Panner's disease: X-ray, MR imaging findings and review of the literature

Osteochondrosis of Humeral Capitellum, Diagnosis and Treatment - A Case Report

Introduction:

Osteochondrosis of humeral capitellum (Panner’s disease) is a rare condition. Very few cases are reported in the literature and may be overlooked or misdiagnosed. Most cases are unilateral in distribution and occur in young boys during the first decade of life. It is often difficult to distinguish osteochondrosis from osteochondritis dissecans of the humeral capitellum that occurs in older children and adolescents in the second decade of life.

Case Report:

We describe a case of a 6-year-old boy who presented with pain, subtle swelling and limited extension in his right elbow following a fall. Diagnosis of Panner’s disease was made 2 weeks later on follow-up based on classical features on plain radiograph of joint effusion, irregular delineation of the articular contour, and faint sclerosis of the capitellum with a radiolucent line in the subchondral bone. The patient had uneventful full functional recovery with conservative treatment: Rest, temporary immobilization, and subsequent remobilization.

Conclusion:

Osteochondrosis of humeral capitellum though rare is a known condition. It may be overlooked or misdiagnosed. High degree of awareness is required and diagnosis can be made with utmost care based on the age of presentation, clinical signs and clearly recognizable plain radiographic features of joint effusion, irregular articular outline with radiolucent line in subchondral bone and faint sclerosis of capitellum.

The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica

During the last 100 years, musculoskeletal radiology has developed from bone-only radiography performed by everyone to a dedicated subspecialty, still secure in its origins in radiography but having expanded into all modalities of imaging. Like other subspecialties in radiology, it has become heavily dependent on cross-sectional and functional imaging, and musculoskeletal interventions play an important role in tumor diagnosis and treatment and in joint diseases. All these developments are reflected in the pages in Acta Radiologica, as shown in this review.

Imaging of Elbow Injuries

Familiarity with throwing mechanics during elbow range of motion allows accurate diagnosis of sports-related elbow injuries, which occur in predictable patterns. In addition, repetitive stress-related injuries are often clinically apparent; however, imaging plays an important role in determining severity as well as associated injuries that may affect clinical management. A detailed understanding of elbow imaging regarding anatomy and mechanism of injury results in prompt and precise treatment.

Tennis overuse injuries in the upper extremity

OBJECTIVE

Tennis is a popular sport with high levels of participation. This article aims to describe how upper extremity overuse injuries occur in relation to tennis biomechanics and to review their imaging characteristics and implications for management. In particular, we will review the imaging patterns of internal impingement, scapular dyskinesis, lateral and medial epicondylitis, ulnar collateral ligament insufficiency, valgus extension overload, capitellar osteochondritis dissecans, extensor carpi ulnaris tendinosis and instability, tenosynovitis, triangular fibrocartilage complex injuries, and carpal stress injuries.

CONCLUSION

Tennis is a complex and physically demanding sport with a wide range of associated injuries. Repetitive overloading commonly leads to injuries of the upper extremity. An understanding of the underlying mechanisms of injury and knowledge of these injury patterns will aid the radiologist in generating the correct diagnosis in both the professional and recreational tennis athlete.

Panner's disease: literature review and treatment recommendations

PURPOSE

To determine the most up-to-date theory on the aetiology of Panner's disease, to form a consensus on the assessment of radiographs and to evaluate clinical outcome in order to summarise the best available evidence for diagnosis and treatment.

METHODS

A review of studies to date on Panner's disease. Studies were eligible if: (1) the study provided criteria for defining Panner's disease in order to eliminate confounding data on other radiographic entities that were mistakenly grouped and presented as Panner's disease; (2) original data of at least one patient was presented; (3) manuscripts were written in English, German or Dutch; and (4) a full-text article was available. Animal studies, reviews and expert opinions were not included. Because the majority of the studies were case reports, we did not use an overall scoring system to evaluate methodological quality.

RESULTS

Twenty-three articles reporting on Panner's disease were included. Most cases of Panner's disease were unilateral in distribution and occurred in boys during the first decade of life. In general, conservative treatment is advised for Panner's disease. Panner's disease is a self-limiting disease and the majority of patients heal without clinical impairment.

CONCLUSIONS

Based on the results of this review, Panner's disease should be treated conservatively. Uniform names and descriptions of signs on radiographs would help to make the correct diagnosis. Since Panner's disease is very rare, higher quality studies are not likely to be performed and, thus, this review provides the best level of evidence on the current knowledge about Panner's disease.

