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Burile GC, Ramteke SU. Conservative Rehabilitation Program for Osteochondroma of the Scapula: A Case Report. Cureus 2024; 16:e58293. [PMID: 38752046 PMCID: PMC11094527 DOI: 10.7759/cureus.58293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
One of the most frequent cartilage-capped outgrowths that develop beneath the periosteum due to cartilage ossification is osteochondroma. The second decade of life is noted as the most prevalent age of presentation. This case report looks at an uncommon osteochondroma presentation in a 20-year-old female with swelling along the right inferomedial border of the scapula. The patient presented with complaints of difficulty in daily activities and exhibited altered posture, decreased range of motion (ROM), muscle weakness, and altered shoulder function. The clinical assessment highlighted restricted shoulder and cervical ROM and muscle weakness in the trapezius, rhomboids, serratus anterior, and other surrounding muscles. Magnetic resonance imaging revealed an inferomedial bony outgrowth indicative of osteochondroma. A comprehensive physiotherapy intervention protocol for eight weeks was designed to alleviate pain, improve mobility, restore ROM, strengthen weakened muscles, correct posture, and enhance functions that were restricted. The protocol encompassed various techniques, such as muscle energy techniques (MET), proprioceptive neuromuscular facilitation (PNF), cold therapy, stretching, scapular mobilization, resistance exercises with TheraBand, postural correction exercises, ergonomic adjustments, scapular stabilization exercises, and 'J'-taping to aid in muscle activation and address rounded shoulder posture. Outcome measures for cervical and shoulder ROM and strength were measured to note the progression after rehabilitation. The case report emphasizes the importance of a tailored physiotherapy rehabilitation protocol in managing osteochondroma-related symptoms, showing the potential benefits of multifaceted interventions in alleviating pain, improving function, and boosting the quality of life for individuals with similar presentations.
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Affiliation(s)
- Ghanishtha C Burile
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swapnil U Ramteke
- Sports Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Ambade R, Mahakalkar C, Sharma Y, Singh R, Kanani K. A Huge Osteochondroma With Chest Wall Deformity Arising From the Ventral Scapula. Cureus 2024; 16:e58275. [PMID: 38752059 PMCID: PMC11094413 DOI: 10.7759/cureus.58275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/11/2024] [Indexed: 05/18/2024] Open
Abstract
Osteochondromas (OC), or exostoses, are developmental defects rather than true neoplasms. Misdirected physeal bone growths give rise to OC. It causes cartilage-capped bony extensions to emerge from the lateral outlines of endochondral bones. We discuss a case of OC in a 35-year-old female who presented with severe chest wall deformity and breathlessness due to compromised left lung function. CT scan showed a vast osteochondroma arising from the ventral surface of the scapula, which was palpable in the supra mammary region on the left side. The tumor mass was completely excised from the base of the stalk. Her breathlessness and compromised left lung function returned to normal in the post-op period. However, the chest deformity was corrected over two months. The article provides insights into the presentation in a patient with such a massive tumor due to its location. Surgical excision should be the treatment of choice for huge osteochondromas.
