Bone necrosis of the elbow is called Panner’s disease. The disease manifests itself mainly in childhood and adolescence.
What is Panner’s disease?
Panner ‘s disease is aseptic bone necrosis that occurs at the elbow joint. Children and young people are primarily affected by the disease. Panner’s disease occurs particularly in children between the ages of 6 and 10 years. Bone necrosis, on the other hand, is rarely seen in adults. See growtheology for Comprehensive Guide to Urinary Tract Infection.
The male gender is significantly more frequently affected by the orthopedic disease than the female gender. At the capitulum humeri, the outer part of the upper arm, a zone develops whose bone tissue has died off. Doctors also call this process osteonecrosis. Panner’s disease usually occurs in the right arm because it acts as the dominant limb. It is not uncommon for the right arm to be under increased strain from sporting activities.
A distinction must be made between Panner’s disease and osteochondritis dissecans, which is also a circulatory disorder in the outer upper arm roll. Here, too, children who are physically active are often affected. However, the circulatory disorder in Panner’s disease expands more.
However, the prognosis is estimated to be more favorable than the course of osteochondritis dissecans. The term Morbus Panner goes back to the radiologist Hans Jessen Panner (1871-1930) from Denmark.
What causes Panner’s disease has not been precisely determined to this day. Circulatory disorders in the growth plate in the lower humerus area or in other bone structures of the elbow are responsible for the bone necrosis.
Various physicians assume that regular microtraumas caused by sports activities or other physical stress are the trigger for the development of the disease and result in reduced blood circulation.
These are sports that put strain on the elbow joint, such as javelin throwing or tennis. Circulatory disorders that are not traumatic can also play a role. Panner’s disease shows up conspicuously often in some families. Doctors therefore also suspect hereditary factors.
Symptoms, Ailments & Signs
Panner’s disease can be divided into three different stages:
- In the first stage, there is increasing compression of the affected bone.
- In the second stage, the diseased bone area starts to decompose.
- The third stage involves destruction of the elbow bone. The adjacent growth plate is also affected.
- The fourth stage is also called the regeneration stage because the growth plate recovers during this stage.
The symptoms that occur as part of Panner’s disease are considered non-specific because they can also be assigned to other diseases of the elbow joint. As a rule, the affected children suffer from elbow pain, which intensifies as the disease progresses, which is particularly the case when the elbow is subjected to stress. At rest, the pain subsides significantly. Without treatment, however, pain-free sections are rare.
Other symptoms of Panner’s disease include swelling in the elbow and increasing stiffness in the joint. In some cases, the stiffening lasts several months. In addition, there are usually restricted movements. Crunching and rubbing noises at the elbow joint are also possible.
Diagnosis & course of disease
There are several steps involved in diagnosing Panner’s disease. First, the patient’s medical history is taken. The doctor asks the child and its parents how long and where the symptoms occur. The child’s lifestyle is also important. A thorough physical examination of the child is also carried out. The doctor not only checks the elbow, but also the neighboring joints.
Deviations from the joint axis as well as swelling and redness are important. An important indication of Panner’s disease is the triggering of pressure pain on the elbow. If the suspicion of Panner’s disease is confirmed, X-ray examinations are carried out. Osteonecrosis can usually be seen on the x-ray in the form of a clear brightening of the capitulum humeri. Magnetic resonance imaging (MRI) is also often performed.
Panner’s disease is a chronic disease and can last up to three years. In principle, however, the prognosis is considered favourable. The disease often heals spontaneously after several months. However, an unfavorable course of the disease can also occur, which makes an operation necessary.
Panner’s disease causes various complaints, especially in children, which occur on the bones and thus significantly reduce the patient’s quality of life. First and foremost, there is a compression and further destruction of the bones. The bones in the elbow are particularly affected, resulting in severe pain in these regions.
Especially in children, Panner’s disease can lead to significant limitations in development and growth. It also causes swelling and stiffening of the joints. It is not uncommon for the stiffening to also occur permanently, so that there are considerable restrictions in the everyday life of the person concerned. There are also various noises at the elbow joint.
The affected person must avoid high loads and strenuous movements to avoid further complications. In most cases, Panner’s disease can be controlled and treated with medication. Surgical interventions may also be necessary to permanently resolve the complaint. However, there are no complications and the patient’s life expectancy is usually not reduced by this disease.
When should you go to the doctor?
