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Osteochondritis Dissecans Elbow Pain Physiotherapy

Osteochondritis Dissecans is a joint condition characterized by:

• Pain
• Swelling
• Tenderness in the joints
• Popping and locking in the joints
• Reduced range of motion
• Weak joints

It is most common in children, adolescents or individuals who regularly partake in sports or other high-impact activities. If there is persistent pain or soreness in your elbow joint, you may be suffering from Osteochondritis Dissecans.

What is Osteochondritis Dissecans

The elbow joint is made up of bones and cartilage.

Osteochondritis Dissecans is a condition in which the bone below the elbow, knee, or other joints in the body is at risk of dying because of reduced blood flow.

The bone below the elbow joint is at risk of coming loose as a result of continuous high-impact activity. If that happens, the cartilage also breaks and the blood supply to the bone breaks, which can result in the bone dying.

The severity of the condition depends upon the extent of the damage.

The doctor will look at the size of the bone fragment, whether it has dislocated or not, as well as how long it has been since the damage occurred.

If the bone does not dislocate, or the size of the fragment is very small, then the person may not experience any noticeable symptoms of the condition. In fact, the condition is actually very common in children, but the bone almost always heals itself without displaying any noticeable signs.

Even if the fragment is partially detached, chances are you are not likely to pay much heed to the symptoms. However, that can be dangerous and can result in long-term damage to the joint.

If, at any point, you experience persistent pain in your joints, you should visit your doctor.

What Causes Osteochondritis Dissecans?

Osteochondritis Dissecans is a very common condition, the exact causes for which are unknown.

There are a lot of situations that can affect the blood flow to the bone. The most common out of all is repetitive trauma to the joint during high-impact activities such as sports.

Such activities can result in multiple injuries to the bone that can often go unrecognized. Not everyone visits a doctor for accidents during sports activities. However, an ice pack or home remedies are not enough.  Sometimes the bone may need a little extra care to help it heal from the trauma. Repetitive hits to an unhealed bone can cause severe damage.

Some people might be at a heightened risk of developing this disorder because of genetics. Some people generally have weaker bones or certain deficiencies that can leave some people more susceptible to developing the disorder, aggravating the condition, or slowing down recovery.

Symptoms of Osteochondritis Dissecans

The symptoms for Osteochondritis Dissecans include:

• Pain – You will only experience persistent pain in the joint if the condition has worsened to cause severe damage to the bone. Otherwise, you may only experience pain during movement, such as swinging the arm in case of damage to the elbow joint or when climbing stairs in case of damage to the knee joint.
• Swelling and Tenderness – if the skin over or around the joint is swollen, it can be an indication of multiple conditions such as bursitis, Osteochondritis Dissecans. It does not always indicate something as serious as these two conditions, but if the swelling does not go away or is painful and tender, then you need to visit a doctor.
• Weak Joints – repetitive damage to the joint can reduce its load-bearing capacity. You may be able to notice the weakening of the knee joint a lot more easily than the elbow joint. If you do experience pain in the elbow when picking up heavy items, it can be an indication of Osteochondritis Dissecans.
• Odd sticking of the Joint – if your elbow joint is sticking out at an odd angle, then it may be because of the broken fragment having come loose. You should definitely visit a doctor if you start to hear popping sounds from the joint. Even if you don’t hear a popping sound but feel the bone stick out or move, consult your doctor immediately.
• Reduced elbow range of motion – If you can’t lift your forearm past a certain angle or a certain movement makes your elbow hurt, then you need to visit a doctor before the condition gets worse.

The symptoms of Osteochondritis Dissecans are very common.

In fact, chances are you may have experienced these symptoms more than once in your life. However, sometimes, these symptoms indicate something more serious, especially if you experience these for a prolonged period or if they disappear and come back time and again.

Who is at Risk of Developing Osteochondritis Dissecans?

• Developing children – children between the ages of 10-20 are most at risk of developing Osteochondritis Dissecans. They are usually very active in sports, and their bones are still developing, which puts them at risk of injuring their bones.
• Athletes – Though uncommon, athletes and professional players are also at risk of developing Osteochondritis Dissecans. Repetitive trauma or multiple injuries to the joint can cause damage to the bone and cartilage.

Children often recover on their own as they are still growing and their bones are developing.

Adults are however, a different story. In fact, in some cases professional players and athletes may be asked to retire early so as not to damage the joint again for fear of causing permanent damage.

It can also lead to the early onset of osteoarthritis resulting from the loss of cartilage due to poor blood flow.

Treatment Options for Osteochondritis Dissecans

Depending on the severity of the condition, the joint may need to be treated surgically or non-surgically. In both cases, you may have to opt for extensive physiotherapy treatment to ensure the joint recovers completely and that you restore its full range of motion.

Your doctor or physical therapist will first check your range of motion, flexibility and ease of mobility. If they find them limited, they may ask for an X-ray, MRI scan or a CT to determine the extent of the damage and recommend the proper treatment for it.

Non-Surgical Treatment (Conservative Management)

A doctor’s first preference is always non-surgical treatments.

A doctor may request our hand therapist to customize a thermoplastic splint your joint and ask you to use a sling or a crutch to prevent excessive movement in the joints. They will ask you to rest and ensure you don’t put too much strain on the affected joint.

You will have to give the joint ample time to heal so that the condition doesn’t worsen.

Surgical Treatment

If the condition worsens or the pain persists, you may need surgical treatment to aid healing. There are multiple surgical treatments for Osteochondritis Dissecans.

• Grafting – in severe conditions, a doctor may take a bone fragment or cartilage from some other part of the body to replace the damaged one in the joint. Grafting is always the last resort, and doctors only go for it in case the bone and cartilage are damaged beyond all hope.
• Pinning – if the bone has broken loose but is still serviceable, a doctor may suggest pinning. In this treatment, a doctor pins the bone back in place and stitches the joint back together to let the bone reattach itself to the joint and function again properly. The pins and screws help keep the bone in place, as even if it does join to the rest of the bone, the joint is weak, and the screws and pins enhance its durability.
• Drilling – In this procedure, the doctor drills a hole in the affected area to promote the growth of new blood capillaries. These new vessels provide blood to the affected area and help it heal properly by restoring blood supply.

How Physiotherapy Can Help People with Osteochondritis Dissecans

Post-surgery, a doctor may recommend you opt for physiotherapy sessions to restore full join functionality, especially if you’ve undergone an invasive surgical procedure such as pinning or grafting.

Your elbow joint will have to get accustomed to operating normally after the addition of foreign elements such as a new bone or pins and screws.

Even with non-surgical treatments, you may need to undergo physical therapy to help the joint regain its strength and recover fully. It can eliminate the risk of a recurring injury, which can lead to substantial damaging of the joint.

Physical therapy includes

• strength and stability training
• range of motion exercises
• manual therapy
  
• flexibility stretching and exercises
• activity guidance
• customized splinting and bracing
  
• and more

Usually, physical therapists combine a series of strength building and restorative movement exercises that help the patient restore the joint’s full range of motion and flexibility.

Strength building exercises are particularly important, as the joint may appear to have fully recovered initially, but it may start to deteriorate over time. With the help of physical therapy, you can ensure long term recovery for the joint. It also helps prevent the risk of early development of osteoarthritis.

If you think you have Osteochondritis Dissecans, contact us for a consultation.