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Kumar S, Jain VK, Prabhakar R. Melorheostosis of upper limb: A report of four rare cases. J Clin Orthop Trauma 2020; 11:321-323. [PMID: 32099304 PMCID: PMC7026615 DOI: 10.1016/j.jcot.2019.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 11/16/2022] Open
Abstract
Melorheostosis is a rare chronic bone disease, etiology of which remains unclear. It mostly affects lower limbs and clinical features vary in each case. Radiographs show characteristic "candle wax pattern" of hyperostosis. Herein we report four cases of upper limb affection with their symptoms, radiographic findings and treatment. First case presented with gradually progressive swelling in forearm which was initially misdiagnosed as filariasis. Plain radiograph eventually demonstrated melorheostosis of ulna. Second patient had deformity of index finger and pain in hand which was diagnosed on radiograph of hand. Third case presented with progressive flexion deformity of ring and little finger. Fourth patient had ulnar involvement which was an incidental diagnosis. First three patients were managed with bisphosphonates following which there was significant improvement in pain and fourth case was kept on follow-up as he was asymptomatic.
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Willacy RA, Clemmons JA, Oyetan O, Khaleel IM, Salib CG, Wilson RH. A rare case of melorheostosis of the hand in a pediatric patient. J Orthop 2019; 16:451-453. [PMID: 31528051 DOI: 10.1016/j.jor.2019.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/23/2019] [Indexed: 11/19/2022] Open
Abstract
Melorheostosis, a rare mesenchymal dysplasia of bone, generally affects about 0.001% of people globally with about 400 cases total being reported. Melorheostosis of the hand, especially in the pediatric population, has been seldom reported. Previous studies have investigated potential genetic mutations associated with melorheostosis however, questions still remain regarding effective treatment options for this disease. This case report describes a unique case of pediatric melorheostosis of the hand and further clarifies current theories on melorheostosis with regards to pathogenesis, best treatment practices, and future research.
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Affiliation(s)
- Rolanda A Willacy
- Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA
- Department of Orthopedic Surgery and Rehabilitation, Howard University Hospital, 2401 Georgia Ave NW Suite 4300, Washington, DC, 20060, USA
- Children's National Health System, Division of Orthopedic Surgery and Sports Medicine, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - James A Clemmons
- Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA
| | - Ore Oyetan
- Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA
| | - Ibrahim M Khaleel
- Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA
| | - Christopher G Salib
- Department of Orthopedic Surgery and Rehabilitation, Howard University Hospital, 2401 Georgia Ave NW Suite 4300, Washington, DC, 20060, USA
| | - Robert H Wilson
- Howard University College of Medicine, 520 W St NW, Washington, DC, 20059, USA
- Department of Orthopedic Surgery and Rehabilitation, Howard University Hospital, 2401 Georgia Ave NW Suite 4300, Washington, DC, 20060, USA
- Children's National Health System, Division of Orthopedic Surgery and Sports Medicine, 111 Michigan Ave NW, Washington, DC, 20010, USA
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Fernandes CH, Nakachima LR, Santos JBG, Fernandes ARC, Jannini MG, Faloppa F. Melorheostosis of the thumb and trapezium bone. Hand (N Y) 2011; 6:80-4. [PMID: 22379444 PMCID: PMC3041889 DOI: 10.1007/s11552-010-9291-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Melorheostosis of the hand is rare. We report a 28-year-old woman with persistent pain associated with a slowly growing mass on the dorsum of the right thumb. The radiographs, computed tomography, and magnetic resonance imaging were used to examine characteristic of melorheostosis involving the trapezium bone, first metacarpal, and proximal phalange. The lesions underwent a surgical debulking of the hyperostotic cortex and a cortical fenestration.
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Affiliation(s)
- Carlos H. Fernandes
- Hand Surgery Group, Department of Orthopedic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo Brazil ,Rua Borges Lagoa 1065 Cj 68/69, São Paulo, São Paulo CEP 04038-032 Brazil
| | - Luis R. Nakachima
- Hand Surgery Group, Department of Orthopedic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo Brazil
| | - João B. G. Santos
- Hand Surgery Group, Department of Orthopedic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo Brazil
| | - Artur R. C. Fernandes
- Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo Brazil ,Department of Radiology, Diagnósticos América (DASA), São Paulo, São Paulo Brazil
| | - Marcelo G. Jannini
- Department of Radiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo Brazil ,Department of Radiology, Diagnósticos América (DASA), São Paulo, São Paulo Brazil
| | - Flávio Faloppa
- Hand Surgery Group, Department of Orthopedic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo Brazil
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Murano T, Egarian M. Case report: Emergency department diagnosis of melorheostosis in the upper extremity: a rare disease with an unusual presentation. J Emerg Med 2010; 43:645-7. [PMID: 20576391 DOI: 10.1016/j.jemermed.2010.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 02/10/2010] [Accepted: 05/02/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Melorheostosis is a rare disease that affects fewer than 1:1,000,000 persons worldwide and most typically affects the lower extremities. It is a non-hereditary disease that may be debilitating due to chronic pain, contractures of the soft tissue, and even shortening of the affected limbs. Although it most commonly occurs in the lower extremities, melorheostosis has been reported in various locations throughout the body. OBJECTIVE This case report describes a patient who presented to the Emergency Department (ED) with this rare disease in an uncommonly affected bone. CASE REPORT The patient was a 21-year-old man who presented to the ED with pain in his left upper extremity that he attributed to playing sports 3 days before presentation. Plain films revealed periosteal hyperostosis typical of melorheostosis in several of his carpals, metacarpals, and phalanges, as well as the humerus and ulna. The patient was discharged with orthopedic follow-up and pain medication. CONCLUSION Melorheostosis is a rare disease that has characteristic radiographic findings likened to the appearance of melting wax flowing down the side of a candle. In certain cases, the disease can be debilitating and may require chronic pain management and even operative intervention. If this diagnosis is made in the ED, the emergency physician should provide adequate pain management and refer the patient to an orthopedic specialist for a work-up to rule out other sclerosing bone dysplasias.
