Panner's Disease: Difference between revisions
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== Definition == | == Definition == | ||
Panner's disease is [[bone]] growth disorder (osteochondrosis) of the humeral capitellum ossification centre, at the lateral aspect of the [[elbow]]<ref>Nordlie H, Rognstad M, Iveland H. [https://tidsskriftet.no/en/2021/06/medisin-i-bilder/panners-disease Panner's disease.] Tidsskr Nor Laegeforen. 2021 Jun 24;141(10). English, Norwegian</ref>. | Panner's disease is [[bone]] growth disorder (osteochondrosis) of the humeral capitellum ossification centre, at the lateral aspect of the [[elbow]]<ref name=":2">Nordlie H, Rognstad M, Iveland H. [https://tidsskriftet.no/en/2021/06/medisin-i-bilder/panners-disease Panner's disease.] Tidsskr Nor Laegeforen. 2021 Jun 24;141(10). English, Norwegian</ref>. | ||
It is a rare disease, found most commonly in boys under 10 years old, and in a unilateral presentation<ref name=":0">Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. [https://pubmed.ncbi.nlm.nih.gov/25663360/ Panner's disease: literature review and treatment recommendations.] J Child Orthop. 2015 Feb;9(1):9-17.</ref>. | It is a rare disease, found most commonly in boys under 10 years old, and in a unilateral presentation<ref name=":0">Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. [https://pubmed.ncbi.nlm.nih.gov/25663360/ Panner's disease: literature review and treatment recommendations.] J Child Orthop. 2015 Feb;9(1):9-17.</ref>. | ||
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== Pathological Process == | == Pathological Process == | ||
If the blood vessels suppyling the nuleus of the capitellum are disrupted, ischemia can occur<ref name=":0" />. This could be due to: | If the blood vessels suppyling the nuleus of the capitellum are disrupted, ischemia can occur, leading to flatterning of the capitellum<ref name=":0" />. This could be due to: | ||
* Repetitive valgus stress (e.g. throwing and catching). | * Repetitive valgus stress (e.g. throwing and catching). | ||
* Trauma to the elbow.<br> | * Increased axial loading. | ||
* [[Trauma-Informed Care|Trauma]] to the elbow.<br> | |||
== Clinical Presentation == | == Clinical Presentation == | ||
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* Lateral elbow pain, aggravted by activity and eased with rest<ref name=":1">John Hopkins Medicine. Panner's Disease. Available from: http://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Panner-s-Disease (Accessed 14/10/2022)</ref>. | * Lateral elbow pain, aggravted by activity and eased with rest<ref name=":1">John Hopkins Medicine. Panner's Disease. Available from: http://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Panner-s-Disease (Accessed 14/10/2022)</ref>. | ||
* Elbow stiffness<ref name=":1" />. | * Elbow stiffness<ref name=":1" />. | ||
* Elbow swelling<ref name=":1" />. | * Reduced [[Range of Motion|range of motion]], especially into extension<ref name=":3">Anisau A, Posadzy M, Vanhoenacker F. [https://europepmc.org/article/MED/30483677 Panner's Disease: The Vacuum Phenomenon Revisited.] J Belg Soc Radiol. 2018 Oct 12;102(1):67</ref>. | ||
* Elbow [[Oedema Assessment|swelling]]<ref name=":1" />.<br> | |||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
[[X-Rays| | The diagnosis is made on the clinical presentation and age of the patient, in combination with using [[X-Rays|radiographs]] and [[MRI Scans|magnetic resonance imaging]] (MRI's) to look for<ref>Sakata R, Fujioka H, Tomatsuri M, Kokubu T, Mifune Y, Inui A, Kurosaka M. [https://pubmed.ncbi.nlm.nih.gov/26628012/ Treatment and Diagnosis of Panner's Disease. A Report of Three Cases. Kobe J Med Sci.] 2015 Apr 22;61(2):E36-9.</ref><ref name=":3" /><ref>Chavda S, Abeid KA, Alhajri KK, Hasan NHA. [https://pubmed.ncbi.nlm.nih.gov/34790609/ Osteochondrosis of Humeral Capitellum, Diagnosis and Treatment - A Case Report.] J Orthop Case Rep. 2021 Jul;11(7):74-77.</ref>: | ||
* Joint [[Effusion tests|effusion]]. | |||
* Irregular delineation of the [[Joint line tenderness|joint line]]. | |||
* Radiolucency (indicating resorption), particularly adjacent to the articular surface. | |||
* Sclerosis. | |||
* Subchondral vacuum phenomenon. | |||
== Outcome Measures == | |||
[[DASH Outcome Measure|DASH Outcome measure]] | |||
[[ | [[Visual Analogue Scale]] | ||
== Management / Interventions == | == Management / Interventions == | ||
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== Differential Diagnosis == | == Differential Diagnosis == | ||
[[Osteochondritis Dissecans|Osteochondritis | * The most common differential diagnosis is [[Osteochondritis Dissecans|osteochondritis dissecans]]<ref name=":2" />[[Osteochondritis Dissecans|.]] | ||
* Lateral epicondylitis<ref>Kotnis NA, Chiavaras MM, Harish S. [https://pubmed.ncbi.nlm.nih.gov/22205505/ Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation.] Skeletal Radiol. 2012 Apr;41(4):369-86.</ref> | |||
== Resources == | == Resources == | ||
== References == | == References == | ||
<references /> | <references /> | ||
Revision as of 11:30, 14 October 2022
Original Editor - Shreya Pavaskar
Clinically Relevant Anatomy
Top Contributors - Chloe Waller, Shreya Pavaskar and Vidya Acharya
Definition[edit | edit source]
Panner's disease is bone growth disorder (osteochondrosis) of the humeral capitellum ossification centre, at the lateral aspect of the elbow[1].