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Affiliation(s)
- Ratnakar Ambade
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chandrashekhar Mahakalkar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yashika Sharma
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rahul Singh
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kashyap Kanani
- Orthopaedics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Faur C, Abu-Awwad A, Patrascu JM, Abu-Awwad SA, Tudoran C. Superomedial Scapula Angle Osteochondroma with Winging in a Young Female Patient-Case Report and Literature Review. J Clin Med 2023; 12:5106. [PMID: 37568508 PMCID: PMC10419713 DOI: 10.3390/jcm12155106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/19/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background: Osteochondromas are the most common benign bone tumors, primarily found in long bones, while scapular osteochondromas are rare and account for less than 1% of all osteochondromas. (2) Methods: We present a case of a young female patient with a unique presentation of scapular osteochondroma. The patient exhibited superomedial scapula angle osteochondroma with winging, a rare manifestation of scapular osteochondroma. The patient had a slow-growing mass on the left scapula for several years. Physical examination revealed a visible deformity with significant winging of the scapula. Imaging studies demonstrated a large osteochondroma arising from the superomedial angle of the left scapula, with a bony stalk. (3) Results: Surgical excision was performed, and histopathological analysis confirmed the diagnosis of osteochondroma. Following the surgery, the patient experienced a significant improvement in scapular winging. A comprehensive literature review revealed only a limited number of reported cases of scapular osteochondroma with winging, underscoring the significance of this case report as a valuable addition to the existing literature. The diagnosis of scapular osteochondroma should be considered in the differential diagnosis of patients presenting with a scapular mass, particularly when associated with winging. Surgical excision is the recommended treatment, and complete excision is crucial to prevent recurrence. (4) Conclusions: This case report highlights a rare presentation of scapular osteochondroma with winging and emphasizes the importance of considering this diagnosis in patients with scapular masses accompanied by winging. The successful surgical intervention in our case resulted in significant improvement. Clinicians should be aware of this entity and consider prompt surgical intervention for complete excision, ensuring optimal patient outcomes and preventing recurrence. Further research and additional case reports are necessary to enhance our understanding of scapular osteochondroma and its varied clinical presentations. Furthermore, comprehensive studies involving larger patient cohorts are necessary to explore the full spectrum of clinical presentations of scapular osteochondromas. By documenting and analyzing a wider range of cases, including variations in tumor location, size, and associated symptoms, researchers can identify patterns and establish more accurate diagnostic criteria. This will facilitate early detection and appropriate management of scapular osteochondromas, ultimately improving patient outcomes.
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Affiliation(s)
- Cosmin Faur
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (C.F.); (J.-M.P.J.)
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu No. 156, 300723 Timisoara, Romania; (S.-A.A.-A.); (C.T.)
- Research Center University Professor Doctor Teodor Șora, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Ahmed Abu-Awwad
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (C.F.); (J.-M.P.J.)
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu No. 156, 300723 Timisoara, Romania; (S.-A.A.-A.); (C.T.)
- Research Center University Professor Doctor Teodor Șora, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Jenel-Marian Patrascu
- Department XV—Discipline of Orthopedics—Traumatology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania; (C.F.); (J.-M.P.J.)
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu No. 156, 300723 Timisoara, Romania; (S.-A.A.-A.); (C.T.)
- Research Center University Professor Doctor Teodor Șora, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Simona-Alina Abu-Awwad
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu No. 156, 300723 Timisoara, Romania; (S.-A.A.-A.); (C.T.)
- Department XII—Discipline of Obstetrics and Gynecology, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Cristina Tudoran
- “Pius Brinzeu” Emergency Clinical County Hospital, Bld Liviu Rebreanu No. 156, 300723 Timisoara, Romania; (S.-A.A.-A.); (C.T.)
- Discipline of Cardiology, Victor Babes University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
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Muacevic A, Adler JR. Osteochondroma of the Scapula: A Case Report and Literature Review. Cureus 2022; 14:e30558. [PMID: 36311482 PMCID: PMC9595258 DOI: 10.7759/cureus.30558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Osteochondromas are bone lesions composed of medullary and cartilaginous bone covered by a cap of hyaline cartilage. The presence of medullary and cortical bone with the continuity of the tumor is pathognomonic for osteochondroma and aid in establishing the diagnosis. We report a case of a two-year-old girl who presented to our clinic following her mother noticing a palpable, growing, and painful mass on her left scapula. There was no limitation in the range of motion. A clear-cut mass was seen on the dorsal aspect and palpated measuring around 2.5x3 cm. Surgical excision of the mass followed by histologic examination confirmed osteochondroma. Upon follow-up, the patient had no pain and had a full range of left shoulder motion without discomfort or pain. In conclusion, scapular exostoses are very rare and more so when they present dorsally. Symptomatic lesions can be managed effectively with surgical excision of exostosis.