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Affiliation(s)
- Tiffany Murano
- Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey 07101-1709, USA
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Jain VK, Arya RK, Bharadwaj M, Kumar S. Melorheostosis: clinicopathological features, diagnosis, and management. Orthopedics 2009; 32:512. [PMID: 19634844 DOI: 10.3928/01477447-20090527-20] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Melorheostosis is a rare sclerosing bone disease. This article describes the histological patterns and radiographic characteristics commonly associated with melorheostosis. A paucity of compiled data about the disease in the literature necessitated a comprehensive review to further define its management.
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Affiliation(s)
- Vijay Kumar Jain
- Department of Orthopedics, Dr Ram Manohar Lohia Hospital, New Delhi, India
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Non-malignant fibrosing tumors in the pediatric hand: a clinicopathologic case review. Hand (N Y) 2009; 4:2-11. [PMID: 19048350 PMCID: PMC2654948 DOI: 10.1007/s11552-008-9148-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 10/24/2008] [Indexed: 10/21/2022]
Abstract
Non-malignant fibrosing tumors in the pediatric hand or juvenile fibromatoses are clinically challenging because of their relatively infrequent occurrence and because of the variety of names associated with these diseases. We conducted a review of a personal case series of pediatric patients with these tumors and discuss here the more common histologic types and clinical characteristics of the disease spectrum in the context of the available published literature. All histologic samples were reviewed by a single pathologist. Infantile myofibromatosis, fibrous hamartoma of infancy, juvenile aponeurotic fibromatosis, palmar fibromatosis (Dupuytren's type), infantile digital fibromatosis (Reye's tumor), fibroma of the tendon sheath, and melorheostosis represent the encountered lesions.
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Hesse E, Brand J, Bastian L, Krettek C, Meller R. [(Over-)flowing bone: the rare disease of melorheostosis: clinical presentation and therapeutic concepts demonstrated by three cases]. Unfallchirurg 2008; 111:553-8. [PMID: 18210039 DOI: 10.1007/s00113-007-1368-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Melorheostosis is a rare, benign, and sporadically occurring osteosclerosis of unknown cause. The onset of the disease is usually in early adulthood. Melorheostosis affects both genders, develops progressively, and is usually limited to one side of the human body. The sclerosis originates predominantly from the cortices of the long bones of the lower limbs and rarely the upper limbs. Frequently, the sclerosis involves the soft tissue surrounding the affected bones which may cause limitations in the range of motion, contractures, deformities, and pain. Melorheostosis is usually diagnosed by radiograms. Pain relief and restoration of the full range of motion are the primary goals of the therapeutic approach. A good outcome cannot always be achieved and a recurrence of the disease happens very often.
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Affiliation(s)
- E Hesse
- Department of Orthopaedics and Cell Biology, Yale University School of Medicine, 333 Cedar Street, SHM-IE 55, P.O. Box 208044, New Haven, CT 06520-8044, USA.
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James SLJ, Davies AM. Surface lesions of the bones of the hand. Eur Radiol 2005; 16:108-23. [PMID: 15834724 DOI: 10.1007/s00330-005-2715-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2004] [Revised: 01/31/2005] [Accepted: 02/08/2005] [Indexed: 10/25/2022]
Abstract
Surface lesions involving the bones of the hand are uncommon. This pictorial review illustrates the spectrum of conditions including benign primary bone tumours, malignant primary bone tumours and non-neoplastic disorders. The review focuses on the radiographic appearances of these lesions and other techniques such as CT and MR imaging that may suggest a specific diagnosis.
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Affiliation(s)
- S L J James
- Department of Radiology, Royal Orthopaedic Hospital, Birmingham, B31 2AP, UK.
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Mariaud-Schmidt RP, Bitar WE, Pérez-Lamero F, Barros-Nuñez P. Melorheostosis: unusual presentation in a girl. Clin Imaging 2002; 26:58-62. [PMID: 11814756 DOI: 10.1016/s0899-7071(01)00351-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Melorheostosis is a rare bone disease of unknown etiology. It is characterized by tense and erythematous skin, contractures and shortening of the affected limbs. Radiographs reveal hyperostosis in long bones resembling melting wax, and spotty or patchy endostic deposits in short bones. An 11-year-old girl showed, since birth, contractural deformities in the right hand without bone abnormalities. At the age of 12 months, she complained of soft tissue tightness in the right buttock. At 3 years, limitation of flexion and extension of the right knee was evident. Radiographs revealed findings typical of melorheostosis.
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Affiliation(s)
- Rocío P Mariaud-Schmidt
- División de Genética, CIBO-IMSS, Sierra Mojada 800, Col. Independencia, CP 44340, AP 1-3838 Guadalajara, Jalisco, Mexico
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