between any of the three articulations.
The primary cause of arthritis is osteoarthritis (aka – “wear and tear” arthritis). Trauma and other illnesses like rheumatoid arthritis, systemic lupus, septic arthritis and psoriasis can result in degeneration of a joint, leading to symptoms of pain and lack of motion.
Arthritis causes pain, loss of motion and strength. Clicking and grinding may be felt inside the elbow. Activities of daily living like brushing your hair and getting dressed can be impacted by severe elbow arthritis.
Arthritis is diagnosed by your physician based on physical exam and X-rays. Your orthopedic surgeon will examine your elbow, noting range of motion, strength and pain with motion. Your surgeon may order additional diagnostic tests to evaluate all elbow structures (CT/”CAT” scan) to evaluate the bones and joints or MRI to evaluate the muscles, tendons and ligaments.
Elbow arthritis can be treated with physical therapy, to strengthen the muscles that support the joint. Aggressive physical therapy is not suggested for advanced elbow arthritis, as it may aggravate symptoms. Your surgeon may prescribe anti-inflammatory medication or offer an injection to reduce the inflammation. Certain nutritional supplements may be beneficial to decrease pain and inflammation.
When non-operative treatment does relieve symptoms, surgery may be indicated in certain situations. Minimally –invasive elbow arthroscopy may be beneficial to remove bone spurs or cartilage fragments that are floating within the joint. Arthroscopic surgery is limited in benefits and is not curative. The definitive treatment for elbow arthritis is joint replacement surgery. Your surgeon will resurface the ends of the bone where the cartilage has worn away, with metal and plastic implants. Because the elbow has several articulations, your surgeon may choose to replace some of the diseased parts (partial elbow replacement) or replace all parts (total joint replacement).