Occult osteoid osteoma presenting as shoulder pain: a case report

Abstract

Objective: The purpose of this case study is to describe the clinical course and treatment of a patient with recalcitrant shoulder pain and osteoid osteoma. Clinical Features: A 28-year-old man had a 2-year history of progressively worsening shoulder and midscapular pain. Intervention and Outcome: 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. Conclusion: 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.

Osteoid Osteoma of the Proximal Humerus: A Case Report and Literature Review

“…A total of 10 cases of proximal humerus osteoid osteoma were found in the literature with the exclusion of cases without a comprehensive history [ Table 1 ]. [ 3 , 11 – 18 ] In most of these cases, the diagnosis was initially missed and the patients were treated for other conditions because it can mimic other shoulder pathologies such as shoulder impingement, rotator cuff tears, calcific tendinitis, glenohumeral instability, C5-C6 radiculopathy, bicipital tendinitis, fractures, and infection.…”

Osteoid Osteoma of the Coracoid Process: Case Report With Literature Review

“…However, if plain radiographs reveal reactive bone formation and osteosclerosis, CT is further indicated since it provides high sensitivity and precision, which are the key features for future treatment. In cases when the underlying tumor cannot be detected on plain radiographs, MRI is usually performed since it provides excellent visualization of both the tumor and the accompanying bone marrow edema 14,30 . A great number of methods have been used in the treatment of OO including a wide spectrum of methods ranging from seldom used conservative approach with NSAIDs over minimally invasive percutaneous treatments which are currently considered the treatment of choice to open surgical methods.…”

Osteoid Osteoma in an Adult Wheelchair Basketball Player Mimicking Musculoskeletal Shoulder Pain: Red Flag or a Red Herring?

“…The size of OO is usually small, measuring 1.0-2.0 cm in width, and it is classified into different subtypes based on its localisation within the cortical, spongious, or sub-periosteal zone [19,21]. Radiographically, OO is characterised by a central nucleus called "nidus", a highly vascularised and innervated structure surrounded by a sclerotic bone area [19,21,[26][27][28], in which the presence of several prostaglandins determines chronic reactive processes and increased intra-cortical pressure [29,30], causing the typical OOrelated pain. This latter is usually well localised; it worsens during the night, and it is relieved only by the intake of non-steroidal anti-inflammatory drugs (NSAIDs) [19], while swelling is the second most referred to symptom [31].…”

“…Conversely, even if the magnetic resonance imaging (MRI) is more sensitive than CT in detecting reactive changes of soft tissues, the bone marrow oedema seen with MRI may conceal typical characteristics of the OO, such as the "nidus"; therefore, the latter is less useful than CT for diagnostic purposes [19,21]. Clinically, manifestation patterns of OO can be misdiagnosed as a common MSD, challenging the HPs' diagnosis process [28,[32][33][34][35]. For instance, when OO is located in the shoulder, it may mimic an impingement syndrome and SP [28,[32][33][34].…”

“…Clinically, manifestation patterns of OO can be misdiagnosed as a common MSD, challenging the HPs' diagnosis process [28,[32][33][34][35]. For instance, when OO is located in the shoulder, it may mimic an impingement syndrome and SP [28,[32][33][34].…”