Panner’s disease is a bone necrosis of the elbow. The disease mainly manifests in childhood and adolescence.
What is Panner’s disease?
Panner’s disease is an aseptic bone necrosis that occurs at the elbow joint. The disease primarily affects children and adolescents. Thus, Panner’s disease occurs particularly in children between the ages of 6
six and ten years of age. In contrast, bone necrosis is rarely seen in adults. The male sex is significantly more frequently affected by the orthopedic disease than the female sex. At the capitulum humeri, the outer roll of the upper arm, an area develops where bone tissue has died off. Physicians also call this process osteonecrosis. Usually, Panner’s disease occurs on the right arm because it is the dominant limb. It is not uncommon for the right arm to also be subject to increased stress due to sports activities. Panner’s disease must be distinguished from osteochondritis dissecans, which is also a circulatory disorder of the outer humerus. Again, children who are active in sports are often affected. However, the circulatory disorder is more extensive in Panner’s disease. However, the prognosis is considered more favorable than the course of osteochondritis dissecans. The name Panner’s disease is derived from the radiologist Hans Jessen Panner (1871-1930) of Denmark.
Causes
What causes Panner’s disease has not been precisely determined to this day. Circulatory disturbances at the growth plate at the lower humerus or at other bone structures of the elbow are responsible for the bone necrosis. Various medical experts assume that regularly occurring microtrauma, which is caused by sports activities or other physical stress, is the trigger for the development of the disease and results in reduced blood circulation. These are sports that lead to stress on the elbow joint, such as javelin throwing or tennis. Likewise, circulatory problems that are not traumatic can play a role. Panner’s disease, for example, shows up conspicuously often in some families. Medical experts therefore also suspect hereditary factors.
Symptoms, complaints, and signs
Panner’s disease can be divided into three different stages:
- In the first stage, increasing compression of the affected bone begins.
- In the second stage, the decay of the diseased bone area begins.
- The third stage involves the destruction of the elbow bone. In the process, the adjacent growth plate is also affected.
- The fourth stage also bears the name regeneration stage, because in its course the growth plate recovers.
The symptoms that occur in the context 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 pain at the elbow, which increases as the disease progresses, which is especially the case with loads on the elbow. At rest, the pain subsides significantly. Without treatment, however, pain-free periods rarely occur. Other symptoms of Panner’s disease include swelling of the elbow and increasing stiffness of the joint. In some cases, the stiffening lasts for several months. In addition, there is usually limited range of motion. Also possible are grinding and rubbing noises at the elbow joint.
Diagnosis and course of the disease
Several steps are required to diagnose Panner’s disease. For example, the patient’s medical history is taken first. In this process, the physician asks the child and his or her parents how long the symptoms have been present and at what site. The child’s lifestyle habits are also important. Furthermore, a thorough physical examination of the child takes place. The doctor checks not only the elbow, but also the neighboring joints. Deviations from the joint axis as well as swellings and redness are important. An important indication of Panner’s disease is the triggering of a pressure pain at the elbow. If the suspicion of Panner’s disease is confirmed, X-ray examinations are performed. On the X-ray, osteonecrosis is usually visible in the form of a distinct lightening at the capitulum humeri. Not infrequently, a magnetic resonance imaging (MRI) is also performed.Panner’s disease is a chronic disease and can last up to three years. In principle, however, the prognosis is considered favorable. After several months, the disease often heals spontaneously. However, an unfavorable course of the disease may occur, making surgery necessary.
Complications
Panner’s disease causes various complaints, especially in children, which occur in the bones and thus significantly reduce the patient’s quality of life. Primarily, there is compaction and further also destruction of the bones. Especially the bones at the elbow are affected, so that there is severe pain in these regions. Especially in children, Panner’s disease can lead to significant restrictions in development and growth. Swelling and stiffening of the joints also occur. It is not uncommon for the stiffening to be permanent, resulting in considerable restrictions in the daily life of the affected person. Various noises are also heard at the elbow joint. The affected person must avoid high loads and strenuous movements to prevent further complications. In most cases, Panner’s disease can be limited and treated with the help of medication. Furthermore, surgical interventions may also be necessary to permanently resolve the complaint. However, complications do not occur and the patient’s life expectancy is usually not reduced by this disease.
When should you go to the doctor?
