My 15 year old son's MRI shows what an orthopedic surgeon, who specializes in elbows and shoulders, thinks is OCD: some dead bone, fluid build-up, and loose pieces of cartilage in his elbow. My son was diagnosed with Panner's disease in the fall of 2009. He was told to rest it two months. He also received some physical therapy. I suppose we were not told to rest it long enough. I also suppose the Panner's Disease never healed, or he would not have dead bone, now. He has protected his arm since then, trying not to throw as much, because he didn't want to hurt himself. But, the OCD has come up this spring. Are there any doctors you can recommend in the Kansas City area or even further out? This sounds terribly bleak to me. I don't know how anyone can fix this. I feel terrible, because we thought we were being careful to not let him pitch or throw too much. I think we got bad advice. I think we ruined his life.
Been there cjp. It is not the end of career injury some doctors will tell you. The ones that tell you that are not up on some of the options. Dallas/Ft Worth is quite a ways from you, but a cheap Southwest flight. If you don't find any specialists in this area in KC you are happy with, there are two excellent options in DFW....Keith Meister in Arlington (Rangers team doctor) and John Conway in FW (team doctor before Meister). Both are elbow specialists and really up on the options with OCD in the elbow. With a good MRI with resolution, they will have an idea of the best option...depending on your son's goals. There are more and less aggressive treatments. Anything from rest/position change, to drilling/microfracture surgery to regrow the dead bone that gets removed, to auto-graft (a bone graft harvested from his knee and placed in the dead bone area...most aggressive but the best in my opinion if his goals are to play high level baseball in a throwing position). It's not nearly as bleak as you think at this point. But it is a long road to recovery...so, your son's goal and how hard he wants to work to get there is key. I think Conway is awesome...he did the work on my son and it was successful when others told him to hang it up.
Last Edit: May 10, 2012 9:11:54 GMT -6 by txhusker
Thank you, txhusker, for the referrals and encouraging/hopeful news. You must be very happy with your son's results. Was your son ultimately able to compete at the level he sought without being compromised by his elbow? I hope that my son will be blessed with successful surgery, and that this will become a character and faith building hurdle rather than a huge disappointment. Thanks again for reading the forum.
He pitched in youth ball up to 8th grade when he was hurt. He had the microfracture done, but it didn't work and we ended up doing the graft which worked. He's back to pitching and will be pitching in college. As a senior, in an unrelated problem he hurt his elbow and is getting Tommy John next month (we're going back to Dr. Conway in FW...he's terrific). But the encouraging thing is that created a reason to get another MRI done and the OCD repair work looked great...no sign of deterioration and the graft took to the bone and is solid. In hindsight, I wish we would have done the aggressive treatment (graft) first. But it all worked out. Tell your son he can get better with the right doctors help and a lot of hard work...it's the same recovery work/timeframe as TJ surgery. It's just a matter of how bad does he want it as it's a tough road and a lot of work. Shoot me a private message if you want to talk live. Keep the faith. What your son has going for him is young bodies have an incredible ability to heal themselves...unlike us old folks.
Post by Glenn Fleisig, Ph.D. on May 11, 2012 7:31:32 GMT -6
You didn't ruin your son's life. I don't know who to recommend near KC, but here is some other advice:
We have been studying OCD of the elbow and shoulder of pitchers at our center in Birmingham. If you are able, the best advice would be to see Dr. Andrews, Cain, or Dugas at Andrews Sports Medicine (www.andrewscenters.com).
Drs. Meister and Conway in Dallas are both excellent.
For a car-ride, Drs. Paletta, Gross, and Miller at "The Orthopaedic Center of St. Louis" (www.toc-stl.com) are excellent.
Let us know what you decide. Feel free to mention my name to any of these docs.
My 14 year old son will be having the OATS surgery for the OCD of the elbow here in Boston. The lesion is 13mm and arguably too large for a microfracture. My concern with OATS is the effect it may have on his knee. He loves baseball but also loves hockey and would like to play in High School. Any comments on the recovery time?? Also wondering about returning to baseball (and reinjury)..is it worth it for a solid but not college level player? He dreams of being an ortho surgeon and will need a non arthritic elbow to do so. Thanks
Mine had the OATS done at 14. His knee (where the plug was harvested from) has never bothered him. After his surgery, he basically when through the same throwing rehab program you do with TJ surgery...it takes time for both the plug to bond with the bone and the elbow/shoulder to get strong enough again. It was +/-9 months before he started playing again, at 1B the first season...about a year before moving to other throwing positions. And we waited two years before he started pitching again because that's when he felt strong enough and confident enough in his arm to do it.
Whether it is worth it or not really depends on the kid and his goals/desires. Unfortunately, I think an arthritic elbow down the line is something that's more than likely a reality for this kind or injury. But it's unclear when it will surface.
In answer to Dr. Fleisig, we chose Dr. Dugas at the Andrews Center to do the surgery. My son had an appointment with Dr. Dugas on Monday, June 18th and surgery was done on Tuesday, the 19th. For any readers, I'll explain how we went about making our decision.
