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Q: osteochondritis dissicans ( Answered,   0 Comments )
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Subject: osteochondritis dissicans
Category: Health > Men's Health
Asked by: jackiega-ga
List Price: $10.00
Posted: 10 Nov 2003 18:48 PST
Expires: 10 Dec 2003 18:48 PST
Question ID: 274576
14 year old male diagnosed with above condition in his right shoulder.
Condition is rare according to MD. Usually found in knees. What is
best treatment? MD has suspended athletics for now. Condition found by
MRI.
Answer  
Subject: Re: osteochondritis dissicans
Answered By: crabcakes-ga on 10 Nov 2003 21:10 PST
 
Hello jackiega,

Before I start, I must make you aware that while I may provide you
with medical information, its purpose is to inform and not diagnose or
treat. Please see the disclaimer at the bottom of this page.

Ok, with the fine print out of the way, let me say, you are correct in
your statement that osteochondritis dissecans (OCD) is rare, and more
so when it occurs in the shoulder. (I?ll speak to that in the next
section!) Incidence of this disease, of all afflicted areas, is
approximately 30 people per 100,000 people! (Some sources state 30-60
per 100,000 people, and others state the incidence is even lower, at
15-30 cases per 100,000 people)  The disorder commonly presents during
the teen-age years, most commonly in the knee (patella) and is more
common in males. However, with more and more girls participating in
sports, it is being diagnosed with greater frequency than in the past.
http://www.physsportsmed.com/issues/1996/06_96/ralston.htm

and
Familydoctor.com
http://familydoctor.org/handouts/488.html

and 
American Family Physician
http://www.aafp.org/afp/20000101/151.html

According to eMedicine.com, OCD of the shoulder is extremely rare,
with only 7 reported cases!  ?Shoulder joint: OCD rarely occurs in the
shoulder joint, where it involves either the humeral head or the
glenoid. Only 7 patients with OCD of the humeral head have been
reported. All of the patients were men, ranging from age 12-44 years.
Five of the patients (71%) demonstrated lesions in the right shoulder,
suggesting an association with right-handedness. Locations of
involvement were the anterosuperior, posterosuperior, posteromedial,
superior, and medio-inferior aspects of the humeral head. ?


Osteochondritis dissecans occurs from a decrease in, or loss of the
blood supply to an area of bone underneath a joint, due to trauma. The
affected bone and its covering of cartilage can slowly loosen and
cause pain. If the area is not allowed to heal, a fragment of
cartilage may separate from the bone, causing pain. Arthritis may
develop later in life.
Repetitive stress/trauma, abnormal bone development, and genetics have
all been blamed for this disorder. The truth is, the exact etiology
(cause) is not totally understood. It is said that the name
?osteochondritis? is actually a misnomer, as there is no histological
evidence that inflammation causes this disease. In other words, when
tissue is examined under a microscope, no inflammation is seen.
Instead, it appears that joint stress and trauma or lack of good blood
supply seems to cause a piece of cartilage to break off and float
freely in the joint spaces.

An image of a shoulder  with osteochondritis dissecans can be seen,
7th and 6th from the bottom of the page, on this eMedicine web site.
http://www.emedicine.com/radio/topic495.htm#target1

This is a fairly good image of a shoulder. The image is an x-ray of a
dog, but it does a pretty good job of illustrating the cartilage
loosening from the bone.
 *Warning* Further down the page are very graphic photos of the
surgical repair and removal of the piece of cartilage.
http://www.thepetcenter.com/xra/ocd.html

Treatment:
If the loose piece is free, in the joint space, it may need to be
surgically removed. If the piece is stable, activities that cause pain
and/or discomfort should be avoided. Competitive sports should be
avoided for 6-8 weeks, allowing  the area to heal, thus steering clear
of further joint problems.
From the Medical College of Wisconsin, ?If cartilage fragments have
not broken loose, a surgeon may fix them in place with pins or screws
that are sunk into the cartilage to stimulate a new blood supply. If
fragments are loose, the surgeon may scrape down the cavity to reach
fresh bone and add a bone graft and fix the fragments in position.
Fragments that cannot be mended are removed, and the cavity is drilled
or scraped to stimulate new growth of cartilage. Research is currently
being done to assess the use of cartilage cell transplants and other
tissues to treat this
disorder.?http://healthlink.mcw.edu/article/926049711.html



Quoted from the Alfred I. DuPont Children?s Hospital Website comes
this recommended treatment: (Meanings of abbreviations at end)
Conservative 
For Type I lesions can try rest, NSAIDs, avoiding all throwing activities 
If severe pain, splint 3-4 wks. Then begin active ROM 
Protect elbow until see radiographic evidence of revascularization and healing 
Surgical 
Indications : if conservative treatment fails to relieve pain or gain
elbow extension; locked elbow; more aggressive approach: any painful
OCD (including Type 1)
Arthrotomy/arthroscopy 
Drilling 
Debridement 
Removal loose bodies 
Internal fixation loose fragments, bone grafting poor results 

NSAIDS are non-steroidal anti-inflammatory drugs, such as
Advil(Ibuprofen), or Naprosyn (naproxen)
ROM stands for Range of Motion

To summarize, short of surgery, the young man in question should rest
his shoulder, take whichever pain reliever the doctor has prescribed,
and avoid sports and activities that cause pain to the area. Rest will
allow the area to heal, and is most important! The doctor who attended
this young man was absoulutely correct in suspending athletic
activities. Follow up with the doctor to determine if further
treatment such as surgery will be needed.
http://gait.aidi.udel.edu/res695/homepage/pd_ortho/educate/clincase/oschcp.htm

There are some new and experimantal treatments on the horizon, such as
grafting and cartilage cell transplantation. You can read more and see
illustrations here:
http://www.orthoteers.co.uk/Nrujp~ij33lm/Orthkneeocd.htm

I hope this answers your question, jackiega. If any part of my answer
is unclear, or I have duplicated information you already found
yourself, please ask for an answer clarification, and I will respond
when I am notified.

Regards,
crabcakes-ga


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