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Panners Disease
From WikiSM
Contents
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
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
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
- Active Radiocapitellar Compression Test: With elbow in extension, apply axial load and supinate/ pronate forearm
- Plica Impingement Test: Flex elbow, move through arc of motion while supinating/ pronating
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 Sling
- Modalities vary: Posterior Long Arm Splint, Long Arm Cast
- Duration varies: 4-11 weeks
- 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
- Internal
- External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ Panner, H. J. "A Peculiar Affection of the Capitijlijm Humeri, Resembling Calve-Perthes Disease of the Hip." Acta Radiologica 10.3 (1929): 234-242.
- ↑ 2.0 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.
- ↑ Duthie, ROBERT B., and GREGORY R. Houghton. "Constitutional aspects of the osteochondroses." Clinical orthopaedics and related research 158 (1981): 19-27.
- ↑ 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.
- ↑ Sty, J. R., and R. Boedecker. "Panner's disease (osteonecrosis of the capitellum)." Clinical nuclear medicine 3.3 (1978): 117.
- ↑ 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
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Last edited:
13 October 2022 14:07:29
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