An Osteochondritis Dissecans Lesion of the Glenoid in an Adult: A Case Report.

Abstract

Osteochondritis dissecans (OCD), a rare lesion involving subchondral bone, is classically located in the femoral condyles as well as in the talar dome and capitellum. Although controversy exists concerning the etiology of OCD, inflammation, repeated microtrauma, bone ischemia, abnormal epiphyseal ossification, and genetic factors have been described as potential causes. OCD is most likely multifactorial in nature. Confusion exists in the literature because many authors use the terms “OCD,” “osteochondral defect,” and “focal cartilage defect” interchangeably, despite the fact that these are three distinctly different pathologies. It is critical to recognize that OCD lesions involve the subchondral bone, and if healing does not occur, there is potential for separation of the bone and overlying cartilage, resulting in a loose body. To the best of our knowledge, there have been few reports in the literature involving the glenoid1-5, and even fewer describing treatment of OCD in this location1,3. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. An eighteen-year-old right-hand-dominant baseball pitcher presented with a three-week history of pitching-related shoulder pain. He had also noticed decreased pitching velocity. He had been participating in physical therapy with the team trainer, but he had not had any improvement. Of note, the history included the diagnosis of Little League shoulder six years prior to evaluation. This had been treated with rest and a gradual return to play. He had been symptom-free until the current season. On physical examination, the patient demonstrated full active forward elevation and abduction. Rotator cuff strength testing was pain-free and symmetric to the contralateral side. Shoulder …