Clinical Reasoning in the Face of Uncertainty: Conservative Physical Therapy Management of a Teenage Athlete Diagnosed With a Proximal Humeral Non-Ossifying Fibroma

Abstract

Background and Purpose: There have been few published studies regarding the treatment of patients with non-ossifying fibromas (NOFs), either conservatively or operatively. The purpose of this case report is to discuss the clinical presentation and conservative management of a teenage athlete diagnosed with a proximal humerus NOF. Case Description:The subject was a 13-year-old male middle school student with a diagnosis of left shoulder pain over the prior year preventing him from participating in sports activities. The combination of radiological findings revealing a NOF and a thorough physical examination allowed for the development of a physical therapy plan of care to address impairments and functional limitations. The subject was seen for eight visits where a combination of manual therapy techniques, neural mobilizations, and therapeutic exercises were administered to the cervical and upper quarter regions. The subject's progress was tracked by measuring pain-free shoulder active range of motion (AROM) and monitoring changes using the Numerical Pain Rating Scale (NRPS) values throughout sessions.Outcomes: After four sessions, AROM shoulder flexion and abduction increased from 123º and 119º to 160º and 180º respectively, and worst NRPS decreased from 9/10 to 3/10. Upon discharge after the eighth visit, the subject's DASH improved from 11.66 to 2.5. The subject remained pain free at an eight month follow up and returned to activity. Discussion: Thorough assessment of both neuromechanical sensitivity and musculoskeletal impairments may provide for the utilization of conservative treatment options for individuals with symptomatic NOFs.

An unusually aggressive multiple non-ossifying fibroma of the distal tibia and fibula: A case report

“…Very few published studies focused on the treatment of patients with NOFs, either conservatively or operatively ( Reynolds et al, 2018 ). The widely accepted attitude towards asymptomatic NOFs is a “wait and see” philosophy ( Bowers et al, 2013 ; Glockenberg et al, 1997 ).…”

“…Even though NOFs can be found in most long bones, their commonest locations are about the knee joint, most commonly at the distal femoral metaphysis, followed by the distal tibial metaphysis ( Hetts et al, 2007 ; Glockenberg et al, 1997 ; Reynolds et al, 2018 ). The mandible is another classic location mostly reported in several case reports ( Bowers et al, 2013 ; Khandaitkar et al, 2023 ).…”

“…Although most of the authors agree that asymptomatic NOFs don't require any further actions, the management of painful and large aggressive lesions is less consensual ranging from simple observation to various surgical techniques ( Reynolds et al, 2018 ).…”