[Imaging of the elbow joint with focused MRI. Part 1: examination techniques and sequences for bone and ligaments]

Imaging of the elbow joint places high demands on the quality of imaging due to the challenging anatomy and the sometimes subtle findings. For the diagnosis of periarticular soft tissues, ligamentous structures and in individual cases for fracture and tumor diagnosis, magnetic resonance imaging (MRI) is mostly groundbreaking and allows a reliable diagnosis in most cases. This review article discusses the complex imaging anatomy and anatomical variants of this joint and the most common osseous and ligamentous injuries of the elbow joint are presented. The typical MRI findings and indications are illustrated and discussed and possible pitfalls are pointed out. The various examination techniques and MRI sequences are also addressed.

Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation

The diagnosis of lateral epicondylitis is often straightforward and can be made on the basis of clinical findings. However, radiological assessment is valuable where the clinical picture is less clear or where symptoms are refractory to treatment. Demographics, aspects of clinical history, or certain physical signs may suggest an alternate diagnosis. Knowledge of the typical clinical presentation and imaging findings of lateral epicondylitis, in addition to other potential causes of lateral elbow pain, is necessary. These include entrapment of the posterior interosseous and lateral antebrachial cutaneous nerves, posterolateral rotatory instability, posterolateral plica syndrome, Panner's disease, osteochondritis dissecans of the capitellum, radiocapitellar overload syndrome, occult fractures and chondral-osseous impaction injuries, and radiocapitellar arthritis. Knowledge of these potential masquerades of lateral epicondylitis and their characteristic clinical and imaging features is essential for accurate diagnosis. The goal of this review is to provide an approach to the imaging of lateral elbow pain, discussing the relevant anatomy, various causes, and discriminating factors, which will allow for an accurate diagnosis.

MR imaging in congenital and acquired disorders of the pediatric upper extremity

Various congenital and acquired disorders can affect the upper extremity in pediatric and adolescent patients. MR imaging can provide unique anatomic and diagnostic information in the evaluation of many of these disorders, including inflammatory, infectious, neoplastic, and arthritic conditions. This article rounds out the issue on pediatric musculoskeletal MR imaging. It focuses on the evaluation of more common congenital disorders, and mainly sports-related injuries of the shoulder, elbow, and wrist in children. MR imaging can be more challenging in diagnosis of some of these disorders. Features of overuse injuries in skeletally immature athletes are a unifying theme throughout the article.

MRI features of posterior capitellar impaction injuries

OBJECTIVE

Posterior capitellar injury is a scantly recognized entity in the literature. Furthermore, irregularity of the posterior capitellum, termed the "pseudodefect" of the capitellum, has been touted as a normal MRI finding, not to be misinterpreted for impaction injury. Our objectives, based on 11 MRI studies, were to report the MRI features of a true posterior capitellar impaction injury and to document associated clinical, osseous, and soft-tissue abnormalities that may shed light on the cause of this injury.

CONCLUSION

Traumatic posterior impaction injuries can occur in the capitellum, albeit infrequently. These lesions often present clinically with elbow instability, have a high incidence of lateral ulnar collateral and radial collateral ligament injuries, and show osseous abnormalities typical of elbow dislocation. Thus, MRI evidence of posterior capitellar impaction injuries, to be distinguished from the pseudodefect of the capitellum, should raise the possibility of previous elbow dislocation or posterolateral rotatory instability.

Imaging of sports injuries of the upper extremity in children

Competitive athletics in school-aged children has become the norm rather than the exception. The increased repetitive stresses placed on the upper extremity in a wide variety of sports result in a host of injuries unique to the skeletally immature athlete. This article focuses on a discussion of the more common upper extremity injuries encountered in the child athlete and the role of radiography and MRI in diagnosis and management.

Lateral compression injuries in the pediatric elbow: Panner's disease and osteochondritis dissecans of the capitellum

Lateral compression injuries of the elbow typically occur in throwing athletes and gymnasts. In the preadolescent and adolescent patient, these injuries predominantly include Panner's disease and osteochondritis dissecans. Panner's disease, an osteochondrosis of the capitellum, is a rare disorder that usually affects the dominant extremity in individuals younger than age 10 years. Symptomatic management of Panner's disease consisting of reduction of stressful activities of the elbow is usually sufficient to allow resolution. Although a prolonged period is required for healing, most patients demonstrate excellent long-term results. Osteochondritis dissecans of the capitellum typically occurs in adolescents and is associated with loose body formation. Panner's disease and osteochondritis dissecans likely represent a continuum of disordered endochondral ossification with presentation and prognosis dependent primarily on age at onset.

Imaging of the elbow. An update

This article focuses on the use of magnetic resonance in the evaluation of the soft tissue (tendons, ligaments, muscles, and nerves) and osseous structures of the elbow. The need for high quality, high resolution imaging with attention to positioning, sequence selection, and equipment is emphasized. Normal magnetic resonance anatomy and criteria for pathologic change are presented.