Introduction:
Osteochondrosis is a group of orthopedic disorders affecting the joints, and the disease is prevalent in children, young adults, and fast-growing animals. The word "osteochondrosis" refers to more than 50 distinct disorders that damage the developing skeleton. It is characterized by a disturbance in the blood supply of a bone (particularly epiphysis), followed by localized bone necrosis and later bone regrowth. The humeral capitellum of the elbow is where osteochondrosis occurs most frequently. The humeral capitellum is a rounded protrusion on the distal articular surface of the humerus bone.
What Is Panner Disease?
Panner disease can be defined as the osteochondrosis of the elbow capitellum. The capitellum is the elbow's outer bone at the tip of the humerus (upper arm bone). Doctor Dane Panner, an orthopedic surgeon from Denmark, first identified radiographic alterations in the capitellum in young adults in the year 1927. This condition is now known as Panner disease. The condition can limit extension and cause pain and stiffness in the affected elbow, which is typically on the individual’s dominant arm. Sports and physical activity may be associated with the condition. Valgus stress in athletes and increased axial load to the radio-capitellar joint in gymnasts often lead to lateral compression injuries of the elbow. Lateral compression injuries can potentially lead to several conditions, including Panner disease.
What Causes Panner Disease?
-
Since Panner disease is incredibly rare, its specific cause is unknown.
-
According to research, the condition may be caused by repeated usage of the elbow, which strains it and puts pressure on it, especially in young kids whose bones are growing quickly.
-
Throwing sports or sports exerting a lot of pressure on the joints, such as baseball, handball, and gymnastics, can cause overuse injuries to the elbow and subsequently lead to Panner disease.
-
These repetitive motions result in microtrauma, swelling, irritation, and pain in the affected elbow.
-
Panner disease develops when the blood supply to the capitellum is compromised. As a result, the cells within the growth plate of the capitellum die, and the growth plate flattens due to the surrounding bone weakening and collapsing.
Who Is Affected by Panner Disease?
-
Most cases of Panner disease occur in boys between the ages of five and ten.
-
Children who are undergoing early growth spurts.
-
Individuals who are involved in sports activities that involve excessive use of arms and involve a lot of throwing.
-
Panner syndrome is more prevalent in boys as compared to girls.
-
One study done on Panner disease in relation to the dominant arm of the patient concluded that about 90 % of the affected children were boys, and the average age of occurrence was nine years.
What Are the Symptoms of Panner Disease?
The signs and symptoms of Panner disease are:
-
Pain in the elbow and pain around the elbow.
-
Swelling in the elbows.
-
Narrowed range of motion.
-
Limitation of elbow extension.
-
Tenderness in the affected area.
-
The symptoms aggravate physical activity.
-
The symptoms often appear suddenly, persist for days or weeks, and in some cases, they may continue for an extended period.
How Is Panner Disease Diagnosed?
The diagnosis of Panner disease involves:
-
Medical History: The doctor will record the patient’s medical history to determine the presence of any pre-existing medical condition. The doctor will inquire about the child's age, athletic engagement, degree of activity, and dominant arm.
-
Physical Examination: Any variations between the two elbows will be noticed and compared between the injured elbow and the healthy elbow. In order to get a precise diagnosis, it is crucial to know where the elbow pain is located and the child's extension and range of motion. The child will be asked to move the arm with the afflicted elbow in different directions to assess the range of motion and extension limitation. The doctor will be able to determine how well the child can move the arm in different directions, and they will be able to see if any of the movements hurt the child.
-
Imaging Tests: In order to confirm the diagnosis, imaging tests may be done, like an X-ray or magnetic resonance imaging (MRI) may be done. Typical radiographs may reveal a capitellum with an uneven shape, sclerosis, subchondral radiolucency, fragmentation, and flattening. The radiograph shows the locations where bone degradation has taken place. Any abnormalities in the capitellum will be visible during the MRI scan, and the bone will be able to see in more detail.
How Is Panner Disease Treated?
The treatment modalities for Panner syndrome are:
-
The goal of the treatment is to relieve the patient from pain.
-
Treatment for Panner disease is extremely limited because most children's bones heal and reconstruct naturally, which causes the growth plate to regenerate and the capitellum to assume its natural shape. The time needed for repair and growth varies from child to child and might range from a few weeks to many months.
-
The child is told to rest the injured elbow and is not allowed to participate in sports or other activities until the elbow has recovered. Rest will enable the pain to subside and the elbow's full range of motion to recover.
-
Children may also be advised to apply heat or an ice pack on the elbow to reduce pain and swelling. Every one to two hours, the child is instructed to use ice or a cold pack on the elbow for at least 15 minutes.
-
Physical therapy may also be advised if the child has significant difficulty bending and straightening the arm.
-
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen or Acetaminophen, are occasionally advised for use in children to treat pain and swelling.
How Can Panner Disease Be Prevented?
The child is advised to stop all sports and physical activities involving the use of the injured elbow until the symptoms subside in order to prevent future cases of Panner disease.
Conclusion:
Panner disease is a medical condition affecting the bones of the elbow. The condition is prevalent in children in their early growth spurts. Panner disease often occurs in sports activities that involve extensive use of elbows and arms (like throwing, basketball, and handball). Rest and restrictions on physical activity and sports using the afflicted arm help children with Panner disease recover quickly. Treatment improves the prognosis, and the damaged capitellum is reconstructed. After successful therapy, the flattened and broken capitellum entirely remodels and assumes its regular circular shape.
