Capitellar OCD

Patient Stories

    Ever since you performed the surgery on my elbow in August, I have been able to make a full return to baseball and football. Baseball has been great and now […]

    Teddy
    Baseball - Elbow Arthroscopy, OCD Lesion

    I am a gymnast and almost three years ago my elbow locked and I couldn’t straighten it all the way. There was no accident that caused my injury, it just […]

    Jillian
    Gymnastics - Elbow Arthroscopy

    I’ve enjoyed playing sports my whole life. I have always dedicated most of my time to swimming and softball. I injured myself playing softball. During the game, I jammed my […]

    Alexandra
    Softball - Elbow Arthroscopy

    After break dancing rigorously for years, my elbow began to change but for the worse. I was doing six to eight performances a week nationally and internationally until one day […]

    Pedro
    Break Dancing- Elbow Arthroscopy

Videos

Overview

Osteochondritis Dissecans of the Elbow

Osteochondritis Dissecans of the elbow, more commonly known as Capitellar OCD, involves a loss of blood supply to part of the cartilage within the elbow joint. When this cartilage ceases to perform its shock absorption duties, the elbow joint can become stiff, inflamed, and generally painful.

Your Capitellum is: A smooth, round, knob on the end of the humerus joined with the radius bone to form a hinge, with a shape similar to a knob and a cup.

Articular cartilage is: A slick, smooth material that protects bone ends from friction when they rub together. Articular cartilage is soft enough to act as a shock absorber.

The Facts on Capitellar OCD:

  • The capitellum endures tremendous force with activities, like throwing a baseball or gymnastics.
  • The repetitive force impacts a location of bone that has relatively weak blood supply. This causes the bone to weaken, crack, and without proper blood flow, not heal.
  • Genetics play a role in determining who develops capitellar OCD.
  • If a crack develops in the weakened capitellar bone, it may begin to separate, and chip away.

Symptoms

These are the most common symptoms of Capitellar OCD:

  • Pain on lateral (outside) elbow
  • Stiffness
  • Swelling
  • Locking or catching sensations

Evaluation by Team Ahmad

Dr. Ahmad and his team of health professionals will greet you and start your visit with a discussion of your symptoms and your sport, level of competition, or desired activity level. Next, the doctor will exam your knee, focusing on:

  • Pain points and reported levels of pain
  • Your elbow's tenderness, which he will apply pressure to assess
  • Both of your elbows' range of motion

If necessary, Dr. Ahmad may request an MRI so he may better estimate the size of the affected area and determine the stability of the bone and cartilage.

Treatment Options

If you are experiencing intense elbow pain and stiffness, you may have Capitellar OCD —do not continue using your elbow. Instead seek medical attention to determine the severity of your injury.

Non-Surgical

Initially, athletes will need to stop their usual sport activities and give their elbow a much needed rest to enable the healing process to begin. If the right precautions are taken, and the severity is low enough, the following treatments are available:

  • Anti-inflammatory medicines can reduce pain and swelling
  • Icing the affected elbow can reduce swelling
  • Physical therapy can help restore motion and strength

Surgical

Dr. Ahmad recommends surgery for more advanced stages of Capitellar OCD.

  • Arthroscopic treatment is used to safely remove loose pieces of bone and cartilage. Perforations are made into the bone to allow stem cells from bone marrow to heal the Capitellar OCD defects.
  • The Graft method is used when the damage is extensive.
    • It entails placing a graft into the defective area, and is capable of achieving better results than debridement and drilling.
  • The graft is cylindrical plug of bone and cartilage that is placed into the defect.
  • The graft will restore the normal function of the original articular cartilage.

 

Red circle indicates that capitellum making contact with the radius bone. This figure also orients the next few scope images. The red circle is what the camera is visualizing

 

A pin is used to make perforations in bone

 

Perforations in the bone allow marrow elements to gain access to the defect and stimulate healing.

Dr. Ahmad's Experience

Dr. Ahmad is nationally recognized expert in capitellar OCD surgery has designed and studied the optimal methods to surgical repair capitellar OCD lesion. His undergraduate training in mechanical engineering has allowed him to research the optimal methods of treatment. Dr. Ahmad has performed several hundred elbow arthroscopies and capitellar OCD treatment in all types of patients from elite pitchers, middle school golfers, and Olympic development gymnasts.

Listed below is Dr. Ahmad’s scholarly articles and research published to help capitellar OCD treatment.

