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Sonographic Assessment of Osteochondritis Dissecans of the Humeral Capitellum

¹ Department of Orthopaedic Surgery, Yamagata University School of Medicine, Iida-Nishi 2, Yamagata City, 990-9585 Japan.
² Department of Radiology, Hokkaido University School of Medicine, Kita 15, Nishi 7, Sapporo City, 060-8638 Japan.

View larger version (11K): [in a new window]   Fig. 1A. —Posterior longitudinal sonography of radiocapitellar joint. H = humerus, R = radius, black line = sonographic probe. Drawing shows posterior longitudinal sonography obtained with elbow in full flexion, revealing anterior aspect of capitellum (arrowheads). Capitellum can be seen from anterior to lateral portion by moving sonographic probe.

View larger version (9K): [in a new window]   Fig. 1B. —Posterior longitudinal sonography of radiocapitellar joint. H = humerus, R = radius, black line = sonographic probe. Drawing shows dynamic scanning performed during gentle elbow motion.

View larger version (7K): [in a new window]   Fig. 2A. —Range of abnormality in osteochondritis dissecans of capitellum. Drawings show lesion with localized subchondral bony flattening and normal articular surface (A), lesion with nondisplaced osteochondral fragment (B), lesion with slightly displaced fragment (C), and capitellar osteochondral defect (D).

View larger version (8K): [in a new window]   Fig. 2B. —Range of abnormality in osteochondritis dissecans of capitellum. Drawings show lesion with localized subchondral bony flattening and normal articular surface (A), lesion with nondisplaced osteochondral fragment (B), lesion with slightly displaced fragment (C), and capitellar osteochondral defect (D).

View larger version (8K): [in a new window]   Fig. 2C. —Range of abnormality in osteochondritis dissecans of capitellum. Drawings show lesion with localized subchondral bony flattening and normal articular surface (A), lesion with nondisplaced osteochondral fragment (B), lesion with slightly displaced fragment (C), and capitellar osteochondral defect (D).

View larger version (7K): [in a new window]   Fig. 2D. —Range of abnormality in osteochondritis dissecans of capitellum. Drawings show lesion with localized subchondral bony flattening and normal articular surface (A), lesion with nondisplaced osteochondral fragment (B), lesion with slightly displaced fragment (C), and capitellar osteochondral defect (D).

View larger version (78K): [in a new window]   Fig. 3A. —Normal capitellum and osteochondritis dissecans of capitellum. C = capitellum, R = radial head. Anterior longitudinal sonogram of 11-year-old boy shows normal capitellum. Note subchondral bone is highly echogenic band (white arrowheads) and overlying articular cartilage is hypoechoic band (black arrowheads).

View larger version (118K): [in a new window]   Fig. 3B. —Normal capitellum and osteochondritis dissecans of capitellum. C = capitellum, R = radial head. Anterior longitudinal sonogram of 11-year-old boy shows stable lesion. Note localized subchondral bony flattening (arrows) and normal outline of articular cartilage (arrowheads).

View larger version (91K): [in a new window]   Fig. 3C. —Normal capitellum and osteochondritis dissecans of capitellum. C = capitellum, R = radial head. Posterior longitudinal sonogram of 12-year-old boy shows stable lesion. Note nondisplaced bone fragment (asterisk), intact articular surface (arrowheads), and narrow gap formation (arrow).

View larger version (80K): [in a new window]   Fig. 3D. —Normal capitellum and osteochondritis dissecans of capitellum. C = capitellum, R = radial head. Posterior longitudinal sonogram of 13-year-old boy shows unstable lesion. Note slightly displaced fragment (asterisk) and wide gap formation (arrows).

View larger version (96K): [in a new window]   Fig. 3E. —Normal capitellum and osteochondritis dissecans of capitellum. C = capitellum, R = radial head. Anterior longitudinal sonogram of 15-year-old boy shows unstable lesion. Note capitellar osteochondral defect (arrow). Hypoechoic structure at surface of defect is hypothesized to be reparative fibrocartilage.

View larger version (117K): [in a new window]   Fig. 4A. —MR images show stable and unstable osteochondritis dissecans of capitellum. Sagittal T1-weighted spin-echo image of 12-year-old boy shows stable lesion. Note homogeneous low-signal-intensity area (arrowheads) in capitellum.

View larger version (104K): [in a new window]   Fig. 4B. —MR images show stable and unstable osteochondritis dissecans of capitellum. Sagittal T2*-weighted gradient-echo image at same level as A shows stable lesion. Note no high-signal-intensity interface or focal articular defect in capitellum.

View larger version (111K): [in a new window]   Fig. 4C. —MR images show stable and unstable osteochondritis dissecans of capitellum. Sagittal T1-weighted image of 15-year-old boy shows unstable lesion. Note irregular low-signal-intensity area (arrowheads) in capitellum.

View larger version (120K): [in a new window]   Fig. 4D. —MR images show stable and unstable osteochondritis dissecans of capitellum. Sagittal T2*-weighted image at same level as C shows high-signal-intensity interface (arrows) beneath displaced fragments.

View larger version (151K): [in a new window]   Fig. 5A. —11-year-old boy unable to extend elbow beyond 60° because of locking accompanied by severe pain. Anteroposterior radiograph of locked elbow shows no definite abnormality.

View larger version (116K): [in a new window]   Fig. 5B. —11-year-old boy unable to extend elbow beyond 60° because of locking accompanied by severe pain. Lateral radiograph of elbow shows no definite abnormality.

View larger version (98K): [in a new window]   Fig. 5C. —11-year-old boy unable to extend elbow beyond 60° because of locking accompanied by severe pain. Posterior longitudinal sonogram shows unstable capitellar lesion with displaced osteochondral fragment (arrowheads). Unstable lesion was confirmed at surgery. C = capitellum, R = radial head.

View larger version (150K): [in a new window]   Fig. 6A. —13-year-old boy with 2-year history of gradually increasing elbow pain while baseball pitching. Anteroposterior radiograph of extended elbow shows almost normal capitellum.

View larger version (146K): [in a new window]   Fig. 6B. —13-year-old boy with 2-year history of gradually increasing elbow pain while baseball pitching. Anteroposterior radiograph with elbow in 45° of flexion shows stable capitellar lesion with nondisplaced fragment (arrow).

View larger version (108K): [in a new window]   Fig. 6C. —13-year-old boy with 2-year history of gradually increasing elbow pain while baseball pitching. Posterior longitudinal sonogram with elbow in full flexion shows stable lesion with nondisplaced bone fragment (arrow). C = capitellum, R = radial head.

View larger version (115K): [in a new window]   Fig. 6D. —13-year-old boy with 2-year history of gradually increasing elbow pain while baseball pitching. Posterior longitudinal sonogram with elbow in 60° of flexion shows displacement of fragment (arrow). Unstable lesion was confirmed at surgery. C = capitellum, R = radial head.

View larger version (73K): [in a new window]   Fig. 7A. —15-year-old boy with 3-year history of elbow pain. Anterior longitudinal sonogram of elbow shows subchondral defect, over which outline of cartilaginous tissue is irregular (arrowheads). C = capitellum, R = radial head.

View larger version (75K): [in a new window]   Fig. 7B. —15-year-old boy with 3-year history of elbow pain. Anterior longitudinal sonogram of elbow shows missing fragment (arrowheads) on subchondral bone of coronoid fossa. F = coronoid fossa, T = trochlea, U = ulnar coronoid process.

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