Occult osteoid osteoma presenting as shoulder pain: a case report.

Chiropractor, Private Practice, Summit, IL.
Journal of chiropractic medicine 09/2012; 11(3):207-14. DOI: 10.1016/j.jcm.2012.06.002
Source: PubMed

ABSTRACT The purpose of this case study is to describe the clinical course and treatment of a patient with recalcitrant shoulder pain and osteoid osteoma.
A 28-year-old man had a 2-year history of progressively worsening shoulder and midscapular pain.
Before chiropractic consultation, he had been evaluated and treated by his family physician, an orthopedic surgeon, a neurologist, and a pain management specialist. The patient underwent arthroscopy with examination under anesthesia and debridement of a posterior labral tear and cervical spine epidural injections, but neither procedure relieved his symptoms. After seeking chiropractic care, presenting symptoms were reproducible during direct clinical examination; and an initial working diagnosis of secondary right glenohumeral impingement syndrome with coexisting scapulothoracic dyskinesis was made. After 2 weeks of chiropractic rehabilitation, therapy was stopped because of no change in symptoms. The patient was referred for orthopedic consultation. Another series of plain films were ordered, and follow-up magnetic resonance imaging revealed an osseous mass at the medial aspect of the proximal metadiaphyseal region of the right humerus, with a diagnosis of osteoid osteoma. The patient underwent radiofrequency thermoablation of the tumor nidus, which was unsuccessful and resulted in open surgical resection. Resolution of symptoms with minimal pain was reported 3 weeks after the surgery. Four years later, the patient's shoulder remains asymptomatic.
This case demonstrates that osteoid osteoma may present with clinical features that mimic common functional musculoskeletal conditions of the shoulder. Information from the patient history and diagnostic imaging are important for diagnosis and appropriate management.

1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We present a case report highlighting the unusual location and atypical imaging characteristics of an osteoid osteoma in the juxta-articular region of the femoral head, and treatment of the condition with radiofrequency ablation. This treatment option is low in both risk and morbidity and is therefore the best option in lesions that are difficult to access surgically because of the risks involved. A 40-year-old Indian man from West Bengal presented to our facility with a history of progressively severe left hip pain of insidious onset, requiring analgesics. Imaging with plain radiographs, computed tomography and magnetic resonance imaging confirmed findings of osteoid osteoma in a subarticular location in the femoral head, although imaging features were atypical due to the intra-articular subchondral location. Radiofrequency ablation is a newer treatment modality for osteoid osteoma that, being minimally invasive, offers comparable results to surgery with a significantly lower morbidity. To the best of our knowledge, treatment of osteoid osteoma in the foveal region of the femoral head with radiofrequency ablation has not been reported to date. We wish to highlight the successful outcome in our index case using this technique.
    Journal of Medical Case Reports 03/2011; 5:115. DOI:10.1186/1752-1947-5-115
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Osteoid osteoma is a benign skeletal neoplasm composed of osteoid and woven bone that rarely exceeds 1.5 cm in greatest dimension. The lesion is most commonly located in the cortex of long bones where it is associated with dense, fusiform, reactive sclerosis. Less often, it may be cancellous, where reactive osteosclerosis is usually less intense and may be distant from the lesion. Cancellous lesions are frequently intraarticular (most often in the hip) and may be associated with synovitis and joint effusion. Rarely, osteoid osteomas occur in a subperiosteal location. Patients are usually young, and there is a strong male predominance. Pain is the most common symptom. Radiographs of patients with cortical osteoid osteoma are often diagnostic. Intraarticular lesions, however, may be subtle, and scintigraphy may be required to locate the lesion for subsequent computed tomography (CT). CT is useful to identify and precisely locate the lesion and to provide guidance for percutaneous localization or treatment.
    Radiographics 08/1991; 11(4):671-96. DOI:10.1148/radiographics.11.4.1887121 · 2.73 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study presents a case of a posttraumatic subacute osteomyelitis in a child with leg pain. A 10-year-old female gymnast with leg pain presented to a chiropractic clinic after having been treated over the previous year for a leg fracture. The patient had leg pain associated with prolonged use of her right leg, restlessness at night, and tenderness over the right tibia. The history did not suggest a mechanical cause of the patient's pain. All available radiographs were reviewed by the chiropractor; a diffuse lytic lesion with bone thickening and sclerosis was clearly visible in the area of the patient's chief complaint, representing a Brodie abscess. The doctor of chiropractic sent the patient back to the hospital. She was treated first with oral antibiotics, which were not successful. She underwent surgery and recovered well. Subacute osteomyelitis may have a diagnostic delay; thus, it is possible for a chiropractor to see this condition in the office. A good case history, examination, and radiographs are important for the diagnosis and to make a proper referral.
    Journal of chiropractic medicine 01/2008; 6(4):159-62. DOI:10.1016/j.jcme.2007.08.006