We chose Dr. Dugas because I learned that the more practice a doctor has, the better. In my research, I learned that elbows are not injured as often as shoulders and knees, so the local doctors I learned of had not operated on many elbows. We also wanted a doctor who had a very low number of returning patients due to complications or problems. And we needed to find a surgeon who was in-network. Living in Kansas City, it would have been nice to have the surgery done by an excellent surgeon in St. Louis who had pediatric experience and elbow experience, according to his biography, but he was out-of-network. Dr. Dugas' biography indicated that he had a lot of experience with elbows and he was in-network. So, we Fed-Ex'ed all our info to him on a Wednesday night. And Dr. Dugas called us at the end of the next day! He described our son's situation as "vanilla." He's done this surgery many, many times. Only one patient had to return for the OATS out of maybe 100 surgeries. I thought that was pretty good! Everyone heals differently. So, we drove to Birmingham. We didn't mind paying for the hotel and gas, because Dr. Dugas had done this surgery so many times. Our son's lesion was 14mm across, but it was not deep. Everything has gone as planned since then. Our son finished his physical therapy last week, and he is in his first week of the interval throwing program. October 1 was the first day that he could play basketball with his right arm. He hasn't had any pain. He followed all the directions given. He used the CPM machine 4 hours/day religiously, planning activities around TV shows, so that he would have something to do, sometimes even falling asleep as it ran. We've done the best we could. Dr. Dugas was great. It's in God's hands.
As I have had time to think about how part of the bone in my son's elbow could have died and been in his arm for two years from the time that he was diagnosed with Panner's disease almost two years earlier, until he suddenly had too much pain to even shoot a basketball, let alone throw a baseball, I have drawn some conclusions. I think that when he was diagnosed with Panner's disease, inflammation of the bone, that he should have received a follow-up MRI or something. I also think the inflammation should have been treated. He was not even told to take anti-inflammatories or to use ice. He was just told to rest his arm for a month or two (I don't remember), and he was prescribed four weeks of physical therapy. I don't know how long the inflammation had been there prior to diagnosis. He never complained of a lot of pain until the autumn when he was diagnosed with Panner's disease. I think that if efforts were made to treat the inflammation, maybe the blood supply to the end of his elbow would not have been cut off, and maybe the bone would not have died.
Post by sportfloor on Nov 14, 2012 10:33:04 GMT -6
New guy here, great info on a tough to research subject. My 16 year old son was just diagnosed with elbow OCD ( we assume form baseball). We have been seeing Dr. O'Driskell at the Mayo clinic (a 9 hour drive from home). I will write what the doctor wrote on his clinical document if anyone can makes heads or tails of it. osteocohondral defect in the central trochlea measuring approx. 10mm x 10mm in the AP and sagittal and coronal planes and about 5 mm deep. Complete loss of subchondral bone immediaely beneath the cartilage. No loose bodies. I will add that later he had an MRI with dye and the cartilage is also unstable. From what I gather this is on the end of the bone that runs from elbow to shoulder and is very rare and obviously in a tough place to fix. Originally (before the cartilage was found to be unstable) they were going to drill behind the cartilage and fill with pieces of bone to regrow. Now with the bad cartilage options are microfracture or osteochondral allograft which is similar to OATS but uses cadaver bone and cartilage plug. From what I have read the microfracture is more sucessful with sound bone which it doesn't sound like he has. The last conversation my wife had was with another doctor that is helping doctor O'Driskell and really wouldn't commit to which prochedure would be the best and wanted us to decide. I would think that one procedure or the other would be better but theres no way I am knowledgable enough to know what it is. I have tried to get ahold of the doctor to see if I could get more info but that hasn't gone well so far as i never seem to get ahold of him or get a call back. Kind of lost at this point and hoping maybe someone has some info or contact that I can talk to to get some help on what road to take. Really scary to think you are trying to make a decision on your kids future but aren't smart enough to do it. Thanks
I would get a different doctor. One that has handled things the way you describe wouldn't have my confidence to work on my son. Dr. Fleisig should be able to help you locate a doctor with experience in this particular area. Ask the doctor how many of the procedures they do a month. And, ask the doctor if his son had this condition and these goals, what would he do. I wouldn't have much confidence in a doctor that wouldn't answer that question directly.
I'm a fan of the OATS procedure, my now 19 year old had OCD at 14....the graft has healed into the bone and the cartilage is still sound.
Last Edit: Nov 14, 2012 11:30:50 GMT -6 by txhusker
Post by sportfloor on Nov 14, 2012 13:06:17 GMT -6
The doctor has been good so far and I am willing to give them some more time as I know how busy life can be ( We have 4 boys). I just need to talk to the actual doctor to get some additional info as it was his "helper" that my wife actually talked to. Don't want to knock him by any means as he may do a lot of these and do a great job but would like to find that out as well as some additional info. That would be really great if I could find someone familiar with the spot his damage is in. Really glad your son is doing great, I hope we can get the same results! Any more help greatly appreciated.
Ask the doctor how many of the procedures they do a month. And, ask the doctor if his son had this condition and these goals, what would he do. I wouldn't have much confidence in a doctor that wouldn't answer that question directly.
Post by sportfloor on Nov 14, 2012 16:43:04 GMT -6
No doubt excellent questions and ones I had on the list to ask about. Dr. Fleisig do you know of any of the doctors in the above posts that may have done any work on the type of problem my son has ? You seem to be "in the loop" so to speak and would really appreciate any help you can give us. Thanks