A 31-year-old, right hand dominant female presented to our orthopaedic clinic, complaining of a continuous dull aching pain around right shoulder, of six months duration, which had been gradual in onset, which radiated to the ipsilateral arm, including the elbow and up to the wrist. Pain was aggravated by movements. There was an associated swelling over the right suprascapular region. She had first noticed the swelling accidentally, following a trivial injury. The swelling produced fullness over the supra scapular region. It gradually progressed in size over the duration of next six months and caused pseudo winging of the right scapula.The right scapula was found at a slightly higher level than the left, with fullness over the superomedial angle. A non tender, cystic mass was felt over the supero medial angle of the right scapula. There was no associated regional lymph node enlargement or neurovascular deficit.An anterio posterior view of the right shoulder joint failed to properly show the tumour mass [Table/ Fig-1]. A standard Y view [Table/ Fig-1] of the scapula clearly demonstrated the tumour as arising from the ventral aspect of the supreo medial border of the scapula. Ultrasound showed presence of a bursa (exostoses bursata) near the swelling. MRI showed the extent of the tumour over the superior angle of scapula [Table/ Fig-2]. A diagnosis of ventral osteochondroma of the superomedial angle of the scapula was made and she was offered surgical excision [Table/ Fig-3]. The surgery was primarily performed for cosmetic reasons.Procedure was performed under general anaesthesia with the patient in prone position. The shoulder was rotated internally, thereby lifting the medial border of the scapula away from the thoracic cage. An incision was made along the medial and superior border of the scapula (parascapular incision). A muscle splitting approach (of the trapezius and rhomboid) was used to reach the bone. No transverse cut was made in any muscle, to ensure a better, prompt post operative recovery without any functional loss.A cauliflower shaped mass with flattening of the ventral surface, which faced the chest wall, was encountered. A pedunculated, irregular mass [Table/ Fig-3] which was about 2x1x1 inches in dimension, caused erosion of the third and fourth ribs. A bursa surrounding the lesion, containing about 100 ml of straw coloured fluid, was noticed, along with two loose bodies. The mass along with its bursa was excised [Table/ Fig-4]. Following excision, erosion of the third and fourth ribs was evident, which corresponded to the flattened region of the tumour.Macroscopically, it was a pearly white, nodular, hard mass, with its cut surface revealing spongy bone with a lobulated cartilaginous cap that was lost over the flattened region of the tumour. Microscopic examination revealed a neoplasm which was composed of bony trabeculae in which mostly fatty tissue and bone marrow intervened.The arm was immobilized by putting it in an arm pouch for three weeks, during which period only pendulum exercises were...

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