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Fang ZW, Zhang HT, Li X, Guo YF, Yu SQ. Imaging features of reactive bursitis secondary to osteochondroma. Jpn J Radiol 2022; 40:712-721. [DOI: 10.1007/s11604-022-01255-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/12/2022] [Indexed: 11/30/2022]
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Abstract
Primary chest wall neoplasms are uncommon and comprise a heterogeneous group of lesions that may be challenging to classify and diagnose. These tumors may be primary or secondary, malignant or benign, and arise from cartilaginous/osseous structures or soft tissues. The role of magnetic resonance (MR) imaging in the evaluation of chest wall tumors continues to expand given its superior soft tissue contrast relative to computed tomography. MR imaging can facilitate differentiation of neoplasms from normal chest wall structures and other disease processes due to infection and inflammation, and can fully characterize abnormalities by demonstrating the various internal components of complex lesions. It is important that radiologists be able to identify key features of primary chest wall neoplasms on MR imaging to provide focused differential diagnoses and guide patient management.
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Chun DI, Cho JH, Choi IH, Yi Y, Kim JY, Kim JH, Won SH. Osteochondroma of ventral scapula associated with chest pain due to rib cage compression: A case report. Medicine (Baltimore) 2018; 97:e0510. [PMID: 29703017 PMCID: PMC5944560 DOI: 10.1097/md.0000000000010510] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE The scapula is relatively rare site for osteochondroma. Scapula osteochondroma is usually asymptomatic, however it may present with features such as pseudowinging, snapping scapula, bursa formation, chronic pain, and cosmetic deformities. To our best knowledge, this is the first report in the English literature about osteochondroma of ventral scapula associated with chest pain due to rib cage compression. PATIENT CONCERNS A 14-year-old boy was transferred to the orthopedic clinic from thoracic surgery department with a complaint of intermittent, dull, and diffuse aching pain around left chest wall and back from the past 2 months. The patient was previously diagnosed with multiple osteochondromas on another side; proximal tibia and distal femur. DIAGNOSIS A radiopaque mass like lesion was observed on the scapula in the posteroanterior view of the chest, and compression of chest wall was also seen. In chest computed tomography (CT), pedunculated outgrowing bony mass was noted in the anterior aspect of the left scapular wing, which showed the continuity of bony cortex and medulla. This bony mass showed the mass effect on the left chest wall, causing left thoracic cavity deformity by making it narrower than the right INTERVENTIONS:: Surgery was performed under general anesthesia. After the surgery, the arm was immobilized by putting it in an abductor pillow brace for 3 weeks, and during that period pendulum exercise was permitted. OUTCOMES The patient's symptoms resolved in the immediate postoperative period. At 1 year's follow-up, the patient was symptom free and there was no evidence of recurrence of the tumor. LESSONS We recommend that in case of patients who have a history of osteochondroma and complaint of chest pain, surgeons should become suspicious of the presence of osteochondroma of the ventral scapula. In this situation, we recommend chest radiography, pulmonary function test, and chest CT for early detection and treatment.
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Affiliation(s)
- Dong-il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Jae-ho Cho
- Department of Orthopaedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Sakju-ro, Chuncheon-si, Gangwon-do
| | - In Ho Choi
- Department of Pathology, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu
| | - Young Yi
- Department of Orthopaedic Surgery, Seoul Foot and Ankle Center, Inje University, Jeo-dong, Jung-gu
| | - Jun Yong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital Seoul, Daesagwan-ro, Yongsan-gu, Seoul, Korea
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Daesagwan-ro, Yongsan-gu, Seoul, Korea
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Solitary Osteochondroma of the Ventral Scapula Associated with Large Bursa Formation and Pseudowinging of the Scapula: A Case Report and Literature Review. Case Rep Orthop 2018; 2018:5145642. [PMID: 29666735 PMCID: PMC5832072 DOI: 10.1155/2018/5145642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/26/2017] [Indexed: 11/18/2022] Open
Abstract
Osteochondroma (OC) is the most common benign bone tumor and may occur on any bone in which endochondral ossification develops. Although scapular OC accounts for less than 5% of the cases of solitary OC, OC is the most common lesion among the tumors and tumor-like lesions of the scapula. OC that develops near the medial scapular border easily causes friction with the ribcage; hence, almost half the number of cases of OC associated with marked bursa formation develops in the ventral scapula. We report a case of a 27-year-old female with a painful OC of the ventral scapular surface associated with large bursa formation and pseudowinging of the scapula. After l2 years of follow-up with magnetic resonance imaging, we confirm that the accompanied bursa left at surgery disappears.
