Panner's disease

What is Panner's disease?¹

Panner's disease is an osteochondrosis of the capitellar ossification centre. The disease was first described in 1927 by the Danish radiologist Hans Jessen Panner, who observed radiographic changes in the capitulum of a young adult similar to those previously described in cases of osteochondrosis of the hip epiphysis (Calvé-Legg-Perthes disease).

The aetiology is unknown, but the condition has been associated with trauma to the elbow or repetitive valgus stress. Valgus stress in throwing athletes and increased axial load to the radiocapitellar joint in gymnasts can typically result in lateral compression injuries of the elbow. Lateral compression injuries can lead to several lesions, including Panner’s disease and osteochondritis dissecans of the humeral capitellum.²

Panner's disease symptoms (presentation)¹

Panner's disease is rare and most often occurs in boys under ten years of age, especially those who play throwing sports. Typical clinical symptoms include pain, swelling, stiffness and reduced range of movement in the elbow joint. Elbow pain and stiffness tends to be exacerbated by activity and relieved by rest.

Examination can reveal tenderness over the capitulum with effusion and synovial thickening of the elbow joint. Full elbow extension may not be possible and there may be some loss of pronation and supination.

Differential diagnosis¹

The main differential diagnosis is osteochondritis dissecans of the capitulum. Osteochondritis dissecans typically occurs in older children aged 10–20 years.

It is unclear whether Panner's disease and osteochondritis dissecans are two different conditions or a continuum of the same condition.

Osteochondritis dissecans is more often associated with the formation of intra-articular loose bodies, and with a longer disease course and the more frequent need for surgical intervention.

Investigations

• X-ray of the elbow:¹
  

  • Morphological changes can be seen on X-ray, along with contour deformity, collapse and increased density of the capitulum.

  • The subchondral vacuum phenomenon is a rare finding, but is very specific. The vacuum phenomenon represents subchondral gas formation, and is a sign of bone ischaemia. It may indicate aseptic necrosis.

• Cone beam CT is more sensitive to depict subtle changes than CT, in particular the vacuum phenomenon. MRI features of Panner’s disease include signal inhomogeneity in the ossification centre of the capitellum, bone marrow oedema and elbow effusion. As intraosseous gas is less conspicuous on MR, this technique is less suited for detecting the subchondral vacuum phenomenon.³

Panner's disease treatment and management

• Treatment of Panner's disease is usually conservative with rest and possibly immobilisation, and the condition typically resolves without sequelae.¹

• Reduction in use of the elbow can provide pain relief and allow elbow movement to return.⁴

• Non-steroidal anti-inflammatory drugs may be helpful.

• Physiotherapy can be used.

• A long arm splint or cast may be needed for 3-4 weeks if there is significant pain, swelling and local tenderness.⁴

Prognosis⁴

Natural history of the disease means that there is usually resolution in 1-2 years. There is usually complete resolution of symptoms but, in some, there may be a persistent loss of elbow extension. Symptoms may resolve before the radiology returns to normal.