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Loose Body in Adolescence

Etiology
Adolescents from age 12 on.
Usually resuls from osteochondritis dissecans of the capitellum.
Osteochondritis dissecans at the elbow is nearly always localised at the capitellum.
In its simplest terminology, it indicates fragmentation and possible separation of the portion of the articular surface.
A history of repetitive use of the elbow on a constant basis in sport has commonly been associated with this condition.
It is seen in young pitchers, gymnasts, basketball players..
Osteochondritis as such is not causing much subjective complaints, and treatment is not needed.
As the disease progresses, the loosely attached cartilage and bony fragments become free and are discharged into the joint.

Symptoms
Internal derangement: Intermittent severe pain, together with sudden locking of the joint - usually in flexion / sometimes in extension.
The 'unlocking' happens slowly and gradually in a few days days.
This series of events (sudden locking followed by gradual unlocking) is repeated.

Signs
A very clear non capsular pattern is found during an attack of internal derangement - with limitation passive extension with a soft endfeel.
During a free period examination is negative.

Radiography
Confirms the diagnosis.
The loose bodies contain an osseous nucleus and are well visible on X-ray. Often multiple loose bodies are present (illustration: in the recessus olecranii).

Treatment
Arthroscopic or surgical removal of the loose pieces should always be advised; because the loose body has an osseous nucleus it may grow and the condition will worsen at each attack.
If surgery is not carried out, the loose bodies may finally cause gross arthrosis.

 

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