Overview
- Adolescents aged about 11 to 16 with repetitive valgus elbow loading, mostly throwers and gymnasts
- Panner’s disease affects younger children and resolves without treatment
- Lateral elbow pain, loss of extension and locking from loose bodies
- MRI assesses stability
- Stable lesions with an open physis settle with rest
- Unstable lesions need debridement and marrow stimulation, fixation or osteochondral autograft
Presentation by Dr Nathan Donovan
Aetiology
- Repetitive valgus compression in throwers and gymnasts
- Tenuous end arterial posterior blood supply
- Dominant arm of males aged 12 to 15
Differential Diagnosis
- Panner disease affects children under about 10, OCD affects adolescents
- Panner involves the whole capitellum, OCD is focal and anterolateral
- Panner resolves with rest and has no loose bodies
Clinical Features
- Loss of terminal extension is often the earliest sign
- Locking and catching with unstable lesions
- Positive active radiocapitellar compression test
Investigations
- 45 degree flexion AP view improves visibility
- MRI instability signs are a T2 high signal line, cysts, cartilage breach and surrounding fluid
Classification
Minami
| Grade | Radiographic features |
|---|---|
| I | Cystic or flattened lesion |
| II | Nondisplaced fragment with a clear zone |
| III | Loose bodies |
ICRS
- Arthroscopic grades I to IV, from intact cartilage to empty defect
Management
- Stable lesion with open physis, stop throwing and arm weight-bearing until radiological healing
- Surgery for instability, closed physis, failed non-operative care or loose bodies
- Debridement and microfracture for small lesions sparing the lateral wall
- Fixation for large unstable in-situ fragments
- Osteochondral autograft from knee or rib for large or lateral wall lesions
Prognosis
- Loss of extension often persists
- Late arthritis follows large lesions, lateral margin involvement and delayed treatment
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.