Panner Disease

  • Etiology:
    — Osteochondrosis of capitellum due to disruption of vascular supply to epiphysis, similar to Legg-Calve-Perthes
    — Injury to tenuous vascularity of capitellum which is supplied by small posterior perforating-end arteries traversing a pliable and compressible epiphyseal cartilage
    — Ischemia of ossific nucleus causes disordered endochondral ossification
  • Imaging Radiograph: Demineralization with irregularity and fragmentation and sclerosis of capitellum
  • Imaging MRI:
    — Loss of normal fatty marrow signal involving entire capitellum ossification center
    — Articular cartilage is intact
    — Stages include ischemia and necrosis followed by revascularization and re-ossification
    — T1WI: Capitellum has low signal intensity
    — T2WI: Capitellum has high signal intensity
  • DDX: Osteochondritis dissecans of the elbow in patients greater than 11 years old
    — Panner disease: Younger 7-12 years, affects all or part of capitellum, normal overlying cartilage, no loose body formation
    — Osteochondritis dissecans of the elbow: Older age group 12-15 years, affects anterolateral capitellum, may have overlying cartilage defects or loose bodies
  • Complications:
  • Treatment: With rest normal capitellar growth resumes without long-term sequelae
  • Clinical:
    — Presents with dull pain or stiffness
    — Associated with prior trauma in 50%
    — Almost always occurs in dominant elbow of boys 5-12 years old with history of throwing

Radiology Cases of Panner Disease

Radiograph of pediatric Panner disease
AP (left) and lateral (right) radiographs of the elbow show demineralization, fragmentation and sclerosis of the capitellum which also has an irregular border.
Radiograph of Panner disease
AP (left) and lateral (right) radiographs of the elbow show a cresenteric lucency anteriorly along the capitellum along with a joint effusion causing elevation of the anterior and posterior fat pads.