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9
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Tungdim PH, Singh II, Mukherjee S, Pertin T. Excision of Solitary Osteochondroma on the Ventral Aspect of Left Scapula Presenting as Pseudowinging in a 4-year-old Boy: A Rare Case Report. J Orthop Case Rep 2017. [PMID: 28630837 PMCID: PMC5458695 DOI: 10.13107/jocr.2250-0685.678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Osteochondroma is a benign bony lesion with cartilaginous cap occurring usually in long bones, but flat bones may also be involved, either isolated or as a part of a syndrome. Usually, they are asymptomatic, but appearance of symptoms such as mass effect may warrant surgical intervention, which is usually delayed till skeletal maturity. Case Report: A 4-year-old male child presented with swelling on ventral aspect of inferior angle of scapula associated with pain, pseudowinging of scapula, and snapping sound of the left shoulder on movement. Despite young age of the patient, the severity of the symptoms required immediate intervention. After preoperative workup and planning, the mass measuring 4 cm × 3 cm × 2.5 cm was resected completely, following which the patient was relieved of all the symptoms without any recurrence for the next 7-month follow-up. Histopathological examination confirmed the diagnosis of osteochondroma. Normally, as the growth usually stops after skeletal maturity, surgical intervention is delayed till that time. In our case, the symptoms were so debilitating that it required immediate surgical resection, following which the patient was symptom-free for the next 6 months and there were no clinical signs or symptoms of recurrence. Conclusion: Excision of osteochondroma can be safely performed in a case, where it is debilitating, progressive, or unmanageable much before skeletal maturity with fair results.
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Affiliation(s)
- P Hegin Tungdim
- Department of Orthopaedics, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - I Ibomcha Singh
- Department of Orthopaedics, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Sagnik Mukherjee
- Department of Orthopaedics, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Tobu Pertin
- Department of Orthopaedics, Regional Institute of Medical Sciences, Imphal, Manipur, India
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Rameez R, Ul-Hassan M, Kotwal HA, Kangoo KAH, Nazir A. Painful Pseudowinging and Snapping of Scapula due to Subscapular Osteochondroma: A Case Report. J Orthop Case Rep 2016; 6:96-99. [PMID: 28507976 PMCID: PMC5404176 DOI: 10.13107/jocr.2250-0685.652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Osteochondroma or exostosis is most common benign bone tumors. They are usually seen in the metaphyses of long bones with more than 35% of cases affecting the bone around the knee and are seldom found in flat bones like scapula. When present in scapula, they may cause abnormal scapulothoracic movements leading to pain, snapping, and pseudowinging of scapula. CASE REPORT We describe a novel case of osteochondroma arising on the ventral aspect of right scapula in a 16-year-old otherwise healthy female patient causing snapping and pseudowinging of scapula and occasional pain in affected area. X-ray and computed tomography findings were consistent with an abnormal bony mass arising on ventral aspect of superior border of the scapula. The patient was treated with open extraperiosteal resection of the mass with relief of symptoms. The histopathological diagnosis was consistent with osteochondroma with no signs of malignancy. CONCLUSION In a patient with winging and snapping of scapula one should be aware of rare diagnosis osteochondroma along with other more common etiology.
