Abstract
Objectives:
Gymnasts, due to repetitive upper extremity weightbearing, are prone to developing capitellar osteochondritis dissecans (OCD) lesions. Surgical intervention is often necessary for these lesions, resulting in time away from sport, training delays, with almost 40% of gymnasts unable to return to sport. (1) Ultrasound has shown promise in detecting early, often asymptomatic, capitellar osteochondral lesions in baseball players. (2) However, this has not been employed in the young, healthy gymnast population.
Methods:
This IRB-approved descriptive diagnostic epidemiology study recruited 15 healthy gymnasts from local gymnastics clubs. Inclusion criteria involved gymnasts aged 10-19 years who primarily engaged in gymnastics, while those under treatment for upper extremity injuries in the prior six months or history of capitellar surgery were excluded. Questionnaires captured sports history, surgery history, activity level according to The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (Pedi-FABS), and dominant elbow function according to the Single Assessment Numeric Evaluation (SANE). Physical examination included assessment of bilateral elbow range of motion, valgus stress, and pain with palpation over the medial elbow and radiocapitellar joint. Ultrasound evaluation of the elbows, including the medial epicondyle, ulnar collateral ligament, radiocapitellar joint, and olecranon, was conducted using a 4-20 MHz High Frequency Linear transducer with a GE Venue Go ultrasound machine (GE HealthCare, Chicago, Illinois, USA). Comparisons of history physical examination findings, and PROs were made between those with and without osteochondral changes.
Results:
Forty-six elbows were evaluated in 23 gymnasts (13.4±3.9 years; 87.0% female). Three elbows in two gymnasts were excluded due to history of OCD surgery. They trained at levels 7-10+ with 8.5±3.9 years of gymnastics participation. Nine (20.0%) elbows had radiocapitellar joint changes. Eight of the nine gymnasts with capitellar changes demonstrated findings in bilateral elbows. Visualized capitellar changes included four subchondral plate concavity (8.7%), three subchondral flattening (6.5%), one subchondral breach (2.2%), and one isolated articular cartilage thickening (2.2%). Capitellar changes were not associated with Pedi-FABS scores, SANE elbow function scores, training volume, elbow ROM, or valgus differences. Two elbows (7.4%) demonstrated healed medial epicondyle avulsions.
Conclusions:
One-fifth of high-level youth gymnast elbows demonstrated capitellar osteochondral changes, irrespective of reported pain or activity levels. All gymnasts with capitellar changes had bilateral findings. Further studies are needed, but screening gymnasts’ elbows with ultrasound may facilitate earlier and more successful treatment for the challenging diagnosis of capitellar OCDs.