Kelley Woodruff Marshall MD, Presenter: Nothing to Disclose

Michael T. Busch MD, Abstract Co-Author: Nothing to Disclose

David L. Marshall MD, Abstract Co-Author: Nothing to Disclose

To identify and characterize osteochondral abnormalities of the humeral trochlea in the pediatric athlete presenting with elbow pain.

With the approval and oversight of the institutional review board, patients with trochlear abnormalities were identified through a RIS database keyword search of radiology dictations from 1999-2007. The patient’s orthopedic medical record, imaging studies and surgical reports were reviewed. Patient presentation including character of symptoms was recorded. The osteochondral lesions were sub-categorized based on the imaging appearance. Surgical results were reviewed in conjunction with the imaging findings.

Of approximately 475 MRIs of the elbow performed in our institution from Jan 1, 1999 to Dec 31, 2007, 17 patients were identified meeting inclusion criteria for the study. Trochlear lesions were stratified into one of 3 imaging groups. Chondromalacia, Osteochondritis Dissecans (OCD) or Avascular Necrosis (AVN). Chondromalacia lesions (n=3) were small (<6 mm), located on the posterior articular surface of the medial trochlea, and were treated non-operatively. OCD lesions (n=10) were larger (10-14 mm), characteristically circumscribed and located on the posterior inferior aspect of the lateral trochlea. Trochlear AVN lesions (n=4) affected growth and development of both the medial and lateral aspects of the trochlea and occurred exclusively in athletes presenting years after remote supracondylar fracture. Of the OCD and AVN groups, 7 of 14 patients underwent elbow arthroscopy. Surgical findings and treatment were summarized.

Trochlear lesions are an infrequent cause of elbow pain in the pediatric athlete but should be considered in athletes presenting with medial elbow pain and flexion contracture/extension block. OCD lesions are seen as a result of osteonecrosis occurring in a narrow zone at risk at the posterior inferior lateral trochlea. If injury occurs earlier in trochlear development, the more global AVN pattern of injury will result.

Humeral trochlear lesions are an uncommon cause of elbow pain in the pediatric athlete but present with suggestive clinical symptoms and characteristic imaging findings.

Marshall, K, Busch, M, Marshall, D, Osteochondral Lesions of the Trochlea in the Pediatric Athlete with Elbow Pain.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6022497.html