Elbow extension deficit: a rare case of an osteochondral lesion on the radial head

An extension deficit of the elbow joint can be caused by various pathologies such as arthroliths, posttraumatic scar tissues, synovitis, capsular fibrosis of the anterior joint compartment, osteophytes in the area of the olecranon fossa or osteochondral lesions (OCL). Arthroscopic treatment is a good therapeutic option for theses pathologies.

We performed a standardized elbow arthroscopy in the case of an 18-year old male roofer presented with an extension deficit of 5° which had existed for several years. As physical activity, the patient performed boxing and BMX bicycle races. The patient had no history of any kind of previous elbow surgery, injury, inflammatory or metabolic rheumatic disease or haemophilia.

In the arthroscopic evaluation, we found a central OCL of the radial head with reactive capsular hypertrophy. The OCL was treated by microfracture with a chondropic. The clinical outcome was assessed by the Disability of Arm, Shoulder and Hand (DASH) score.

The restoration of the elbow joints full range of the motion (ROM) was achieved by arthroscopic treatment and adhesiolysis. In the follow-up examination one year after arthroscopy, the patient was asymptomatic and the elbow joint could be moved freely. Evaluation of the DASH score showed an improvement from a preoperative score of 7.0 to a postoperative score of 2.6.

Arthroscopy of the elbow is a good tool to treat OCL on the radial head. In cases of an extension deficit of the elbow, an OCL should be considered as a differential diagnosis.