0:01

This is an elbow of an eight

0:03

year old boy with elbow pain.

0:06

So he started playing baseball quite vigorously

0:09

and then had elbow pain and this is the plain

0:11

film radiographs that we have available.

0:14

I love this case because you don't need any

0:16

other imaging to diagnose, make the diagnosis.

0:19

What do we have here?

0:20

We have an area of sclerosis

0:23

involving the capitellum.

0:25

Not only that, but you have this

0:26

beautifully outlined chrysantic

0:29

lucency at the very periphery.

0:31

Let's say you saw this in the hip.

0:34

What would you call it on the hip?

0:35

You'd call it a vascular necrosis, or

0:38

maybe leg cap herpes disease, depending

0:40

on what the age of the patient was.

0:42

And that's no different here in the elbow.

0:44

What do you have?

0:44

You have an area of sclerosis involving

0:47

the entire capitellum, and you have an

0:49

area of subchondral lucency, which is sort

0:51

of a subchondral fracture, if you will.

0:54

Question is, how do you know

0:55

this is an osteochondral lesion?

0:58

Oftentimes, you don't.

0:59

What I do is I look at the age of the patient.

1:02

The younger they are, a lot more likely to

1:06

be Panner's disease, what this is, which

1:08

is an, um, osteochondrosis, if you will.

1:11

It's the fact that you're not getting enough

1:13

blood supply or the tiny blood supply to this

1:15

area is being compromised somehow, causing this

1:18

area of decreased perfusion and abnormal bone.

1:23

The prognosis for Panner's disease

1:25

is much, much better better than the

1:28

prognosis for an osteochondral lesion.

1:29

Again, because the child is, is younger,

1:32

there's, it's more, they're more resilient

1:34

and there's more healing ability happening.

1:37

So if you rest this child, most of the time

1:40

they're going to heal without any complication.

1:42

As opposed to the osteochondral lesion,

1:44

uh, if it's very bad, no amount of

1:47

rest may bring complete function back.

1:50

They may even need surgery and

1:51

even after surgery, they may not,

1:53

uh, get complete function back.

1:55

But this is Panner's disease and if

1:56

you rest it, typically they do great.

1:59

But this is what you're looking for.

2:00

You're looking for an area that involves the

2:03

entire ossified caputellum with sclerosis.

2:07

And you may or may not see this chrysantic

2:10

area of lucency, which indicates a

2:12

subchondral fracturing or collapse.