Panner’s Disease

Panner’s disease is a rare orthopedic condition that affects the developing elbow joint, specifically targeting the capitellum, the rounded end of the humerus (upper arm bone) that articulates with the radius (one of the forearm bones). Named after Danish radiologist Hans Jessen Panner, who first described it in 1927, this condition primarily affects boys between the ages of 5 and 10 during the phase of rapid bone growth. Panner’s disease is categorized as an osteochondrosis, which refers to a group of disorders that result from temporary loss of blood supply to a growing bone, leading to bone necrosis (death of bone tissue) (1).

Although the disease is self-limiting, meaning it resolves on its own over time, it can cause considerable discomfort and temporarily affect joint function. Early recognition and conservative management are essential to prevent complications and ensure a full recovery.

Symptoms

The symptoms of Panner’s disease usually develop gradually and are localized to the affected elbow (1). Common clinical features include

• Pain in the Elbow: This is the most prominent symptom, often exacerbated by activity and relieved by rest. Pain is usually located on the lateral (outer) side of the elbow.
• Swelling and Tenderness: The elbow may appear swollen and tender to touch, particularly over the lateral condyle.
• Stiffness and Limited Range of Motion: Children may experience difficulty in fully extending or flexing the elbow due to discomfort or joint stiffness.
• Mechanical Symptoms: In some cases, clicking, locking, or a catching sensation might be reported, although these are more commonly associated with other conditions like osteochondritis dissecans (OCD).
• Weakness or Reluctance to Use the Arm: Especially in active children, there may be a noticeable decrease in strength or willingness to use the affected arm during sports or play.

Causes

Panner’s disease is believed to be caused by avascular necrosis (temporary loss of blood supply) to the developing ossification center of the capitellum (2). The exact etiology is not fully understood, but several contributing factors have been proposed

• Repetitive Microtrauma: Frequent stress to the elbow from activities such as throwing, gymnastics, or racket sports can disrupt the blood flow to the growing bone.
• Growth-Related Vulnerability: During the early years, bones are more vulnerable to vascular compromise due to the ongoing development and ossification processes.
• Mechanical Overload: Excessive compressive forces on the lateral elbow, especially during valgus loading (elbow bent outward while throwing), can contribute to bone stress and degeneration.

Risk Factors

Several factors may predispose a child to develop Panner’s disease

• Age and Gender: Most commonly occurs in boys aged 5 to 10, possibly due to higher levels of physical activity and differences in skeletal development.
• Sports Participation: Young athletes engaged in repetitive arm motions, such as baseball pitchers, gymnasts, or tennis players, are at increased risk.
• Dominant Arm Usage: The condition typically affects the dominant arm due to greater use and stress.
• Rapid Growth Spurts: As the bones grow rapidly, the vascular supply may temporarily fail to keep up, making the developing bone more susceptible to necrosis.

Diagnosis

Diagnosis of Panner’s disease is typically based on a combination of clinical history, physical examination, and imaging studies (2).

• Medical History and Physical Exam: The clinician will ask about the child’s activity level, symptom onset, and pain triggers. A physical exam will evaluate tenderness, swelling, and range of motion.
• X-rays: This is the primary imaging modality. Early radiographs may show irregularity or fragmentation of the capitellum, with areas of sclerosis (increased bone density) and flattening.
• MRI: In uncertain cases or to rule out similar conditions like osteochondritis dissecans, an MRI can provide detailed images of the bone and cartilage, revealing bone edema or vascular insufficiency.
• Differential Diagnosis: It’s essential to differentiate Panner’s disease from OCD, which affects older children and may lead to permanent cartilage damage if untreated.

Treatment Options

The treatment for Panner’s disease is conservative and aims to relieve symptoms and allow the bone to heal naturally (3).

• Rest and Activity Modification: Avoiding activities that stress the elbow, such as throwing or weight-bearing, is crucial for healing. Rest may be needed for several weeks.
• Immobilization: In some cases, a sling or splint may be used temporarily to minimize movement and provide comfort.
• Physical Therapy: Gentle range-of-motion exercises are introduced after the initial pain subsides to prevent stiffness and restore normal joint function.
• Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.
• Follow-Up: Regular monitoring with clinical assessments and periodic X-rays ensures the bone is healing properly and prevents misdiagnosis of more serious conditions.

Most children recover fully within 6 to 12 months without long-term complications.

Living With or Prevention

Living With Panner’s Disease

Though temporary, Panner’s disease can impact a child’s daily activities, especially those involving the upper extremities. Parents and caregivers should encourage compliance with rest and therapy to ensure a smooth recovery. Emotional support is also vital, especially for young athletes who may feel frustrated by activity restrictions.

Prevention

While it may not be entirely preventable due to its developmental nature, certain measures can reduce the risk:

• Limiting Overuse: Avoid repetitive stress on the elbows by regulating the intensity and duration of sports participation, particularly in young children (3).
• Cross-Training and Rest Days: Encourage a variety of physical activities and include rest periods to prevent localized overuse injuries.
• Proper Technique and Equipment: Ensure that children are taught proper throwing or swinging techniques and use age-appropriate sports gear.
• Regular Check-Ups: For children involved in high-risk sports, periodic evaluations by a pediatrician or sports medicine specialist can help detect early signs of stress injuries.

References

1. Chavda S, Abeid KA, Alhajri KK, Hasan NHA. Osteochondrosis of Humeral Capitellum, Diagnosis and Treatment – A Case Report. J Orthop Case Rep. 2021 Jul;11(7):74-77. doi: 10.13107/jocr.2021.v11.i07.2324. PMID: 34790609; PMCID: PMC8576768.
2. Claessen FM, Louwerens JK, Doornberg JN, van Dijk CN, Eygendaal D, van den Bekerom MP. Panner’s disease: literature review and treatment recommendations. J Child Orthop. 2015 Feb;9(1):9-17. doi: 10.1007/s11832-015-0635-2. Epub 2015 Feb 7. PMID: 25663360; PMCID: PMC4340849.
3. van den Bekerom MP, de Klerk HH, van Riet R. Update in diagnosis, treatment, and prevention of osteochondritis dissecans of the capitellum. Shoulder Elbow. 2024 Mar;16(1 Suppl):24-34. doi: 10.1177/17585732231190011. Epub 2023 Jul 25. PMID: 38425733; PMCID: PMC10901169.