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Affiliation(s)
- Raja Rameez
- Department of Orthopaedics, Government Medical College Srinagar, Jammu and Kashmir, Himachal Pradesh, India
| | - Mehmood Ul-Hassan
- Department of Orthopaedics, Government Medical College Srinagar, Jammu and Kashmir, Himachal Pradesh, India
| | - Hilal A Kotwal
- Department of Orthopaedics, Government Medical College Srinagar, Jammu and Kashmir, Himachal Pradesh, India
| | - Khursheed A H Kangoo
- Department of Orthopaedics, Government Medical College Srinagar, Jammu and Kashmir, Himachal Pradesh, India
| | - Asif Nazir
- Department of Orthopaedics, Government Medical College Srinagar, Jammu and Kashmir, Himachal Pradesh, India
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11
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Kwee RM, Fayad LM, Fishman EK, Fritz J. Multidetector computed tomography in the evaluation of hereditary multiple exostoses. Eur J Radiol 2015; 85:383-91. [PMID: 26781144 DOI: 10.1016/j.ejrad.2015.11.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 10/29/2015] [Accepted: 11/25/2015] [Indexed: 10/22/2022]
Abstract
Hereditary multiple exostoses (HME) is an autosomal dominant disorder characterized by the formation of multiple osteochondromas. Because of its superior soft tissue contrast and absence of ionizing radiation, magnetic resonance imaging is the first choice imaging technique for the evaluation of complex lesions and complications related to HME. However, multidetector computed tomography (MDCT) also can be of value in the evaluation of patients with HME, which is reviewed in this article. Topics outlined are low-dose MDCT technique, 3-dimensional visualization techniques, typical MDCT appearances, differential diagnostic considerations, and the usefulness of MDCT in the assessment of emergent and non-emergent complications related to HME, among which spinal cord compression, pneumothorax and hematothorax, pseudoaneurysms, fractures, growth disturbances, chondrosarcoma transformation, and muscular and peripheral nerve involvement.
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Affiliation(s)
- Robert M Kwee
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Radiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Laura M Fayad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jan Fritz
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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12
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Ng C, Bibiano L, Grech S, Magazinovic B. Antecubital Fossa Solitary Osteochondroma with Associated Bicipitoradial Bursitis. Case Rep Orthop 2015; 2015:560372. [PMID: 26413363 PMCID: PMC4564615 DOI: 10.1155/2015/560372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/11/2015] [Indexed: 12/25/2022] Open
Abstract
Antecubital fossa lesions are uncommon conditions that present to the orthopaedic clinic. Furthermore, the radius bone is an uncommonly reported location for an osteochondroma, especially when presenting with a concurrent reactive bicipitoradial bursitis. Osteochondromas are a type of developmental lesion rather than a true neoplasm. They constitute up to 15% of all bone tumours and up to 50% of benign bone tumours. They may occur as solitary or multiple lesions. Multiple lesions are usually associated with a syndrome known as hereditary multiple exostoses (HME). Malignant transformation is known to occur but is rare. Bicipitoradial bursitis is a condition which can occur as primary or secondary (reactive) pathology. In our case, the radius bone osteochondroma caused reactive bicipitoradial bursitis. The differential diagnosis of such antecubital fossa masses is vast but may be narrowed down through a targeted history, stepwise radiological investigations, and histological confirmation. Our aim is to ensure that orthopaedic clinicians keep a wide differential in mind when dealing with antecubital fossa mass lesions.
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Affiliation(s)
- Colin Ng
- Department of Trauma and Orthopaedics, Mater Dei Hospital, Triq Dun Karm, Msida MSD 2090, Malta
| | - Luigi Bibiano
- Clinica Ortopedica, Seconda Università degli Studi di Napoli, 4 Via De Crecchio, 80138 Napoli, Italy
| | - Stephan Grech
- Department of Trauma and Orthopaedics, Mater Dei Hospital, Triq Dun Karm, Msida MSD 2090, Malta
| | - Branko Magazinovic
- Department of Trauma and Orthopaedics, Mater Dei Hospital, Triq Dun Karm, Msida MSD 2090, Malta
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14
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Abstract
Scapulothoracic bursitis is a rare disease and presents as pain or swelling around the bursa of the scapulothoracic articulation. It has been reported to be related to chronic repetitive mechanical stress of the periscapular tissue, trauma, overuse, and focal muscle weakness. The authors experienced an atypical case of scapulothoracic bursitis with shoulder and periscapular pain after quadriparesis.This case implies that muscular atrophy around the scapula and chest wall from quadriparesis may contribute to the development of scapulothoracic bursitis with shoulder and periscapular pain. In addition, clinician should be alert to it as a possible cause when a patient with quadriparesis complains of shoulder and periscapular pain and consider proper diagnostic options such as ultrasonography or magnetic resonance imaging.
