8 glenoid ocd · 2018. 11. 8. · 11/19/2018 1 glenoid ocd in baseball christopher s. ahmad, md...
TRANSCRIPT
11/19/2018
1
Glenoid OCD In Baseball
Christopher S. Ahmad, MDHead Team Physician, New York YankeesHead Team Physician, New York City Football ClubChief, Sports Medicine ServiceVice Chair of Clinical ResearchProfessor, Clinical Orthopaedic SurgeryColumbia University Medical Center
Disclosure1. Basic Science Support
a. Arthrexb. Smith-Nephew
2. Consultant a. Arthrex
3. Royaltiesa. Arthrexb. Lead Player Publishing
4. Board Member1. Baseball Health Network2. Sports Science Institute of America
Case
• 22M pro position player (bats R/throws R)
• R shoulder pain
• Mechanical symptoms
11/19/2018
2
Glenoid OCD
Osteochronditis Dissecans (OCD)
• Med Femoral Condyle
• Capitellum
• Talus
4
Capitellar OCD
What is OCD?
• Focal osteonecrosis with subchondral separation
• Pain, mechanical sx, flexion contracture
• Treatment depends on degree of separation and size of lesion
Capitellar OCD
Why ?
Ischemia
Repetitive microtrauma
• Immature capitellarepiphysis supplied by one or two vessels
• End artery supply
11/19/2018
3
Capitellar OCD
High prevalence
• Male throwers
• Female gymnasts
Capitellar OCD
Stage 1: non-displaced
Treat non-operatively
Capitellar OCD
• Stage 2: partially separated
• In situ fixation - low healing rate
• Debridement/drilling
11/19/2018
4
Capitellar OCD
• Stage 3: fully displaced
• Loose body removal
• Debridement/drilling
11
Glenohumeral Forces
Glenoid OCD
Glenohumeral Forces
Compressive Force
• 480N Shoulder
• 270N Elbow
• Scapular mechanics
• Throwing mechanics
11/19/2018
5
Case
• 22M pro position player (bats R/throws R)
• R shoulder pain
• Mechanical symptoms
Glenoid OCD
Glenoid OCD
11/19/2018
6
Glenoid OCDLabral Repair
CASE 2
17
• 19 yo RHD M
• Collegiate shortstop
• Right shoulder pain x 6 months
• No trauma
• Denies mech symptoms
• Failed rest PT, NSAIDs, injection
18
Physical Examination
• Pain with posterior load and shift
11/19/2018
7
Imaging
19
20
Glenoid OCD
21
11/19/2018
8
Glenoid OCD22
23
Week 0 – 6: Immediate active ROM without resistance
Week 6 – 16: Gentle Strengthening
Week 16: Throwing
Rehab
24
Literature Limited to Case reports
• Gogus A, Ozturk C. Osteochondritis dissecans of the glenoid cavity: a case report. Arch Orthop Trauma Surg. 2008 May;128(5):457-60. Epub 2008 Jan 4.
• Shanley DJ, Mulligan ME. Osteochondrosis dissecans of the glenoid. Skeletal Radiol. 1990;19(6):419-21.
• Nishinaka N, Tsutsui H, Mihara K, et al. A case report: painful throwing shoulder accompanied by a peculiar glenoid osteochondral injury. Shoulder Joint. 2002;26 (3):419-22.
• Rossi F, Dragoni S. Osteochondrosis dissecans of the shoulder glenoid fossa diagnosed in four throwing athletes. J Sports Med Phys Fitness. 2006 Mar;46 (1):111-5.
Outcomes
11/19/2018
9
25
Mark 21 yo collegiate outfielder
26
Anthony 21 right handed collegiate pitcher
• Mark and Anthony attend same college
• Mark and Anthony are twins
27
• Repetitive compressive forces
• Problem of bone not supporting cartilage
• More common in elbow than shoulder
• Arthroscopic treatment can be successful
Glenoid OCD Summary
11/19/2018
10
Thank You