Panner’s Disease

Panner’s Disease is a pathology involving the capitellum of the distal humerus with changes similar to Legg Calve Perthes disease. Panner’s disease is seen in the younger patient population (about 5–11 years of age) and it typically occurs in the dominant elbow. With Panner’s disease, loose bodies are not usually seen within the elbow joint — residual deformity is also not common. This condition is believed to be avascular necrosis of the capitellum secondary to trauma. It runs a relatively benign course and typically occurs within the first decade of life. This process is caused by interference of the blood supply of the growing epiphysis (capitellum) which results in resorption and later on repair and replacement of the ossific center.

It is important to note that in people under the age of 20, the capitellum is only supplied by arteries that enter posteriorly. Surgical procedures involving children should not be done posteriorly due to the risk of injury to the blood supply. Although trauma, especially chronic repetitive trauma, is involved in this condition, it is believed that Panner’s disease may be congenital due to fat embolism or endocrine disturbances.

Differential Diagnosis

· Osteochondritis Dissecans

o Usually occurs in older boys

o Usually related to throwing activities

o X-rays may appear similar to Panner’s disease

o The progression of changes on the x-ray will be different from Panner’s disease

The patient complains of intermittent pain and stiffness that lasts for a few months. The pain and stiffness is aggravated by activity and improved by rest. There may be local tenderness over the capitellum, slight joint effusion, and there may be minimally loss of extension, pronation, and supination.

X-rays will show irregularity of the capitellum with some areas of radiolucency. This means that there is some degree of resorption, especially near the articular surface. Some sclerosis may be present. After a few months, the area of radiolucency will be larger. It is then followed by reconstruction of the bony epiphysis again. Then in 1–2 years, the epiphysis will return to its normal configuration and shape. In about 50% of patients, the radial head on the same side will show early maturation.

Treatment can by Symptomatic — the epiphysis will revascularize and become normal in time, elbow activity will need to be reduced or modified, and a long arm cast or splint may need to be used if the pain is severe.

The x-ray findings may be different compared to the patient’s complaints. The patient may be doing very well, however the x-ray may show the presence of the disease. Be patient, the x-ray may be lagging behind.