Panner Disease

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Osteochondrosis refers to injuries to the epiphyses, physes, and apophyses of children that occur because of a disturbance of epiphyseal growth during childhood. This results in necrosis in the subchondral bone and adjacent epiphyseal cartilage. Most osteochondroses are self-limiting.

Panner disease is an osteochondrosis characterized by necrosis of the capitular ossification center and is a cause of lateral elbow pain in children. It is thought to be due to compromise of the blood supply to the capitular ossification center due to valgus stress, and is a self-limiting process, with restoration of the normal morphology of the capitulum.

It usually occurs in the dominant elbow in children, usually boys, between the ages of 7 and 12 years. Patients present with insidious-onset dull ache and swelling over the lateral elbow. The pain is typically aggravated by activity and relieved by rest. Treatment is usually conservative and includes avoidance of activities that stress the radiocapitular joint.

Radiography reveals areas of demineralization or sclerosis, usually involving the entire ossific nucleus of the capitulum. Fragmentation of the ossification center may or may not be present.

MRI is used to assess the integrity of the overlying cartilage and to look for intra-articular fragments, but is generally not needed for diagnosis. However, MRI can reveal radiographically occult abnormalities early in the course of disease. The typical appearance is signal abnormality in the capitulum with intact overlying cartilage.

The main differential consideration is osteochondritis dissecans of the elbow, which tends to affect older patients (12-15 years, around the time of epiphyseal plate ossification), does not affect the entire ossific nucleus of the capitulum, and is not a self-limited process. Chondroblastoma is also a consideration, as it tends to affect the epiphysis.

Panner disease and osteochondritis dissecans are now thought to represent a continuum of abnormal endochondral ossification, with presentation and prognosis depending on the age of onset.

References

• Doyle SM, Monahan A. Osteochondroses: a clinical review for the pediatrician. Curr Opin Pediatr. 2010 Feb;22(1):41-6.
• 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. Epub 2011 Dec 30.