Dr. Ahmad’s Scholarly Publications related to Capitellar OCD

Peer Reviewed Scientific Journal Articles
  1. Gancarczyk SM, Makhni EC, Lombardi JM, Popkin CA, Ahmad CS. Arthroscopic Articular Reconstruction of Capitellar Osteochondral Defects. Am J Sports Med. 2015 Oct;43(10):2452-8. doi: 10.1177/0363546515594448. Epub 2015 Aug 13.
  2. Iyengar JJ, Grantham, Byrum, Ahmad CS: The Curveball as a Risk Factor for Injury: A Systematic Review, Sports Health, Sports Health. 2015 Jan;7(1):19-26.
  3. Redler LH, Watling JP, Ahmad CS: Physical Examination of the Throwing Athlete’s Elbow. American Journal of Orthopedics 2015 Jan;44(1):13-8.
  4. Makhni EC, Morrow ZS, Luchetti TJ, Mishra-Kalyani PS, Gualtieri AP, Lee RW, Ahmad CS: Arm Pain in Youth Baseball Players: A Survey of Healthy Players. Am J Sports Med. 2015 Jan; 43(1) 41-6.
Review Articles, Current Concept Articles and Surgical Techniques
  1. Churchill RW, Munoz J, Ahmad CS, Osteochondritis dissecans of the elbow. Current Reviews in Musculoskeletal Medicine, 2016 Apr 28.
  2. Makhni E, Jegede KA, Ahmad CS: Pediatric Elbow Injuries in the Athlete, Sports Medicine and Arthroscopy Review on Athletic: Elbow Injuries and Their Treatment, Editor Marc Safran, 22:16-24, 2014
  3. Byram IR, Kim HM, Levine WN, Ahmad CS: Elbow Arthroscopic Surgery Update for Sports Medicine Conditions, Am J Sports Med, 41:2191-202, 2013
  4. Byram IR, Shillingford JN, Fink LA, Ramirez JM, Ahmad CS: Lesser Tuberosity Osteotomy With Cerclage Wire Repair for Total Shoulder Arthroplasty: Surgical Technique , Techniques in Shoulder & Elbow Surgery. 13:151-156, 2012
  5. Hsu SH, Moen TC, Levine WN, Ahmad CS: Physical Exam of the Athlete’s Elbow. American Journal of Sports Medicine, 40(3) 699-708, 2012
  6. Greiwe MR, Saifi CS, Ahmad CS: Pediatric Sports Elbow Injuries, Clinics in Sports Medicine, 29:677-703, 2010
  7. Ahmad CS, ElAttrache NS: Treatment of Elbow Capitellar Osteochondritis Dissecans. Techniques in Shoulder and Elbow Surgery, 7:169-174, 2006
  8. Alcid J, Ahmad CS, Lee TQ: Elbow Anatomy and Structural Biomechanics. Clinics in Sports Medicine, 23:503-517, 2004
Textbooks/ Guest Editorship
  1. Ahmad CS, Editor: Sports Medicine 2. Instructional Course Lectures Sports Medicine Specialty Volume 2: American Academy of Orthopaedic Surgeons, Illinois, 2011
  2. Ahmad CS, Editor: American Academy of Orthopaedic Surgeons Monograph Series. Pediatric and Adolescent Sports Injuries. American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons, Rosemont.  Series 43, pp 1-199, 2010
  3. Ahmad CS, Levine WN, Co-Editors: Current Concepts in Elbow Surgery Part-1 Soft Tissue/Sports. Operative Techniques in Orthopaedics.  Elsevier, Illinois.  Vol 19, 189-264, 2009
  4. Levine WN, Blaine TA, and Ahmad CS, Editors: Minimally Invasive Shoulder and Elbow Surgery. Informa Publishers, New York. 2007
Book Chapters
  1. Ahmad CS, Gonzalez-Lomas: “Elbow Injuries in the Athlete” AAOS Comprehensive Orthopaedic Review 2cd edition, edited by Martin Boyer, MD Keener editor of the Shoulder and Elbow section, 2014
  2. Vitale MA, Ahmad CS: Elbow Arthroscopy: Setup, Portal Placement and Simple Procedures: Instructional Course Lectures Volume 60: Egol, Editor: American Academy of Orthopaedic Surgeons, Illinois, 60:171-180, 2011
  3. Ahmad CS, Vitale MA, ElAttrache NS: Elbow Arthroscopy: Capitellar Osteochondritis Dissecans and Radiocapitellar Plica: Instructional Course Lectures Volume 60: Egol, Editor: American Academy of Orthopaedic Surgeons, Illinois, 60:181-190, 2011
  4. Gonzalez-Lomas, G, Ahmad CS, Wanich T, ElAttrache NS: Osteochondritis Dissecans of the Elbow: Diagnosis, Operative and Non-Operative Management, Including Grafting: Indications and Techniques: AANA Advanced Arthroscopy: The Wrist and Elbow, Field & Savoie III, Editors: Elsevier, Elsevier, 2010
  5. Vadasdi KB, Perez V, Ahmad, CS: Adolescent Throwing Injuries, American Academy of Orthopaedic Surgeons Monograph Series. Management of Common Sports Injuries in Pediatric and Adolescent Patients: Ahmad CS, Editor: American Academy of Orthopaedic Surgeons, Illinois, 2010
  6. Ahmad CS: Elbow Injuries in the Athlete, American Academy of Orthopaedic Surgeons. Comprehensive Orthopaedic Review: Lieberman, Editor: American Academy of Orthopaedic Surgeons, Illinois, 2009
  7. ElAttrache NE, Wei AS, Lomas G, Ahmad CS: Elbow Arthroscopy, Biologic Joint Reconstruction: An Alternative to Joint Arthroplasty:  Cole, Gomoll, Editors:  SLACK Incorporated, New Jersey, 2009
  8. Ahmad CS, Lomas G: Pediatric and Adolescent Sports Elbow Injuries, American Academy of Orthopaedic Surgeons Monograph Series. The Athletes’ Elbow-Current Concepts: Levine WN, Editor: American Academy of Orthopaedic Surgeons, Illinois, 2008
  9. Ahmad CS: Athletic Injuries and the Throwing Athlete: Elbow, Orthopaedic Knowledge Update: Shoulder and Elbow 3: Galatz LM, Editor: American Academy of Orthopaedic Surgeons , Chicago, 2008
  10. Ahmad CS, ElAttrache NS: Mosaicplasty for Capitellar Osteochondritis Dissecans, Advanced Reconstruction of the Elbow: Yamaguchi K, King GJW, McKee, O’Driscoll SWM, Editors: American Academy of Orthopaedic Surgeons , Chicago, 2007
Moderator for Scientific Sessions and Instructional Courses

