What are the possible causes of Panner’s disease?
The exact causes of Panner’s disease have not yet been conclusively clarified. It is certain, however, that restricted blood flow to the bony parts of the elbow joint is a decisive factor in the development of the disease. In addition, it is assumed that the repeated occurrence of the smallest traumas (so-called micro-traumas) during stress and sporting activity lead to this reduced blood circulation.
In addition, non-traumatic blood circulation disorders are also thought to be a possible cause. Since Panner’s disease also occurs with conspicuous frequency in some families, it can be assumed that it has a hereditary component. The direct cause of this disease is a circulatory disorder of the growth plate in the area of the lower humerus or other bony structures of the elbow joint.
Panner’s disease can be diagnosed at different stages depending on the extent of bone necrosis. This fact has a decisive influence on both the possible treatment options and the prognosis. In addition, it can be observed that children and adolescents who practice sports that put a lot of strain on the elbow are more likely to develop Panner disease. An empirical correlation between these sports and bone necrosis of the elbow joint can therefore be assumed. The extent to which the risk of disease actually increases due to heavy strain has not yet been conclusively clarified.
How is Panner disease treated?
As a rule, the treatment of children suffering from Panner’s disease is primarily symptom-oriented. It is therefore important to alleviate the symptoms and above all the pain of the affected children.Various painkillers (analgesics) can be taken for this purpose. In addition, a temporary immobilization of the affected elbow joint and a sports leave (break) should be aimed at. Panner disease usually heals completely within one to three years. Surgical therapy is only rarely necessary for Panner disease.
Diagnosis of Panner’s disease
The diagnosis of Panner’s disease is performed in several steps. First, a detailed doctor-patient consultation (anamnesis) is usually conducted. During this conversation, the parents and the affected child are extensively interviewed about existing symptoms.
In this context, the localization of the pain is of enormous importance. In addition, living habits and situations in which increased pain occurs are also decisive. Subsequently, the attending physician conducts an extensive physical examination of the child.
In addition to the elbow joint, this examination also focuses on the neighboring joints of the hand and shoulder. The doctor inspects the affected arm, paying particular attention to redness, swelling and deviations from the normal joint axis. In addition, the attempt to trigger a pressure pain in the area of the elbow joint can be effective in many cases.
If the suspicion of the presence of Panner’s disease is confirmed during the physical examination, a further step should be the preparation of X-rays. As a rule, X-rays show a marked brightening in the area of the humerus forming the joint (capitulum humeri), indicating the presence of osteonecrosis. For a more precise diagnosis of Panner’s disease, a magnetic resonance tomogram (MRI of the elbow) can also be made.
With the help of this MRI image of the elbow, both the involvement of the bone metaphysis and the course of the disease can be assessed. In addition, important differential diagnoses (other possible diseases with similar symptoms should be excluded by the MRI) in the course of Panner’s disease diagnostics. The most common differential diagnosis to Panner’s disease is acute or chronic arthritis.
For differentiation, an extensive laboratory examination is usually performed. Furthermore, the symptoms of Panner’s disease may also indicate the presence of a disease called osteochondrosis dissecans. In older adolescents, additional attention should therefore be paid to demarcation (demarking) of a bone fragment on the joint surface.
In addition, the so-called avascular necrosis of the lower part of the upper arm (avascular necrosis of the trochlea humeri, Hegemann’s disease) is considered a frequent differential diagnosis to Panner’s disease. Besides X-rays, magnetic resonance imaging is a standard method for the diagnosis and follow-up of Panner’s disease. An MRI of the elbow is very well suited to determine the stage of bone necrosis and to treat it according to the classification. A favorable advantage of MRI is that this diagnostic method works without harmful radiation.
