Hand osteoid osteoma: evaluation of diagnosis and treatment

Osteoid Osteoma, a Diagnostic Problem: A Series of Atypical and Mimicking Presentations and Review of the Recent Literature

Osteoid osteoma (OO) is a common benign bone tumour, usually affecting young people. Typically, it is localised to the diaphyses or metaphyses of long bones. The classical manifestation includes distinctive night pain, almost always present, responding well to non-steroidal anti-inflammatory drugs, sometimes accompanied by complaints due to physical activity, and a typical picture on additional tests. A characteristic of osteoid osteoma is the presence of a nidus, usually visible on imaging tests. The nidus generally presents as a single, round lytic lesion up to 1 cm in diameter, surrounded by an area of reactive ossification. However, OO is a multifaceted neoplasm, and its diagnosis can cause numerous difficulties. OO can mimic multiple diseases and vice versa, which often leads to a prolonged diagnostic and therapeutic path and associated complications. There are few literature reviews about the differentiation and diagnostic difficulties of osteoid osteoma. Very effective therapies for this tumour are known, such as ablation and resection. Enhanced detection of osteoid osteoma could result in faster diagnosis and less suffering for the patient, avoidance of complications, and reduced costs of incorrect and prolonged treatment.

The Diagnostic Challenge of Osteoid Osteoma in the Bones of the Hand—A Case Series

Osteoid osteoma (OO) is a benign bone tumor that rarely occurs in the bones of the hand. Due to the comparatively non-specific symptoms when occurring in the hand, OO is often misdiagnosed at first presentation, posing a diagnostic challenge. In the present case study, six cases of phalangeal and carpal OO, treated surgically at our department between 2006 and 2020, were retrospectively reviewed. We compared all cases regarding demographic data, clinical presentation, imaging findings, time to diagnosis, surgical treatment, and clinical outcome in follow-up examinations. When OO occurs in the bones of the hand, it can lead to swelling and deformities, such as enlargement of the affected bone and nail hypertrophy. Initial misdiagnoses such as primary bone tumors other than OO, tendinitis, osteomyelitis, or arthritis are common. Most of the presented cases showed a prolonged time until diagnosis, whereby the primarily performed imaging modality was often not sensitive. CT proved to be the most sensitive sectional imaging modality for diagnosing OO. With adequate surgical treatment, complications and recurrence are rare.

Osteoid osteoma in the bones of the hand: a systematic literature review

INTRODUCTION

Osteoid osteoma (OO) is a common benign bone tumor. OO is observed most frequently in the long bones, especially in the tibia and femur. When occurring in the bones of the hand, OO can be a diagnostic and therapeutic challenge. The aim of this study was to provide a systematic review of occurrence, symptoms, diagnosis and treatment options regarding OO in hand bones.

MATERIALS AND METHODS

We performed a systematic review of the literature. All studies from the online databases PubMed and SpringerLink, which reported cases of osteoid osteomas in the bones of the hand, were included. By summarizing the literature, we evaluated the localization within the hand as well as diagnostic and therapeutic options.

RESULTS

We included 133 studies reporting 401 cases. OO was mostly common in the phalanges. The diagnosis was mostly made by CT (computed tomography) scan. Most of the OO were treated surgically by open curettage or en bloc resection.

CONCLUSIONS

Osteoid osteomas in the bones of the hand are rare and a delayed diagnosis is common. In cases of pain combined with particular symptoms such as nail hypertrophy and swelling OO should be considered. Of the most used imaging methods, CT scans have the highest sensitivity.

Osteoid Osteoma: An Updated Review of Epidemiology, Pathogenesis, Clinical Presentation, Radiological Features, and Treatment Option

Osteoid osteoma, the third most common benign bone tumor, usually occurs in the cortex of long bones. It consists of a radiolucent nidus surrounded by reactive osteosclerosis. Generally, osteoid osteoma affects young males. Nocturnal pain that eases with salicylates or nonsteroidal anti-inflammatory drugs (NSAID) is the typical clinical presentation. Sometimes, it remains undiagnosed for a long time. Plain radiography and computed tomography are usually sufficient for the diagnosis of osteoid osteoma. Initial treatment includes salicylates and NSAID because the tumor often regresses spontaneously over 2-6 years. Surgical treatment is indicated in case of unresponsive pain to medical therapy, no tolerance of prolonged NSAID therapy due to side effects, and no willingness to activity limitations. Nowadays, minimally invasive techniques have replaced open surgery and are considered the gold standard of surgical treatment. Although cryoablation seems superior in terms of the nerve damage and immunotherapy effect, radiofrequency ablation is the preferred technique.

Osteoid osteoma of the wrist misdiagnosed as de Quervain's tenosynovitis due to normal X-ray at the first visit: A case report

INTRODUCTION

Osteoid osteomas are benign bone tumors that can occur in various bones throughout the body but are mainly found in the long bones.

PRESENTATION OF THE CASE

We report the case of a patient who had been treated for more than three years for a case of de Quervain's tenosynovitis due to tenderness in the first compartment of the right wrist joint. An X-ray on his first visit to a clinic was normal, but it was eventually discovered that he had an osteoid osteoma of the wrist.

DISCUSSION

The age of onset and gender proclivity of each disease should be considered. An X-ray should be taken in cases such as this, even to diagnose tendonitis. When any symptom, such as pain, has lingered for a long time and resisted treatment, we must reconsider the diagnosis. In patients with a low risk of tendonitis, it is essential to consider the possibility of other diseases if there is no improvement after treatment. As this patient's tumor was missed on the initial X-ray, it grew to a mature case of osteoid osteoma in three years.

CONCLUSION

We experienced a very educational case of osteoid osteoma of the wrist misdiagnosed as de Quervain's tenosynovitis.