The risk group for Panner’s disease includes children and adolescents in particular. Parents who notice abnormalities and changes in the elbow area in their offspring should therefore be particularly vigilant. If the symptoms persist for a long time or if there are signs of an increase in symptoms, we recommend that you seek medical advice. A visit to the doctor is already necessary as soon as the child repeatedly expresses discomfort or discomfort. If there are problems with the circulation, an uncomfortable feeling in the elbow or changes in the skeletal system, a doctor is needed. Bone thickening is characteristic of the condition and needs to be presented to a doctor.
If movement restrictions or other mobility disorders occur, it is advisable to clarify the complaints. If physical performance or general resilience decreases, this is to be understood as a warning from the organism. A doctor’s visit is necessary as soon as school or everyday obligations can no longer be fulfilled. An unusual noise development during a movement, pain or a stiffening of the joint must be examined and treated.
If the person affected shows abnormalities in mood or behavior, this can also be interpreted as a sign of health impairment. A doctor should be consulted if emotional problems persist and the mental state does not improve within a few weeks.
Treatment & Therapy
For the treatment of Panner’s disease, it is often sufficient to temporarily avoid heavy physical activity. In addition, the symptoms of the disease are treated. This primarily includes relieving the pain by giving the child special painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs). It is also possible to apply ointment bandages with an antiphlogistic such as diclofenac.
If the case is persistent, the affected arm can also be immobilized with a splint for a few weeks. The pain and swelling then usually subside spontaneously. In rare cases, an unfavorable development of Panner’s disease is also possible. Then the disease is treated by surgery. The surgical methods to be considered are the removal of free joint bodies or Pridie holes.
Sometimes an arthroscopy of the elbow is sufficient. The focus of inflammation can be treated with the help of an endoscope. If there is detachment of the dead bone area, the surgeon removes it, which can be done with arthroscopy.
Outlook & Forecast
Panner’s disease generally offers a relatively good prognosis. The disease occasionally heals spontaneously. Spontaneous recovery is possible even after a history of several years. As a rule, lasting symptoms are not to be expected if the course is positive.
In the event of an unfavorable course, a surgical intervention such as arthroscopy of the elbow is necessary in order to avoid permanent damage to the elbow. Until recovery, a number of symptoms also appear that impair the quality of life. The severe pain and restricted mobility are particularly problematic. Those affected can often no longer practice their profession and are also restricted in everyday tasks. In the long term, these symptoms can also develop into mental illnesses, which worsen the prognosis.
In principle, however, Panner’s disease offers the prospect of a full recovery. Life expectancy is not limited by the condition. The responsible specialist doctor makes the exact prognosis with regard to the symptoms and the previous course of the disease. Patients who suffer from Panner’s disease in the context of other bone necrosis require an individual prognosis that also includes the symptoms of the accompanying diseases.
Effective preventive measures against Panner’s disease are not known. So far, the triggering cause could not be precisely determined.
Patients with Panner’s disease have the opportunity to carry out various follow-up measures. In their own interest, they exploit the potential for aftercare so that the complaints in the elbow heal completely and the arm remains resilient and operational in the long term. Patients with a favorable course of the disease observe all doctor’s instructions and for a certain period of time reduce the loads acting on the arm.
This applies, for example, to sporting activities or strenuous movements in everyday life. After healing, sufferers continue to rest the diseased arm for a while. In more difficult cases, it is necessary for patients with Panner’s disease to immobilize their arm for a few weeks. Follow-up care then includes gradually getting the elbow used to the strain again and gradually increasing the flexibility of the tendons again.
The patients undergo medical check-ups to ensure the long-term success of the therapy. In some cases, however, patients with Panner’s disease are affected by a more severe course. Surgery may then be necessary to prevent the arm from suffering long-term damage from the disease. After the operation, aftercare measures are particularly important. Patients take care to support wound healing through hygiene and careful scar care and not to put excessive strain on the arm.
You can do that yourself
Panner’s disease does not usually require extensive treatment measures. Patients should avoid heavy exertion and, if necessary, immobilize the affected arm. The prescribed ointments can be supplemented with various alternative means in consultation with the doctor. Soothing ointments and cooling pads, massages or methods from Chinese medicine have proven effective. If these measures are followed, Panner’s disease should resolve within a few days to a week. Normally, further medical help is not required.
If the symptoms get worse, the doctor must be involved. It is possible that the pain syndrome is based on another condition that must first be diagnosed. The patient can also create a complaints diary and note down all symptoms as well as the time and severity of their occurrence. This makes it easier for the doctor to diagnose and also helps to find the right treatment methods.
In individual cases, Panner’s disease must be treated surgically. After such an operation, general measures such as rest and rest apply. In addition, the responsible doctor should be consulted closely in the first few days so that any complications can be reacted to quickly.