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Affiliation(s)
- Seung Jun Seol
- From the Department of Rehabilitation Medicine, Hanyang University College of Medicine, Seoul, Korea
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15
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Osteochondroma of the hip with adjacent bursal chondromatosis. Skeletal Radiol 2014; 43:1743-8. [PMID: 25001874 DOI: 10.1007/s00256-014-1954-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/31/2014] [Accepted: 06/24/2014] [Indexed: 02/02/2023]
Abstract
It is well established that irregular bursae can form adjacent to an osteochondroma (bursa exostotica) as a result of mechanical irritation and that these bursae can be complicated by inflammation, hemorrhage, or infection. Bursal chondromatosis is a rare complication, with only seven published cases in the literature according to our searches. We present the case of a 53-year-old female who presented with slowly progressive left hip/thigh pain and was found to have an osteochondroma arising from the lesser trochanter with numerous ossified bodies in the adjacent soft tissues. MRI demonstrated osteochondral bodies in a fluid-filled bursa adjacent to the osteochondroma, with several of the bodies noted to be fairly displaced from the osteochondroma cartilaginous cap. At surgery, the osteochondroma was removed and numerous bodies of varying sizes were excised, some of which were noted to be adherent to the bursal lining and others that were separated/distant from the cartilage cap. The question arises as to whether this process represents bursal chondromatosis resulting from benign neoplasia of cells lining the abnormal bursa, "cartilage shedding" from the osteochondromatous cap, or both. The purpose in presenting this case is to introduce a rare complication of an osteochondroma, demonstrate that soft tissue calcification and osteochondral densities displaced from an underlying osteochondroma are not always the result of sarcomatous degeneration, and provide support for the theory that cells lining a bursa in a nonphysiologic location can undergo benign neoplasia with subsequent formation of osteochondral bodies.
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16
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Lin YC, Goldsmith JD, Gebhardt MG, Wu JS. Bursal synovial chondromatosis formation following osteochondroma resection. Skeletal Radiol 2014; 43:997-1000. [PMID: 24453028 DOI: 10.1007/s00256-014-1821-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 12/31/2013] [Accepted: 01/06/2014] [Indexed: 02/02/2023]
Abstract
Osteochondroma is a common tumor of the bone and can be complicated by adventitial bursa formation and malignant transformation of the cartilaginous cap. Synovial chondromatosis formation within these bursae is extremely rare and can be confused with malignant transformation of the osteochondroma cap to a chondrosarcoma. We describe a case of extra-articular synovial chondromatosis formation several years following osteochondroma resection. Cartilage nodule formation within the bursal synovial lining and proliferation of cartilage debris shed from the cartilaginous cap during surgery or biopsy are potential etiologies of this rare complication of osteochondromas.
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Affiliation(s)
- Yu-Ching Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung, Taiwan,
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Kumar C Y, Shervegar S, Gadi D, P R. Solitary sessile osteochondroma of scapula, a rare case report. J Clin Diagn Res 2014; 8:174-5. [PMID: 24783126 PMCID: PMC4003631 DOI: 10.7860/jcdr/2014/7025.4156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Accepted: 01/20/2014] [Indexed: 11/24/2022]
Abstract
Osteochondromas are the most common benign tumours of bone. These are most commonly seen on the metaphysis of a long bone, but they can arise from any bone which is preformed from cartilage. To best of our knowledge, very few cases of osteochondroma scapula have been reported in literature. We hereby report a very rare case of osteochondroma which arose from scapula in a four year old boy, which was treated by excisional biopsy.
