Osteoid Osteoma of the Thumb: A Case Report

Abstract

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.

Imaging features of osteoid osteoma of the phalanges

“…Half of the cases were located in the proximal phalanx. Based on our review of the literature, the vast majority of cases of phalangeal OO occur in the hand and mainly affect the distal phalanx [3,10,13,18,20,21,23,24]. In our series, the nidus was most commonly located in the medulla and one case was subperiosteal.…”

“…Themistocleous and co-workers reported 9 phalangeal OOs in their series of 39 cases of upper limb OO, but they only described the imaging appearances of 2 of these lesions [17]. Table 3 highlights imaging findings that have been described in previously published cases of phalangeal OO [3,10,12,13,[17][18][19][20][21][22][23][24].…”

“…There are only sporadic case reports that refer to MR appearances of phalangeal OO and no previously reported series [3,20,[22][23][24]. Since MRI is now often the modality of choice for imaging hand lesions, after initial radiographic examination, establishing common imaging features of phalangeal OO may help to prevent misdiagnosis and confusion with other lesions affecting the digits.…”

A Phalangeal Osteoid Osteoma: A Case Report

“…2 Pain, worse at night and relieved by oral non-steroidal anti-inflammatory medications is the most typical symptom. 3 Since osteoid osteoma is a vascular tumor, substances that cause vasodilatation, such as alcohol, may precipitate acute pain.…”

“…3 Radiograph of the affected long bone shows a lucent area less than 1.5 cm in diameter called nidus surrounded by a zone of reactive bone formation in the cortical or medullary canal. 4 Osteoid osteomas of the hand are uncommon, most commonly seen in the phalanges and often result in atypical clinical and radiologic findings.…”