AOSSM

  1. AOSSM Annual Meeting, Moderator, The Adolescent Elbow: A Rapid Fire Case-Based Discussion, Colorado Springs, CO, July 2016
  2. AOSSM Annual Meeting, IC 402, The Baseball Thrower: What Can Non-Surgeons Teach Us?, Michael T. Freehill MD, Thomas F. Walter, Jeff Strahm ATC, Matt Hobbs, Kevin E. Wilk PT, DPT, Christopher S. Ahmad MD, Colorado Springs, CO, July 2016.
  3. AOSSM Annual Meeting, Moderator, Throwing Elbow, Orlando, FL, July 2015.
  4. AOSSM Annual Meeting, Elbow Injuries in Throwing Athletes IC 204, Instructional Course, Christopher S. Ahmad MD (New York, NY); Jeffrey R. Dugas MD (Birmingham, AL); Michael G. Ciccotti MD (Philadelphia, PA), Buddy Savoie, MD, Seattle, WA, July 2014
  5. AOSSM Annual Meeting, Elbow Injuries in Throwing Athletes IC 204, Instructional Course, Christopher S. Ahmad MD (New York, NY); Jeffrey R. Dugas MD (Birmingham, AL); Michael G. Ciccotti MD (Philadelphia, PA); George A. Paletta Jr, MD (Chesterfield, MO), Buddy Savoie, MD, Chicago, IL, July 2013
  6. AOSSM Annual Meeting, Scientific Session: Elbow: Moderator. Chicago, IL July 2013
  7. AOSSM Specialty Day Annual Meeting, Scientific Session 3: Elbow, Moderator.  San Francisco, CA, February 2012

Orthopaedics Today Conferences (Moderator)

  1. Orthopedics Today Symposium, Moderator, Sports Elbow Conditions, Lahaina, HI, January 2017
  2. Orthopedics Today Symposium, Moderator, Sports Elbow Conditions, Waikoloa, HI, January 2016
  3. Orthopaedics Today Symposium, Sports Elbow, Moderator, Koloa, Hawaii, January 2015.
  4. Orthopaedics Today Symposium, Elbow Update, Moderator. The Fairmont Orchid. Kohala Coast, Hawaii. January 2009

