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.

Objective: The purpose of this report was to describe the presentation of a patient with hereditary multiple exostoses and thoracic spinal cord compression from an osteochondroma. Clinical Features: A 31-year-old female presented to a chiropractic clinic with a history of hereditary multiple exostoses and back pain that had existed since the age of 16 years. She had a past medical history that was remarkable for 3 prior surgeries for mass removal. Examination revealed a left upper midscapular mass with decreased sensation. Intervention/Outcome: Magnetic resonance imaging, computed tomography, and biopsy led to a diagnosis of osteochondroma. These diagnostic modalities confirmed that there was no malignant degeneration. Initial magnetic resonance imaging revealed a large expansive lesion involving the left posterior elements at the region of T3-T4. Subsequent thoracic hemilaminectomy and resection of the spinal tumor with posterior instrumentation and stabilization from T2-T5 resulted in 90% overall subjective improvement. Conclusions: A detailed case history, thorough examination, guided advanced imaging, and biopsy provide important information for the diagnosis and appropriate treatment of expansive lesions in patients with hereditary multiple exostoses. (J Chiropr Med 2017;16:72-77)