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Panners Disease

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Other Names

  • Avascular Necrosis of the Capitellum
  • Osteochondrosis of the Capitellum
  • Juvenile osteochondrosis deformans of the capitulum humeri

Background

  • This page describes Osteochondrosis of the Capitellum of the distal Humerus
    • Should not be confused for an Osteochondral Defect of the capitellum where intra-articular loose bodies can exist
    • Should not be confused for osteonecrosis of the elbow

History

  • Originally described in 1927 by Dr Panner[1]

Epidemiology

  • Overall, rare and poorly studied disease
  • Most commonly seen in children ages 4-8 (need citation)
  • 90% male (need citation)
  • Primarily affects dominant elbow

Pathophysiology

  • See: Osteochondrosis (Main)
  • Fusion between the centre of ossification of the capitellum and the adjacent centres occurs roughly at the age of 10 years in girls and at the age of 12 years in boys.
  • Believed to be caused by an interference in blood supply to growing epiphysis
  • Subsequently, there is resorption & eventual repair and replacement of the ossification center

Etiology

  • Controversial
  • In a review of 23 case reports, 13 reported a history of elbow trauma[2]
  • Thought to predominantly occurs in boys due to delayed appearance and maturation of the secondary growth centres[3]
  • Abnormal valgus stress after the age of 5 years may be a factor[4]

Risk Factors

  • Sports
    • Baseball
    • Gymnastics
    • Handball

Differential Diagnosis


Clinical Features

  • History
    • Symptoms usually occur for several weeks-to-months prior to evaluation
    • Patients will describe pain, swelling and stiffness
    • Often describe a history of valgus stress (i.e throwing or overhead sports)
  • Physical: Physical Exam Elbow
    • Loss of range of motion, usually 15-25° extension
    • Possible effusion
    • Slight loss of pronation and supination
    • Warm elbow
  • Special Tests

Evaluation

Radiographs

  • Standard Radiographs Elbow
  • Typically sufficient to make the diagnosis
  • Findings seen within the humeral capitellum[2]
    • Irregularity of texture or destruction of epiphysis
    • Increased density, Flattening
    • Deossification[5]
    • Lytic lesions, increased radiotranslucency
    • Fragmentation, Sclerosis

Bone Scan

  • Not routinely used
    • One case report noted increased uptake in the capitellum

MRI

  • Not necessary to make diagnosis
  • Findings
    • Decreased signal intensity of the capitellum (T1).
    • Joint effusion (T2)

Classification

  • N/A

Management

  • Duration of symptoms varies from months up to 2 years
  • Generally considered self limited with excellent long term prognosis

Nonoperative

  • Initial management approach of choice[2]
  • Relative rest
    • Duration unclear
  • Activity modification
    • Avoid strenuous activity including lifting, throwing, etc
  • Immobilization
  • Consider NSAIDS

Operative

  • Unclear indications for arthroscopy but generally considered non-surgical

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play

  • Decision partially driven by radiographic outcomes
  • Radiological improvement occurs over 1–3 years and may lag behind symptom resolution[6]
    • Full or complete healing is seen in most cases
    • Irregularity, sclerosis and flattening of the capitellum can be seen in some cases

Complications

  • Unknown

See Also


References


  1. Panner, H. J. "A Peculiar Affection of the Capitijlijm Humeri, Resembling Calve-Perthes Disease of the Hip." Acta Radiologica 10.3 (1929): 234-242.
  2. 2.0 2.1 2.2 Claessen, Femke MAP, et al. "Panner’s disease: literature review and treatment recommendations." Journal of children's orthopaedics 9.1 (2015): 9-17.
  3. Duthie, ROBERT B., and GREGORY R. Houghton. "Constitutional aspects of the osteochondroses." Clinical orthopaedics and related research 158 (1981): 19-27.
  4. Douglas, G. A. R. Y., and M. E. R. C. E. R. Rang. "The role of trauma in the pathogenesis of the osteochondroses." Clinical orthopaedics and related research 158 (1981): 28-32.
  5. Sty, J. R., and R. Boedecker. "Panner's disease (osteonecrosis of the capitellum)." Clinical nuclear medicine 3.3 (1978): 117.
  6. Walz M, Auerbach F. Distal intraarticular humerus fractures in elderly patients. Treatment with combined percutaneous screw fixation and an external fixator. Unfallchirurg (2006); 109(11):940–947 10.1007/s00113-006-1141-2
Created by:
John Kiel on 30 June 2019 20:50:47
Authors:
Last edited:
7 April 2022 16:59:07