Distinguished Speaker/Guest Professor

  1. 20th Annual Robert K. Kerlan, M.D. Memorial Lecture, Distinguished Lecturer, Adolescent Throwing Injuries, October 13-14, 2016, Los Angeles, CA.
Multimedia
  1. AAOS/POSNA Webinar: Elbow Injuries in the Adolescent Throwing Athlete, “UCL Injuries in Adolescent Pitchers,” June 2016.
  2. Ahmad CS: “Arthroscopic Treatment of Osteochondritis Dissecans”. Elbow Arthroscopy DVD, AAOS/AANA, Larry Field and Scott Steinmann co-editors, 2014
  3. Ahmad CS, ElAttrache NS: Elbow Arthroscopy: Beginners to Advanced, American Academy of Orthopaedic Surgeons, 2009
  4. Ahmad CS, ElAttrache NS: Athletic Injuries about the Elbow, Orthopaedic Knowledge Online, American Academy of Orthopaedic Surgeons, 2004
National Research Podium Presentations Presented
  1. Ahmad CS, O’Driscoll SW, ElAttrache NS: Elbow Arthroscopy: Beginners to Advanced. American Academy of Orthopaedic Surgeons, San Diego, CA, February 2011
  2. Ahmad CS, Conway J, O’Driscoll S, ElAttrache N: Elbow Arthroscopy: Beginners to Advanced. American Academy of Orthopaedic Surgeons, New Orleans, LO, March 2010
  3. Conway JE, Ahmad CS: The Throwing Athlete. American Academy of Orthopaedic Surgeons-Specialty Day, Las Vegas NV, February 2009
Scientific Exhibit Presentations
  1. Mlynarek R, Weber A, Nepple J, Dines J, Li X, Ahmad CS, Bedin, A Scientific Exhibit #29: Approach to Diagnosis and Treatment of Shoulder and Elbow Pain in the Skeletally Immature Athlete, American Academy of Orthopaedic Surgeons Annual Meeting, Orlando, March 2016
Invited Instructional Course and Symposium Presentations
  1. O’Donnell E, Vitale M, Ahmad CS, authors, Paper Presentation: A National and Statewide Analysis of Elbow Arthroscopy, American Academy of Orthopaedic Surgeons Annual Meeting, Orlando, March 2016
  2. AAOS ICL 130, Elbow Arthritis in the Young Athlete, Elbow Injuries Surgical Management, American Academy of Orthopaedic Surgeons, Orlando, FL March 2016
  3. AAOS ICL 127, Savoie F, Ramsey M, Romeo A, Ahmad CS: Elbow Arthroscopy: Beginners to Advanced- Throwing Elbow Injuries. Throwing Elbow Injuries, American Academy of Orthopaedic Surgeons, New Orleans, LA, March 2014
  4. AAOS ICL 368, Savoie F, Ramsey M, Romeo A, Ahmad CS: Elbow Arthroscopy: Beginners to Advanced- Throwing Elbow Injuries. Throwing Elbow Injuries, American Academy of Orthopaedic Surgeons, Chicago, IL, March 2013
  5. AAOS ICL Savoie F, Ramsey M, Romeo A, Ahmad CS: Elbow Arthroscopy: Beginners to Advanced- Throwing Elbow Injuries, American Academy of Orthopaedic Surgeons, San Francisco, CA, February 2012
  6. 2011 AAOS Top Controversies, Speaker, Elbow Arthroscopy: “How To” Beginners Guide and Shoulder I Transition from Open Capsular Releases and Tennis Elbow Releases to an All-Arthroscopic Technique, New York, NY, October, 2011

AOSSM

  1. Ahmad CS: Elbow, AOSSM & AAOS Sports Medicine Review Course for Subspecialty Certification and Maintenance of Certification, Chicago, August 8, 2014
  2. Ahmad CS: Elbow, AOSSM & AAOS Sports Medicine Review Course for Subspecialty Certification and Maintenance of Certification, Chicago, August 9, 2013
  3. AOSSM Annual Meeting, Faculty, IC: Overview of the Athlete’s Elbow. Providence, RI.  July 2010
  4. Arthrex Elbow Arthroscopy Series, Basic Elbow Arthroscopy. Scottsdale AZ, July 2004 

Orthopedics Today Symposia

  1. Orthopedics Today Symposium, Faculty, Surgical Spotlight: Elbow Arthroscopy Basics and Treatment of Capitellar OCD, Waikoloa, HI, January 2016
  2. Orthopedics Today Symposium, Faculty, Panel Discussion: Getting Control of High School Baseball Elbow Injuries, Waikoloa, HI, January 2016
  3. Orthopedics Today Symposium, Faculty, High School Baseball Elbow Injuries, Koala, HI, January 2015
Invited Grand Rounds and Guest Lectureships
  1. Roosevelt Hospital Grand Rounds, Speaker, Elbow Throwing Injuries, New York, NY, December 20, 2011
  2. Detroit Metropolitan Course, Faculty, Adolescent Shoulder and Elbow Sports Medicine Injuries (Clinical), January 27, 2010
  3. Danbury Hospital Grand Rounds, The Throwing Athlete. Danbury CT, April 2009
 

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