Panner Disease

  • Etiology: ischemia of ossific nucleus causes disordered endochondral ossification, injury to tenuous vascularity of capitellum which is supplied by small posterior perforating-end arteries traversing a pliable and compressible epiphyseal cartilage, osteochondrosis of capitellum due to disruption of vascular supply to epiphysis, similar to Legg-Calve-Perthes
  • Radiograph: demineralization with irregularity, fragmentation and sclerosis of capitellum
  • MRI: loss of normal fatty marrow signal involving entire capitellum ossification center so capitellum has low signal intensity on T1WI and high signal intensity on T2WI, articular cartilage is intact, stages include ischemia and necrosis followed by revascularization and re-ossification
  • 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 / loose bodies
  • Clinical: clinically 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, with rest normal capitellar growth resumes without long-term sequelae

Radiology Cases of Panner Disease

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.