It is a rare disease, found most commonly in boys under 10 years old, and in a unilateral presentation[2].
Clinically Relevant Anatomy
[edit | edit source]
The elbow joint is a synovial hinge joint. The three bones that make up the articulation of the joint are: the distal end of the humerus and proximal ends of the radius and ulna. The capitellum is the smooth,rounded lateral aspect of the distal articular surface of the humerus, which articulates with the head of the radius.
Pathological Process[edit | edit source]
If the blood vessels suppyling the nuleus of the capitellum are disrupted, ischemia can occur, leading to flatterning of the capitellum[2]. This could be due to:
- Repetitive valgus stress (e.g. throwing and catching).
- Increased axial loading.
- Trauma to the elbow.
Clinical Presentation[edit | edit source]
- Lateral elbow pain, aggravted by activity and eased with rest[3].
- Elbow stiffness[3].
- Reduced range of motion, especially into extension[4].
- Elbow swelling[3].
Diagnostic Procedures[edit | edit source]
The diagnosis is made on the clinical presentation and age of the patient, in combination with using radiographs and magnetic resonance imaging (MRI's) to look for[5][4][6]:
- Joint effusion.
- Irregular delineation of the joint line.
- Radiolucency (indicating resorption), particularly adjacent to the articular surface.
- Sclerosis.
- Subchondral vacuum phenomenon.
Outcome Measures[edit | edit source]
Management / Interventions[edit | edit source]
Symptomatic treatment for Panner's disease is sufficient because epiphysis becomes revascularized & develops normal configuration. Reducing elbow activities and avoiding straining activities can help with pain management and healing process. The use of a long arm splint for 3 to 4 weeks may be necessary until pain, swelling, and local tenderness subside. A cast was recommended for an inconsistent period of time ranging from 4 weeks to 11 months.[7]Non-steroidal anti-inflammatory drugs may be helpful.
It takes one to two years for the growth plate that makes up the capitellum to grow into solid bone. At this point, pain and symptoms usually go away completely. Treatments such as heat, cryotherapy, and ultrasound may be used to ease pain and swelling.
Differential Diagnosis[edit | edit source]
- The most common differential diagnosis is osteochondritis dissecans[1].
- Lateral epicondylitis[8]
Resources[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 Nordlie H, Rognstad M, Iveland H. Panner's disease. Tidsskr Nor Laegeforen. 2021 Jun 24;141(10). English, Norwegian
- ↑ 2.0 2.1 Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. Panner's disease: literature review and treatment recommendations. J Child Orthop. 2015 Feb;9(1):9-17.
- ↑ 3.0 3.1 3.2 John Hopkins Medicine. Panner's Disease. Available from: http://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Panner-s-Disease (Accessed 14/10/2022)
- ↑ 4.0 4.1 Anisau A, Posadzy M, Vanhoenacker F. Panner's Disease: The Vacuum Phenomenon Revisited. J Belg Soc Radiol. 2018 Oct 12;102(1):67
- ↑ Sakata R, Fujioka H, Tomatsuri M, Kokubu T, Mifune Y, Inui A, Kurosaka M. Treatment and Diagnosis of Panner's Disease. A Report of Three Cases. Kobe J Med Sci. 2015 Apr 22;61(2):E36-9.
- ↑ Chavda S, Abeid KA, Alhajri KK, Hasan NHA. Osteochondrosis of Humeral Capitellum, Diagnosis and Treatment - A Case Report. J Orthop Case Rep. 2021 Jul;11(7):74-77.
- ↑ Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. Panner’s disease: literature review and treatment recommendations. Journal of children's orthopaedics. 2015 Feb 1;9(1):9-17.
- ↑ Kotnis NA, Chiavaras MM, Harish S. Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal Radiol. 2012 Apr;41(4):369-86.
