Early Differential Diagnosis by High Resolution Computed Tomography (HRCT) of Occupational Vibration-Induced Osteochondritis Dissecans of Elbow Joint

László Németh1, Ádám Mester2, Tibor Kákosy1, Mária Posgay1, and Kinga Karlinger2

1 National Institute of Occupational Health, József Fodor National Centre for Public Health, Budapest, Hungary
2 Department of Diagnostic Radiology and Oncotherapy, Semmelweis University Medical School, Budapest, Hungary

Corresponding author: László Németh M.D., Ph.D.
    National Institute of Occupational Health
    József Fodor National Centre for Public Health
    P.O. Box 22
    H-1450 Budapest, Hungary
    Telephone: (+36) 1-476-1160
    Fax number: (+36) 216-9907
    E-mail: nemethl@fjokk.hu

CEJOEM 2003, Vol.9. No.1.: 3–12

Key words:
Osteochondritis dissecans, osteoarthritis, elbow, hand-arm vibration syndrome

Abbreviations:
AVN     = avascular bone necrosis
HAVS   = hand-arm vibration syndrome
HRCT   = high resolution computed tomography
MRI      = magnetic resonance imaging
OA        = osteoarthritis
OD        = osteochondritis dissecans
PR         = plain film radiography
WOEV  = workers occupationally exposed to vibration

Abstract:
The aim of the study was to differentiate the specific radio-morphological patterns of vibration-induced osteochondritis dissecans (OD) and avascular bone necrosis of elbow (AVN) as occupational diseases from osteoarthritis (OA) of elbow by means of plain film radiography (PR) and high resolution tomography (HRCT). Twenty workers occupationally exposed to vibration (WOEV) c omplaining of painful elbow joint were investigated and the findings were compared to those of 20 non-exposed control subjects match-paired by age. OD of elbow could be proved by high resolution of imaging of HRCT, even if PR seemed negative. Necrotic subchondral bone demarcation first appeared as a radiolucent area (Stage I). Later the dissection bed was demarcated from the healthy bone by a relatively thin sclerotic reactive rim (Stage II). The dissected bone became sclerotic and demarcated from the bone bed by a larger sclerotic layer. The dissected particle or the few fragments sometimes scattered as calcareous loosed bodies in the joint cavity (Stage III). All these stages of the process could be well depicted by HRCT. In the WOEV group, a typical finding of OD was a normal joint cavity around the dissection sometimes with a few tiny marginal osteophytes, in contrast to osteoarthritis (OA) that occurred with extensive irregular subchondral sclerosis, and irregular narrowed joint cavity and larger marginal osteophytes in the control group. It is worth mentioning that in Hungary, OD has been recognised as a consequence of occupational exposure to vibration i.e., as an occupational disease, while osteoarthritis has not. HRCT finding together with documented vibration exposure of more than five years is the proper way to reliably verify OD of the elbow as an occupational disease. Cessation of exposure can help to prevent progression. In the group of WOEW, higher incidence of OD can be detected by HRCT than by PR.

Received: 25 August 2003
Accepted: 14 November 2003
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