FITNESS & NUTRITION Bones/Joints/Muscles • Juvenile rheumatoid arthritis • Osteoarthritis • Rheumatoid arthritis • Bursitis • Fibromyalgia • Gout • Lupus • Osteoporosis • Sjogren's syndrome • Tendinitis • Trigger finger • Achilles tendon rupture • Back pain • Hip fracture • Rotator cuff injury • Scoliosis • Muscular dystrophy • Dislocation • Shin splints • Bunions • Muscle cramp • Polymyositis • Dermatomyositis • Sprains and strains • TMJ disorders • Scleroderma • Osgood-Schlatter disease • Frozen shoulder • Polymyalgia rheumatica • Baker's cyst • Flatfeet • Morton's neuroma • Tennis elbow • Psoriatic arthritis • Hammertoe and mallet toe • Ankylosing spondylitis • Paget's disease of bone • Reactive arthritis • Metatarsalgia • Plantar fasciitis • Spinal stenosis • Sciatica • Marfan syndrome • Neck pain • Septic arthritis • Knee pain • Stress fractures • CREST syndrome • Dislocated shoulder • Patellar tendinitis • Costochondritis • Bone spurs • Avascular necrosis • Legg-Calve-Perthes disease • Water on the knee • Mixed connective tissue disease • Kyphosis • De Quervain's tenosynovitis • Cervical spondylosis • Thumb arthritis • Ehlers-Danlos syndrome • Golfer's elbow • Pseudogout • Sacroiliitis • Dupuytren's contracture • Achilles tendinitis • Diffuse idiopathic skeletal hyperostosis (DISH) • Osteochondritis dissecans • Osteomyelitis • Ganglion cysts • Chondromalacia patella • Chronic exertional compartment syndrome • Adult Still's disease • Rickets • Growth plate fractures • Greenstick fractures

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Osteochondritis dissecans is a condition that results from a loss of blood supply to an area of bone beneath the surface of a joint. The knee is most commonly affected, although osteochondritis dissecans also can occur in other joints, including your elbow and ankle.

The affected bone and its covering of cartilage may stay in place and may not cause any symptoms. Or a fragment may gradually loosen and cause pain.

Most people diagnosed with osteochondritis dissecans are teenagers and young adults. The juvenile form affects growing bone, while the adult form affects mature bone. Osteochondritis dissecans is more common in males. Although osteochondritis dissecans is rare, it's becoming more common, particularly among girls and young women as their participation in youth and college sports increases.

Early diagnosis and treatment of osteochondritis dissecans are important to minimize your risk of long-term disability. Some people with osteochondritis dissecans eventually develop osteoarthritis. When the disorder is treated promptly, most people recover and return to their usual activities, including participation in sports.

Pain is the most common symptom of osteochondritis dissecans. The pain tends to be sharp or aching, and is usually triggered by physical activity — for example, knee pain that occurs while walking up stairs, climbing a hill or playing sports. Other signs and symptoms include:

• A clicking sound when you move your joint
• A "locking" of your joint — the joint "sticks" and won't move through its full range of motion
• A feeling that your joint is "giving way" or weakening
• Decreased joint movement — an inability to straighten your leg or arm fully, or a limited range of motion
• Limping
• Swelling and tenderness of the skin over your joint
• Stiffness after resting

Doctors are unsure of the cause of osteochondritis dissecans. However, a number of factors may contribute to the disorder.

High on the list is repetitive force (trauma or stress) to the affected joint, particularly if you're very active. You may experience small, multiple episodes of minor unrecognized injury that, over time, cause a tiny fracture that damages the overlying cartilage of a joint. Researchers have reported a relationship between osteochondritis dissecans of the elbow and particular sports motions, such as baseball pitching.

An impaired blood supply to the bone (vascular insufficiency) also may play a role in the condition. The impaired supply is due to a slight blockage of a small artery and gradually can cause a breaking down or death of bone tissue (avascular necrosis).

Some family groups appear to have a genetic tendency to develop osteochondritis dissecans, although this is not believed to be a major factor in most cases.

Regular physical activity — particularly when it involves repetitive impact movement, such as jumping — may put stress on your joints and place you at increased risk of osteochondritis dissecans.

The largest group of people affected by the condition is active boys and men in the 10- to 20-year age group who are participating in organized sports. While pitchers in baseball may be at particular risk, those in other sports may be vulnerable as well, including athletes in tennis, gymnastics, shot put, golf and wrestling.

If you have pain or soreness in your knee, elbow or another joint, see your doctor. Other signs and symptoms that should prompt a call or visit to your doctor include swelling at the site of a joint or an inability to fully extend an extremity.

