Osteoid osteoma of the distal thumb phalanx: a case report

Osteoid Osteoma of the Hand: Surgical Treatment versus CT-Guided Percutaneous Radiofrequency Thermal Ablation

(1) Background: Osteoid osteoma (OO) is one of the most common benign bone tumors. This type of osteogenic tumor is generally characterized by a well-defined lytic area with a vascularized central nidus surrounded by sclerosis and bone thickening. The wrist and hand bones are infrequent sites for osteoid osteoma: only 10% of the cases arise in these areas. Standard treatments are surgical excision and radio-frequency ablation (RFA), both with advantages and disadvantages. This study aimed to compare the two techniques to prove if RFA could be a potential alternative to surgery in the treatment of OO of the hand. (2) Methods: Patients treated for OO of the hand between January 2011 and December 2020 were evaluated and data was collected regarding the lesions' characteristics and the treatment outcome. Each patient was followed up for 24 months and VAS pain (Visual Analogue Scale), DASH (Disability of the Arm, Shoulder and Hand), and PRWE (Patient-Related Wrist Evaluation) scores were collected. (3) Results: A total of 27 patients were included in the study: 19 surgical and 8 RFA. Both treatments showed a significant improvement in pain and functionality. Surgery was associated with a higher complication rate (stiffness and pain), while RFA was associated with a higher recurrence rate (2/8 patients). RFA allowed for a speedier return to work. (4) Conclusions: We believe that osteoid osteoma treatment with RFA in the hand should be an available alternative to surgery as it allows rapid pain relief and a swift return to work. Surgery should be reserved for cases of diagnostic uncertainty or periosteal localization.

Osteoid Osteoma of the Distal Phalanx: A Rare Condition

Osteoid osteoma of the distal phalanges in the hand is rare and difficult to diagnose. We report a case of a 37-year-old Caucasian female patient who presented with a mass on the distal phalanx of the index finger. The patient was suffering from intermittent nocturnal pain for more than 18 months along with thickening, localized swelling, and clubbing of the distal phalanx of the right index finger. Radiographs revealed a lytic lesion of the distal phalanx of the right index finger with surrounding sclerosis. An MRI showed an intramedullary lesion with infiltration of the bone marrow, cortex, and surrounding tissue with focal sclerosis and elements of enhancements. A presumptive diagnosis of osteoid osteoma was made and surgical removal of the lesion by curettage and bone grafting was the treatment of choice. The curetted specimen was sent to pathology and the diagnosis of osteoid osteoma was confirmed. The patient was asymptomatic at six months postoperatively. Osteoid osteoma should be included in every differential diagnosis for patients presenting with atypical features of the distal phalanx of the hand.

Phalangeal Osteoid Osteoma of Thumb

Osteoid osteomas are typically benign osteoblastic bone tumors. Patients often present in their twenties with progressively increasing pain that is worse at night and relieved with nonsteroidal anti-inflammatory drugs. These lesions rarely occur in the hand or wrist; however, when those are involved, the proximal phalanx is the most common location and the index finger is the most commonly affected digit. Lesions affecting the distal phalanges are least likely to occur and the thumb is least likely to be affected. Osteoid osteomas of the distal phalanges can cause great diagnostic challenges. They often present with atypical radiographic and physical examination findings. Although rare, osteoid osteomas of the distal phalanx can be a major cause of digit enlargement and pain. In a patient with a painful and/or swollen digit, the diagnosis should be considered.

Unusual localization and presentation of osteoid osteoma mimicking juvenile spondyloarthritis: a case report

Background

Osteoid osteoma is a painful benign skeletal tumour of unknown aetiology. Most often it occurs in the long bones of extremities and responds well to nonsteroidal anti-inflammatory medications. However, unusual localization and atypical presentation of this tumour might present a diagnostic challenge, especially if symptoms mimic that indicative of juvenile spondyloarthritis.

Case presentation

A misdiagnosed ten-and-a-half-year-old girl with osteoid osteoma involving the distal phalanx of a little finger is presented. Her initial symptoms were pain and swelling of the little finger resembling dactylitis, while various imaging modalities showed signs of tenosynovitis, indicating a possible development of juvenile spondyloarthritis. Several trials of different non-steroid anti-inflammatory drugs gave no satisfactory results and ultrasound guided triamcinolone-hexacetonide injection provided only a short relief. Finally, almost three years after initial presentation, persistent clinical symptoms warranted repeated imaging that raised suspicion of an osteoid osteoma. Directed treatment with surgical intervention led to almost immediate and complete resolution of her symptoms.

