Elbow

Panner Disease

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Panner Disease, Capitellum Osteochrondrosis, Avascular Necrosis of the Capitellum

  • See Also
  1. Osteochondrosis
  • Epidemiology
  1. Children under age 10 years old
  2. Boys account for 90% of cases
  3. More common in athletes
    1. Repeat valgus stress at elbow (baseball)
    2. Repeat axial stress at elbow (gymnastics)
  • Pathophysiology
  1. Distal humeral Ossification Center (at capitellum) with abnormal ossification, necrosis and degeneration
  2. Differentiate from Osteochondritis Dissecans of the Capitulum which affects the articular cartilage
  • Symptoms
  1. Vague lateral Elbow Pain, stiffness and decreased range of motion
  • Signs
  1. No point tenderness over lateral elbow
  • Differential Diagnosis
  1. Osteochondritis Dissecans of the Capitulum
    1. Affects articular cartilage, NOT the epiphysis
  • Imaging
  1. XRay elbow
    1. Epiphysis and capitellum of Humerus with fragmentation and fissuring
  2. MRI Elbow
    1. Indicated in non-diagnostic XRay imaging
  • Management
  1. Relative rest
  2. Immobilize for 4 weeks
  3. Acetaminophen or NSAIDs
  4. Repeat XRays every 4-6 months
  5. Consider pediatric orthopedic Consultation
  • Course
  1. Self-limited with spontaneous resolution
  • References
  1. Achar (2019) Am Fam Physician 99(10): 610-8 [PubMed]
  2. Atanda (2011) Am Fam Physician 83(3): 285-91 [PubMed]
  3. Singer (1984) Am J Sports Med 12(5):351-60 [PubMed]