Osteochondritis Dissecans of the Elbow

Osteochondritis dissecans of the elbow is a localized condition of the articular surface that is commonly seen in the young athlete. This disorder refers primarily to lesions of the capitellum and can he difficult to treat. Although trauma and ischemia play significant roles, the exact etiology remains unknown. The natural history is poorly understood and long-term sequelae include degenerative arthritis. The integrity of the articular surface and the stability of the lesion can be carefully evaluated with MRI and anhroscopy. Management is based mainly upon these two factors, yet no good universal outcomes exist among the varied treatment options. Stable lesions identified early appear to have the best prognosis with conservative management. Indications for surgery include persistent or worsening symptoms despite prolonged conservative care, loose bodies, or evidence of instability. Whether to excise and debride or to fix an unstable fragment is a highly controversial topic. The clinician should recognize Osteochondritis dissecans of the elbow as a potentially disabling condition where the prognosis for return to sport is guarded

Posterolateral rotatory instability of the elbow

Posterolateral rotatory instability [PLRI] of the elbow is recurrent elbow instability caused by injury to the radial ulnohumeral ligament or lateral ulnar collateral ligament. Deficiencies of the radial ulnohumeral ligament and laxity of the lateral capsule allow the proximal radioulnar joint to rotate and the radial head to subuxate posteriorly when stressed. Whether isolated or in conjunction with other injuries, PLRI represents the initial stage in the pathology of the unstable elbow. The diagnosis of PLRI can be difficult because the provocative tests are challenging to perform. Diagnostic arthroscope is an excellent tool to demonstrate this instability. Treatment options include bracing for acute injuries, and primary repair or reconstruction for chronic injuries. Although arthroscopic plication and repair have been as effective as open techniques, the clinician should be prepared for open reconstruction if needed