Conclusions

Osteoid osteoma should be suspected in case of a tender swelling of a digit in children and adolescents, regardless of initial imaging findings and clinical presentation. Early diagnosis and treatment of this benign condition can have a substantial impact on quality of life of patients and their families and protect them from many unnecessary diagnostic procedures and treatment.

Electronic supplementary material

The online version of this article (10.1186/s12891-018-2383-1) contains supplementary material, which is available to authorized users.

Proximal Phalanx Osteoid Osteoma: A Case Report and Literature Review

Osteoid osteoma is a rare clinical entity often mistaken for osteomyelitis, enchondroma, osteochondroma and other bony pathologies. Cardinal features include localized swelling and nocturnal pain often relieved by nonsteroidal antiinflammatory drugs. Definitive treatment requires surgical removal of the lesion by curettage or en bloc excision. The following case report details the diagnosis and management of a recurrent case of osteoid osteoma in a long finger proximal phalanx. Included with this case report is a literature review of osteoid osteomas on the hand and the anatomic distribution of 289 cases published in the last 30 years.

Osteoid Osteoma of Distal Phalanx of Middle Finger-A Diagnostic Dilemma

Osteoid Osteoma is benign bone forming tumor which commonly occurs in long bones of lower limb. Presence of these rare tumors in the distal phalanx of the digits of the hand is considered a rare phenomenon. In hand, they usually present as chronic pain, swelling, nail enlargement and increase in size of digit. Diagnosis is challenging with clinical examination and usual imaging modalities and often confused with glomus tumor, enchondroma, infection, trauma and rheumatic disease. Surgical excision of the tumor, if present in hand, is the treatment of choice that aids in coming to the exact diagnosis too. The aim of the paper is to report yet another uncommon case of osteoid osteoma of distal phalanx of middle finger mimicking glomus tumor.

Osteoid osteoma of the thumb: a case report

Osteoid osteoma is a rare occurrence in the hand, and only a small percentage affects the thumb and distal phalanges. An 18-year-old right-hand-dominant man presented to our office with an approximately 1-year history of left thumb pain without any history of trauma. He had seen several doctors previously and undergone multiple diagnostic tests with no definitive diagnosis. Plain radiographs and computed tomography at our institution were consistent with the diagnosis of osteoid osteoma. The patient was treated with surgical excision of the lesion without bone grafting. The diagnosis of osteoid osteoma was confirmed by pathology. At 6 months follow-up, the patient showed complete resolution of pain and full restoration of hand function. This case demonstrates that osteoid osteoma should not be forgotten as a differential diagnosis in patients with finger pain, especially in individuals who have not yet or just recently have reached skeletal maturity.

Radiofrequency ablation of osteoid osteoma in atypical locations: a case series

BACKGROUND

Osteoid osteoma has a nidus surrounded by sclerotic bone with a size usually less than 20 mm. Its diagnosis is made on typical presentation of nocturnal pain and imaging findings. Excision of the niduses, which are often small and difficult to precisely identify, sometimes may result in resection of surrounding normal bone. Minimally invasive percutaneous treatments have been used to try to minimize resection of normal bone. Although minimally invasive radiofrequency ablation generally relieves pain, its ability to relieve pain is less well known in locations other than lower extremity long bones.

QUESTIONS/PURPOSES

We determined the pain relief and complication rates after radiofrequency ablation of osteoid osteomas presenting in atypical locations and followed patients to assess possible recurrence or late complications.

PATIENTS AND METHODS

We retrospectively reviewed 21 patients with osteoid osteomas in unusual locations (eg, hip, radioulnar joint, and proximal phalanx) in whom we used radiofrequency ablation. Postoperative activities were not restricted for any of the patients. We assessed the time for patients to become symptom free, their activity status, and possible recurrence or complications. The minimum clinical followup was 12 months (mean, 27.8 months; range, 12-37 months).

RESULTS

All patients became symptom free within 24 hours to 1 week. During followup, none of the patients experienced recurrence or any major complications.

CONCLUSIONS

Radiofrequency ablation for osteoid osteomas in unusual locations reliably relieves pain with few complications and recurrences at short-term followup.

LEVEL OF EVIDENCE

Level IV, case series. See Guidelines for Authors for a complete description of level of evidence.