Epidemiology: Gymnasts with open growth plates (meaning they are still growing and have not yet finished puberty) are at risk for developing OCD.
Mechanism of Injury/Description: Osteochondritis dissecans (OCD) is a condition which can occur throughout the body (most commonly at the knee, elbow, and ankle) which occurs from repetitive impact/pounding or trauma on skeletally immature (meaning growing athletes). From repetitive impact/pounding on skeletally immature bone, this leads to a lack of blood flow to the bone and cartilage. In OCD, the proper nutrients needed to generate healthy bone growth are not reaching the affected area, causing more injury, pain, and possible breakage or small fragments of bone.
Signs/Symptoms: Gymnasts will complain of posterior lateral elbow pain in the capitellum. They may have mechanical signs and symptoms, resulting in the elbow feeling as if it is “catching” or “locking.” Gymnasts may also experience a loss of motion while flexing (bending) and extending (straightening) the elbow.
Diagnosis: The diagnosis of OCD is made by physical exam (pain to palpation/pushing on the capitellum, decreased range of motion, and a “locking” sensation) and imaging including X-rays (which show an OCD lesion), and an MRI (to confirm the diagnosis and stage the lesion).
Treatment: Depending on the severity of the OCD, the Medical Provider may prescribe non-surgical or surgical treatment. Non-surgical treatment typically requires bracing, physical therapy, and anywhere between 3-9 months of rest. Surgical treatment is needed if the OCD is unstable and will not heal on its own.
Prevention: Focusing on posture and strengthening, as well as avoiding hyperextension of the elbow and limiting repetitions are important in preventing OCD lesions.
Gymnastics Medical Provider PEARLS: OCD lesions can be seen on x-ray but it is important to also perform an MRI to stage the lesion as this will help determine if surgical or non-surgical intervention is needed.
Gymnast, Parent, and Coach PEARLS: Do NOT ignore elbow pain or decreased elbow motion. These could be warning signs that your gymnast has OCD.