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Affiliation(s)
- Yashavantha Kumar C
- Assistant Professor, Department of Orthopaedics, M S R Medical College, Bangalore, India
| | - Satish Shervegar
- Professor, Department of Orthopaedics, M S R Medical College, Bangalore, India
| | - Daksh Gadi
- Junior Resident, Department of Orthopaedics, M S R Medical College, Bangalore, India
| | - Rahul P
- Assistant Professor, Department of Orthopaedics, M S R Medical College, Bangalore, India
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Nam SJ, Kim S, Lim BJ, Yoon CS, Kim TH, Suh JS, Ha DH, Kwon JW, Yoon YC, Chung HW, Sung MS, Choi YS, Cha JG. Imaging of Primary Chest Wall Tumors with Radiologic-Pathologic Correlation. Radiographics 2011; 31:749-70. [DOI: 10.1148/rg.313105509] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Bernard SA, Murphey MD, Flemming DJ, Kransdorf MJ. Improved differentiation of benign osteochondromas from secondary chondrosarcomas with standardized measurement of cartilage cap at CT and MR imaging. Radiology 2010; 255:857-65. [PMID: 20392983 DOI: 10.1148/radiol.10082120] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To validate a technique for reproducible measurement of the osteochondroma cartilage cap with computed tomography (CT) and magnetic resonance (MR) imaging and to reevaluate the correlation of the thickness of the cartilage cap with pathologic findings to improve noninvasive differentiation of benign osteochondromas from secondary chondrosarcomas. MATERIALS AND METHODS The institutional review board approved the study and waived the need for informed consent. HIPAA compliance was maintained. After validation of the measurement technique, 101 pathologically confirmed osteochondromas were retrospectively reviewed. Patient demographic data, histologic diagnosis, and chondrosarcoma grade were recorded. Two musculoskeletal radiologists used a standardized technique to independently measure the thicknesses of the cartilage caps on CT and MR images; these measurements were compared for interobserver agreement. Agreement between measurements with CT and MR imaging was also evaluated, as were the sensitivity and specificity of both modalities for differentiation of osteochondromas from chondrosarcomas. RESULTS Evaluated were 67 benign osteochondromas (from 49 male patients and 18 female patients; mean age, 23.4 years) and 34 secondary chondrosarcomas (from 27 male patients and seven female patients; mean age, 33.2 years). On the basis of the proposed measuring technique, there was 88% interobserver measurement agreement with MR imaging (95% confidence interval [CI]: 80%, 94%) and 93% with CT (95% CI: 84%, 98%). The median difference between measurements of cap thickness at CT and MR imaging was 0 cm (25th and 75th percentiles, -3 mm and 1 mm, respectively). With 2 cm used as a cutoff for distinguishing benign osteochondromas from chondrosarcomas, the sensitivities and specificities were 100% and 98% for MR imaging and 100% and 95% for CT, respectively. CONCLUSION The proposed measuring technique allows accurate and reproducible measurement of cartilage cap thickness with both CT and MR imaging. Cap thickness of 2 cm or greater strongly indicated secondary chondrosarcomas.
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Affiliation(s)
- Stephanie A Bernard
- Department of Radiology, Penn State-Milton S. Hershey Medical Center, 500 University Dr, Room H066, Hershey, PA 17033, USA.
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Mohsen MS, Moosa NK, Kumar P. Osteochondroma of the scapula associated with winging and large bursa formation. Med Princ Pract 2006; 15:387-90. [PMID: 16888399 DOI: 10.1159/000094275] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Accepted: 08/16/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report a case of scapular osteochondroma associated with pain and winging that is rarely reported in the medical literature. CASE PRESENTATION AND IDENTIFICATION A 19-year-old male presented with pain and winging of the right scapula. CT scan revealed an osteochondroma of the medial border of the scapula with a large bursa between the chest wall and the tumour. Excision of the tumour relieved the symptoms. Pathological study showed osteochondroma of the scapula. In a follow-up 1 year later he was free of pain with no clinical or radiological sign of recurrence. CONCLUSION A case of scapular osteochondroma associated with pain and winging treated by excision and follow-up showed no sign of clinical or radiological recurrence.