Children and adolescents in particular belong to the risk group of Panner’s disease. Therefore, parents who notice abnormalities and changes in the area of the elbow in their offspring should be particularly vigilant as a matter of priority. If the complaints persist over a longer period of time or if there are signs of an increase in symptoms, medical clarification is recommended. A visit to the doctor is already necessary as soon as the child repeatedly expresses discomfort or indisposition. If there are disturbances of blood circulation, an unpleasant feeling in the elbow or changes in the skeletal system, a doctor is needed. Thickening of the bones is characteristic of the disease and must be presented to a doctor. If movement restrictions or other disturbances of mobility occur, a clarification of the complaints is advisable. If the physical performance or general resilience decreases, this is to be understood as a warning sign of the organism. A visit to the doctor is necessary as soon as school or everyday obligations can no longer be fulfilled. An unusual noise during a movement, pain or stiffness of the joint should be examined and treated. If the affected person shows abnormalities in mood or behavior, this may also be interpreted as a sign of impaired health. A physician should be consulted if there is persistent emotional discomfort and there is no relief of the mental condition within a few weeks.
Treatment and therapy
For the treatment of Panner’s disease, it is often sufficient to temporarily refrain from heavier stress. In addition, the symptoms of the disease are treated. This primarily includes relieving pain by giving the child special pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDs). It is also possible to apply ointment dressings with an anti-inflammatory such as diclofenac. If it is a persistent case, the affected arm can also be immobilized with a splint for a few weeks. As a rule, the pain and swelling then subside spontaneously. In rare cases, an unfavorable development of Panner’s disease is also possible. Then the disease is treated by surgery. Surgical methods include removal of free joint bodies or pridie drilling. Sometimes an arthroscopy of the elbow is sufficient. In this case, the focus of inflammation can be treated with the aid of an endoscope. If there is detachment of the dead bone area, the surgeon removes it, which can be done during arthroscopy.
Outlook and prognosis
Panner’s disease generally offers a relatively good prognosis. The disease occasionally heals spontaneously. Spontaneous cure is also possible after a history of several years. Permanent symptoms are usually not expected with a positive course.If the course is unfavorable, surgical intervention such as arthroscopy of the elbow is necessary to prevent permanent damage to the elbow. Until recovery, a number of symptoms also occur, which impair the quality of life. In particular, the severe pain and restricted movement are problematic. Often, those affected cannot continue to practice their profession and are also restricted in everyday tasks. In the long term, these complaints can also develop into mental illnesses, which worsen the prognosis. In principle, however, Panner’s disease offers the prospect of a complete recovery. Life expectancy is not limited by the condition. The exact prognosis is determined by the responsible specialist with regard to the symptom picture and the course of the disease to date. Patients who have Panner’s disease in the context of other bone necrosis require an individualized prognosis that also includes the symptoms of concomitant diseases.
Prevention
Effective preventive measures against Panner disease are not known. Thus, the triggering cause could not be precisely determined so far.
Follow-up
Patients with Panner’s disease have the opportunity to perform various aftercare measures. In their own interest, they take full advantage of the potential for aftercare to ensure that the elbow discomfort heals completely and that the arm remains resilient and usable in the long term. Patients with a favorable course of the disease follow all medical instructions and reduce the stresses acting on the arm for a certain period of time. This applies, for example, to sports activities or strenuous movements in everyday life. After healing, those affected continue to take care of the diseased arm for a while. In more difficult cases, it is necessary for patients with Panner’s disease to immobilize the arm for a few weeks. Follow-up care then includes slowly re-acclimating the elbow to loads and gradually increasing the flexibility of the tendons again. 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. In such cases, surgical intervention may be necessary to prevent the arm from sustaining long-term damage from the disease. After surgery, aftercare measures are particularly significant. For example, patients take care to support wound healing through hygiene and careful scar care and not to put excessive stress on the arm.
Here’s what you can do yourself
Panner’s disease usually does not require extensive treatment measures. Patients should avoid heavier loads and, if necessary, immobilize the diseased arm. The prescribed ointments can be supplemented with various alternative remedies in consultation with the physician. Soothing ointments as well as cooling compresses, massages or methods from Chinese medicine have proven effective. If these measures are followed, Panner’s disease should subside within a few days to a week. Further medical help is normally not necessary. If the symptoms become more severe, the doctor must be consulted. It is possible that the pain syndrome is based on another condition, which must first be diagnosed. The patient can also create a diary of complaints and note down all the symptoms as well as the time and severity of their occurrence. This makes it easier for the doctor to make a diagnosis 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 recuperation apply. In addition, close consultation with the responsible physician should be maintained during the first few days so that any complications can be responded to quickly.
