II. Epidemiology

  1. Children under age 10 years old
  2. Boys account for 90% of cases
  3. More common in athletes
    1. Repeat valgus stress at elbow (baseball)
    2. Repeat axial stress at elbow (gymnastics)

III. Pathophysiology

  1. Distal humeral Ossification Center (at capitellum) with abnormal ossification, necrosis and degeneration
  2. Differentiate from Osteochondritis Dissecans of the Capitulum which affects the articular cartilage

IV. Symptoms

  1. Vague lateral Elbow Pain, stiffness and decreased range of motion

V. Signs

  1. No point tenderness over lateral elbow

VI. Differential Diagnosis

  1. Osteochondritis Dissecans of the Capitulum
    1. Affects articular cartilage, NOT the epiphysis

VII. Imaging

  1. XRay elbow
    1. Epiphysis and capitellum of Humerus with fragmentation and fissuring
  2. MRI Elbow
    1. Indicated in non-diagnostic XRay imaging

VIII. Management

  1. Relative rest
  2. Immobilize for 4 weeks
  3. Acetaminophen or NSAIDs
  4. Repeat XRays every 4-6 months
  5. Consider pediatric orthopedic Consultation

IX. Course

  1. Self-limited with spontaneous resolution

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