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Fujikawa A, Oshika Y, Tamura T, Naoi Y. Chronic scapulothoracic bursitis associated with thoracoplasty. AJR Am J Roentgenol 2004; 183:1487-8. [PMID: 15505325 DOI: 10.2214/ajr.183.5.1831487] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Akira Fujikawa
- Department of Radiology, Japan Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, Tokyo 154-8532, Japan
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22
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Higuchi T, Ogose A, Hotta T, Okamoto K, Kamura T, Sasai K, Hatano H, Morita T. Clinical and imaging features of distended scapulothoracic bursitis: spontaneously regressed pseudotumoral lesion. J Comput Assist Tomogr 2004; 28:223-8. [PMID: 15091127 DOI: 10.1097/00004728-200403000-00012] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe clinical and imaging findings of distended scapulothoracic bursitis without scapular snapping, which is often confused with a soft tissue tumor. METHODS Nine patients (6 male, 3 female; age range: 50-73 years; mean age = 67 years) with distended scapulothoracic bursitis diagnosed by clinical and magnetic resonance (MR) imaging findings were studied. The results of a histologic examination were available in 1 case. RESULTS All patients presented with painless palpable masses below the scapula, and the initial diagnoses were soft tissue tumors. On MR images, the lesions were 5.5 to 12 cm in maximum diameter (mean = 7.7 cm) and well-demarcated cystic masses situated in the subscapular region between the serratus anterior and the chest wall. There was no solid portion on the cyst walls. The findings of hemorrhage within the bursae were present in all cases. Every mass regressed in size spontaneously after a few to several weeks, and no lesions revealed any malignant findings of sarcomas. CONCLUSIONS Distended scapulothoracic bursae without scapular snapping resemble soft tissue tumors. They have some specific MR findings; therefore, precise recognition of these findings is important to avoid misdiagnoses and unnecessary treatments.
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Affiliation(s)
- Takeshi Higuchi
- Department of Radiology, Niigata City General Hospital, Niigata, Japan.
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Hodler J, Gilula LA, Ditsios KT, Yamaguchi K. Fluoroscopically guided scapulothoracic injections. AJR Am J Roentgenol 2003; 181:1232-4. [PMID: 14573410 DOI: 10.2214/ajr.181.5.1811232] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Juerg Hodler
- Mallinckrodt Institute of Radiology, Washington University Medical Center, 510 S Kingshighway Blvd., St. Louis, MO 63110-1076, USA
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Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH. Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics 2000; 20:1407-34. [PMID: 10992031 DOI: 10.1148/radiographics.20.5.g00se171407] [Citation(s) in RCA: 447] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Osteochondroma represents the most common bone tumor and is a developmental lesion rather than a true neoplasm. It constitutes 20%-50% of all benign bone tumors and 10%-15% of all bone tumors. Its radiologic features are often pathognomonic and identically reflect its pathologic appearance. Osteochondromas are composed of cortical and medullary bone with an overlying hyaline cartilage cap and must demonstrate continuity with the underlying parent bone cortex and medullary canal. Osteochondromas may be solitary or multiple, the latter being associated with the autosomal dominant syndrome, hereditary multiple exostoses (HME). Complications associated with osteochondromas are more frequent with HME and include deformity (cosmetic and osseous), fracture, vascular compromise, neurologic sequelae, overlying bursa formation, and malignant transformation. Malignant transformation is seen in 1% of solitary osteochondromas and in 3%-5% of patients with HME. Continued lesion growth and a hyaline cartilage cap greater than 1.5 cm in thickness, after skeletal maturity, suggest malignant transformation. Variants of osteochondroma include subungual exostosis, dysplasia epiphysealis hemimelica, turret and traction exostoses, bizarre parosteal osteochondromatous proliferation, and florid reactive periostitis. Recognition of the radiologic spectrum of appearances of osteochondroma and its variants usually allows prospective diagnosis and differentiation of the numerous potential complications, thus helping guide therapy and improving patient management.
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Affiliation(s)
- M D Murphey
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 6825 16th St NW, Bldg 54, Rm M-133A, Washington, DC 20306, USA.
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