What it is
Osteochondritis dissecans of the capitellum is a focal injury to the cartilage and underlying bone on the outer part of the elbow in young athletes. Repeated valgus loading and compression during throwing or tumbling can disrupt the blood supply and weaken the area.
Symptoms range from lateral elbow pain to catching or locking when a fragment becomes unstable. Early identification protects joint surfaces.
What happens when it occurs
Compression between the radial head and capitellum during high‑speed extension and rotation stresses the cartilage–bone unit. Stable lesions may heal with offloading and strengthening. Unstable lesions risk the formation of loose bodies and may require surgery.
Common causes and risk factors
- High volumes of throwing, tumbling, or handstands
- Valgus overload with poor trunk and shoulder contribution
- Rapid growth with relative forearm tightness
Who is most affected
Early to mid-adolescents in sports such as cricket, baseball, gymnastics, and cheerleading.
Typical symptoms
- Outer elbow pain with extension or loading
- Loss of extension range
- Clicking, catching, or locking in advanced cases
When to seek care
If extension is limited, catching occurs, or if pain persists during a season.
How we diagnose
History and examination with extension testing. X‑ray screens for lesion location and size. MRI assesses stability and cartilage health; CT is used selectively for surgical planning.
Management
- Unload high‑compression tasks and lockout positions
- Strength for the cuff, scapula, and forearm; mobility for the shoulder and thorax
- Gradual return to throw or tumbling when pain-free with stable imaging
- Surgical drilling, fixation, or graft procedures for unstable or advanced lesions
Rehabilitation milestones
Phase 1 weeks 0–6: pain control, avoid end‑range compression, maintain fitness.
Phase 2 weeks 6–12: progressive strength and range without lockout pain.
Phase 3 months 3–6: return‑to‑throw or tumbling progressions as imaging and symptoms allow.
Post-op timelines follow the procedure and the surgeon's protocol.
Readiness to progress
- Pain-free extension and daily tasks
- Strength symmetry within 90 per cent
- Sport drills completed without next‑day symptoms
Prevention
- Manage volumes and avoid repeated hard lockouts early in the season
- Build trunk and shoulder power to reduce valgus compression
- Use deload weeks during growth spurts
Australia snapshot
- Seen in cricket fast bowlers and gymnastics programmes
- Early referral improves outcomes for unstable lesions
- Access to MRI and arthroscopy is broad in metropolitan areas
Latest insights
Compression plus speed is the problem. Reduce lockout stress while you rebuild capacity.
Stable lesions heal best when volumes are controlled and mechanics improve.
