Last reviewed:September 2019
Last updated:November  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • pain is exacerbated by activity
  • location of pain anteromedial aspect of the knee with the knee flexed to 90 degrees
  • location of pain lateral aspect of elbow
  • location of pain posteromedial aspect of dorsiflexed ankle or anterolateral aspect of plantar-flexed ankle
  • effusion present
  • locking of joint
  • catching of joint
  • decreased range of motion

Other diagnostic factors

  • knee involvement, age 10 to 15 years
  • elbow involvement, age 11 to 21 years
  • talus involvement, second to fourth decade
  • absence of history of trauma involving the knee or elbow
  • antalgic gait in osteochondritis dissecans involving the knee or talus
  • external rotation gait in osteochondritis dissecans involving the knee
  • relieving factors: non-steroidal anti-inflammatory drugs (NSAIDS), rest, ice, elevation
  • crepitus
  • Wilson's test
  • quadriceps atrophy

Risk factors

  • repetitive throwing/valgus stress
  • gymnastics/weight-bearing on upper extremity
  • ankle sprain/instability
  • competitive athletics
  • family history

Diagnostic investigations

1st investigations to order

  • knee x-rays
  • ankle x-rays
  • full-length lower extremity film
  • elbow x-rays
Full details

Investigations to consider

  • computed tomography (CT)
  • magnetic resonance imaging (MRI)
  • MR arthrogram
  • diagnostic arthroscopy
Full details

Treatment algorithm


Professor of Clinical Orthopedic Surgery

University of California, San Diego

Rady Children’s Hospital

San Diego



HGC has acted as a consultant to OrthoPediatrics, undertaken research for Allergan, and is an associate editor for Developmental Medicine and Child Neurology. HGC is an author of a number of references cited in this topic.

Dr Henry G. Chambers would like to gratefully acknowledge Dr James L. Carey, Dr Jon Divine, Dr Michael Nett, and Dr Cedric Ortiguera, the previous contributors to this topic. JLC is an author of a number of references cited in this topic. JD, MN, and CO declare that they have no competing interests.

Peer reviewersVIEW ALL

Orthopedic Surgeon

The Hughston Clinic PC




JEM declares that he has no competing interests.

Centre Lead and Professor of Sports and Exercise Medicine

Consultant Trauma and Orthopaedic Surgeon

Barts and The London School of Medicine and Dentistry

Institute for Health Sciences Education

Centre for Sports and Exercise Medicine

Queen Mary University of London

Mile End Hospital




NM declares that he has no competing interests.

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