Case Report #2 |
OSTEOCHONDRITIS OF THE CAPITELLUM IN A 13 YEAR-OLD
L.M., a 13 year-old, came to Caring Medical on June 14, 2010 for possible Prolotherapy treatment on his elbow. L.M. was a pitcher on a junior boys baseball team for his middle school. He had a six month history of elbow pain, especially severe when pitching. An MRI on 2/24/2010 revealed osteochondritis dissecans of the capitellum. (See Figure 3.) At the time of the initial evaluation the patient was not able to pitch or throw a baseball at all. The patient had seen several orthopedic surgeons, all suggesting he rest for various periods of time, during which time his elbow would feel better, only to have the pain recur with activity. One orthopedist said he would never pitch again. His goal (as well as his father’s goal for him) was to be able to pitch again.
On physical examination, tenderness was elicited both in the medial and lateral elbow especially at the locations of the ulnar and radial collateral ligaments. Both radiocapitellar and ulnohumeral joint instability was present, but with full range of motion. No crepitation was noted. Hackett-Hemwall dextrose Prolotherapy was injected into and around the bony attachments of the ligament, tendon and muscle origins of both the medial and lateral elbows, with emphasis on the ligamentous support. A total of 48cc of solution with 35 separate injections were utilized. Human Growth Hormone (2IU) was injected into and around the osteochondritis dissecans injury.
| Figure 3. MRI right elbow without contrast, prior to Prolotherapy. The arrow points to the evolving osteochondral defect involving the capitellum typical of osteochondritis dissecans. The defect is stable without evidence of in situ loose body. |
 |
L.M. was next seen once month later where he reported a 50% reduction in pain and stiffness. He was now able to perform all activities of daily living without pain, including weight lifting, running, and swimming. At this point, however, he had still not thrown a baseball. A second Prolotherapy treatment was given to the same areas as the first.
On L.M.’s third and final Prolotherapy visit, he reported no pain in his elbow and was able to throw a baseball for 15 minutes without pain, along with no other restrictions during his other workouts.
L.M. had a repeat MRI on September 20, 2010 which revealed resolution of the osteochondritis dissecans. (See Figure 4.) As of November 2010, L.M. is back to pitching without restriction. He has no elbow pain or disability whatsoever.
| Figure 4. MRI right elbow with intra-articular contrast, after Prolotherapy. Arrows show resolution of the articular cartilage fraying, as well as the subchondral cystic changes. Improvement of the subchondral edema with almost complete resolution of the osteochondral lesion. |
 |
 |
 |
