Osteochondritis dissecans (OCD) of the elbow affects the cartilage and bone of the elbow joint, most often in young throwing athletes and gymnasts. It typically affects the capitellum — the knuckle of bone on the outer side of the elbow. Left untreated, it can cause a loose fragment, locking, and early arthritis. So what causes OCD of the elbow, and how do we diagnose and treat it?

skeleton picture with highlighted elbow joint

What is OCD of the elbow?

OCD occurs when a small area of bone just beneath the cartilage loses its blood supply, causing the bone — and the cartilage above it — to separate from the joint surface. In the elbow, the commonest site is the capitellum, on the outer (lateral) side. It’s closely related to OCD of the knee, which is the commonest site overall, and it’s part of the same family of adolescent overuse injuries as little league shoulder. 

What causes OCD of the elbow?

The exact cause isn’t fully understood, but it’s thought to result from repetitive stress combined with a vulnerable blood supply to the growing capitellum. Repeated compression and shear across the outer elbow — as happens with throwing and weight-bearing on the arms — gradually damages the bone beneath the cartilage.

That’s why it’s classically seen in adolescent throwing athletes (such as baseball pitchers) and gymnasts, usually between about 11 and 16 years of age, while the bones are still growing. In throwers, it’s sometimes grouped with the overuse elbow injuries known as “little league elbow”.

Symptoms of OCD of the elbow

Symptoms often come on gradually and can be subtle at first:

  • Pain on the outer side of the elbow, worse with throwing, weight-bearing, or lifting
  • Stiffness and reduced range of movement, especially difficulty fully straightening the elbow
  • Swelling
  • Locking or catching, if a fragment becomes loose within the joint

Early lesions may cause little pain, which is one reason the diagnosis is sometimes delayed.

How is OCD of the elbow diagnosed?

Diagnosis combines the history and examination with imaging:

  • X-ray — can show the lesion, though early changes may be subtle; special views of the elbow improve the yield
  • MRI — the gold standard. It detects early lesions and, crucially, shows whether the fragment is stable or unstable, which drives treatment. An unstable fracture is one in which oedema is present between the fragment and the underlying subchondral bone. 
  • Ultrasound — can help assess the cartilage surface in experienced hands

Because early lesions can be missed, a young thrower or gymnast with persistent outer-elbow pain warrants a high index of suspicion and proper imaging.

How is OCD of the elbow treated?

Treatment depends on the age, the stability of the lesion, and the symptoms.

Non-surgical treatment

In young athletes with stable lesions and open growth plates, non-surgical treatment is preferred. The key is rest from the aggravating activity — stopping throwing or weight-bearing — to let the lesion heal, sometimes with a period in a brace. Physiotherapy helps maintain movement and strength, and a graded return of function follows once healing is confirmed on imaging. Adequate calcium and vitamin D intake supports bone healing.

Surgery

If the lesion is unstable, there’s a loose body, or a stable lesion fails to heal with rest, surgery is considered. Options — usually arthroscopic (keyhole) — include drilling to stimulate healing, fixing a fragment that’s still viable, removing a loose body, or, for larger defects, cartilage restoration procedures such as an osteochondral graft. Return to sport after surgery is generally good, though it takes several months and a structured rehabilitation programme.

Frequently asked questions about OCD of the capitellum

Who gets OCD of the capitellum?

It’s classically an adolescent injury — most often seen in young throwing athletes (such as baseball pitchers) and gymnasts, usually aged around 11–16, when the bones are still growing. The repeated compression and shear across the outer elbow drive it.

Is OCD of the elbow serious?

It can be if missed. An unstable lesion or a loose fragment can cause locking, restricted movement, and early osteoarthritis of the elbow. Caught early, especially a stable lesion in a young athlete, it often heals with rest — which is why prompt diagnosis matters.

How long does osteochondritis dissecans of the capitellum take to heal?

A stable lesion managed with rest often takes several months to heal, and imaging is used to confirm healing before returning to sport. Surgically treated lesions take longer to resolve, with a gradual return over months. Rushing back risks the lesion failing to heal or a fragment coming loose.

Can my child return to throwing or gymnastics?

Usually yes, with the right treatment and patience. Stable lesions often heal with rest and rehabilitation, and even lesions needing surgery generally allow a return to sport after a structured recovery. Confirming healing on a scan before return is essential — as is addressing the training load that caused it.

Final word from Sport Doctor London about OCD of the capitellum

OCD of the elbow is an important overuse injury in young throwers and gymnasts, affecting the capitellum on the outer side of the elbow. Early diagnosis is the key to preventing a loose fragment, restricted movement, and early arthritis. Any young athlete with persistent outer-elbow pain should be assessed and imaged, so the lesion can be graded and treated before it progresses.

If you or your child has persistent elbow pain, Dr Masci can assess you in London, including the right imaging. Contact the team here or call +44 (0) 203 488 0350.

Related conditions: