The exact mechanism by which osteochondritis dissecans (OCD) lesions develop is poorly understood. This month’s “Case Connections” spotlights 3 case reports of OCD in young baseball players, 2 of whom developed the condition in the shoulder. A fourth case report details 3 presentations of bilateral OCD of the femoral head that occurred in the same family over 3 generations.
The springboard case report, from the December 28, 2016, edition of JBJS Case Connector, describes a 16-year-old Major League Baseball (MLB) pitching prospect in whom an OCD lesion of the shoulder healed radiographically and clinically after 8 months of non-throwing and physical therapy focused on improving range of motion and throwing mechanics. Three additional JBJS Case Connector case reports summarized in the article focus on:
- Shoulder OCD in a teenage baseball player that was treated arthroscopically
- Early elbow OCD in young throwers
- Three cases of bilateral femoral head OCD that occurred in multiple members of the same family
Among the take-home points emphasized in this Case Connections article:
- MRI arthrograms are the best imaging modality to determine the stability of most OCD lesions. Radiographs in such cases often appear normal.
- Early-stage OCD has the potential to heal spontaneously. Activity modification and physical therapy are effective treatments.
- There is not a “gold-standard” surgical intervention for treating unstable/late-stage OCD. Surgery frequently provides clinical benefits but often does not result in radiographic improvement.
Young baseball players who want to stay out of the operating room should look into purchasing the Throw Like a Pro app ($9.99 for iPhones and iPads). According to leading surgeons in the field of throwing injuries, this app could reduce throwing injuries by 60% if used correctly. The app, released by James Andrews, MD and Kevin Wilk, DPT receives the highest marks from TopOrthoApps, an app review site, for functionality, coolness and overall features. The app breaks down stretches and exercises that players should do during pre-season as well as in-season. Both pre-season and in-season sections include video showing stretching exercises, warm-ups, and workouts for general throwing and pitching. Included is a modifiable tool that adjusts pitch-count recommendations according to the patient’s age and number of rest days.