Phalangeal Osteoid Osteomas in the Hand

Abstract

Osteoid osteomas in the phalanges of the hand often present with atypical clinical and radiologic characteristics. These unusual presentations may cause a delay in diagnosis and treatment. In this study, seven cases (seven patients) of phalangeal osteoid osteomas in the hand were examined, six of which were misdiagnosed for long periods of time. These seven cases illustrate unusual presentations, including absence of reactive bone, monoarticular arthritis, clubbing, macrodactyly, painless swelling, and absence of bony lysis. Phalangeal osteoid osteomas also have unusual histologic features. Recognition of these unusual clinical, radiographic, and histologic features may prevent misdiagnosis and lead to prompt definitive therapy.

Osteoid Osteoma of the Thumb: A Case Report

“…MRI has been found to be misleading in the diagnosis of an osteoid osteoma, as soft tissue edema surrounding the lesion can produce a falsely aggressive appearance [11]. It might show the lesion, but soft tissue or periosteal edema [2] can make the diagnosis difficult. In our case, MRI was consistent with infection due to soft tissue edema.…”

Painful fingertip swelling of the middle finger

“…Zampa et al recently reported the added value of dynamic contrast-enhanced MR imaging for OO in atypical locations, in terms of nidus conspicuity and diagnostic confidence [7]. Third, the histological features may even be unusual [5]. All those reasons could explain the delay, sometimes of several months to years, in the diagnosis and the treatment of phalangeal OOs.…”

“…Besides, endosteal sclerosis may be counterbalanced by local osteopaenia. Furthermore, other bony lesions of the fingertips, such as chronic osteomyelitis, epidermoid cyst, enchondroma or glomus tumour, may mimic an OO [3,5,6]. Zampa et al recently reported the added value of dynamic contrast-enhanced MR imaging for OO in atypical locations, in terms of nidus conspicuity and diagnostic confidence [7].…”

“…First, the typical clinical features may not be present [2,3,5]. Pain may not be worse at night, or be relieved by aspirin.…”

“…Second, its imaging characteristics (i.e. a small radiolucent lesion with central calcification, peripheral sclerosis and periosteal reaction [1]) may also be atypical [3][4][5][6]. Because of the presence of thickened Sharpey's fibres, a periosteal reaction is rarely found in the distal phalanx [6].…”