If you know that you've recently suffered a joint injury — or feel a worsening of pain during physical activity — this could be a further indication of possible osteochondritis dissecans. Seek medical attention.

The diagnosis for many people is delayed simply because they ignore their symptoms as long as possible before finally seeing a doctor. One study showed that this interval between the beginning of symptoms and the time of diagnosis was about one year.

To make the diagnosis of osteochondritis dissecans, your doctor begins by taking a thorough medical history — asking about your symptoms, including pain, and whether you've had joint problems in the past.

Your doctor will ask about whether you've experienced an injury to the affected joint and when it occurred. In addition, your doctor will ask about your exercise routines, whether they involve any throwing movements (if the pain is in your elbow), and whether the discomfort has increased in recent weeks and months.

Then your doctor will likely conduct a physical examination, checking the stability of the joint and whether there is a clicking or locking when you move the joint.

Imaging tests
Your doctor may ask you to undergo one or more imaging procedures to help diagnose and determine the severity of the disorder. X-rays of your joint from various angles could show abnormalities in the surface of your joint. Your doctor may recommend that both joints be X-rayed (both the right and left knee, for example) to compare them.

Although the diagnosis can often be made with X-rays alone, X-rays cannot show breaks or cracks in the cartilage, nor the stability of the joint. Other imaging techniques may be used to analyze the cartilage and provide other information to help make the diagnosis:

• Computerized tomography (CT) provides computer-enhanced images of the joint structures. It can also detect any bone and cartilage fragments and pinpoint their location, including whether they have settled in the joint space.
• Magnetic resonance imaging (MRI) uses magnetic fields to create detailed pictures of your joint, which will provide information about its structure, the accumulation of fluid in the area and the visualization of loose fragments. Doctors frequently use MRI to help decide whether healing will occur with conservative treatment or whether surgery is necessary.
• Bone scans involve injecting dye into your bloodstream, and then taking images of your bones.

If you don't receive effective treatment for osteochondritis dissecans, you risk degenerative osteoarthritis developing in the affected joint.

Treatment of osteochondritis dissecans is intended to restore the normal functioning of the affected joint and to relieve pain, as well as reduce the risk of osteoarthritis. No single treatment, however, is effective for everybody.

Initially, your doctor will likely recommend conservative measures, which are effective in most cases. They may include:

• Resting your joint. Refrain from impact activities such as jumping and from cut-pivot activities in which you can put strain on your knee as you rotate the joint.
• Immobilizing your joint. This may involve using a hinged brace or crutches if your knee or ankle is affected.
• Using nonsteroidal anti-inflammatory medications. These include aspirin, ibuprofen (Motrin, Advil, others) and naproxen sodium (Aleve, Naprosyn).
• Avoiding competitive sports and intense physical activity. These may put a strain on your affected joint and cause pain. At least six to eight weeks of limited activity are helpful for most people.
• Adopting low-intensity physical therapy. Most often, this therapy includes stretching and range-of-motion exercises, and conditioning exercises to strengthen the muscles that support the involved joint. Low-impact aerobic conditioning, such as use of a stationary bicycle, helps to maintain cardiovascular fitness.

When surgery is an option
Although most people see improvement with conservative measures, surgery is an option when problems persist for at least three to six months. Adults have a greater likelihood of requiring an operation, but they also have a lower chance of successful post-surgical results than adolescents have.

Surgery called arthroscopy is minimally invasive. It begins when your surgeon inserts a thin scope into the joint space to visualize the area on a television monitor, determine the location of the damage and decide upon the best type of surgical procedure.

Then tiny surgical instruments are inserted into small incisions, and loose bone fragments may be reattached or removed. When cartilage fragments are still attached to the bone, they can be tightly secured with pins or screws. The goal of this surgery is to restore normal blood flow and improve joint function.

Physical therapy after surgery is necessary to optimize strength, stability and function.

Although most people with osteochondritis dissecans are free of symptoms after appropriate treatment, in some cases doctors may recommend restrictions on daily activities. For example, while young athletes may be able to return to playing sports, doctors may ask that they limit participation initially to light workouts, and then gradually work back into competition.

You may be able to prevent osteochondritis dissecans by limiting the overuse of your joints. That may require reducing the time spent in certain athletic activities that place stress on your joints. Stretching and strengthening exercises also may help prevent osteochondritis dissecans.

Adolescents participating in organized sports can benefit from education on the risks to their joints associated with overuse, with emphasis on the proper mechanics and techniques of their sport, which can reduce the chances of injury.