Osteochondroma
Original Editors - James Mountain
Top Contributors - James Mountain, Leana Louw, Admin, Elaine Lonnemann, WikiSysop, Lydia Xenou, Mariam Hashem and Claire Knott
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (19 May 2024)
Definition/Description[edit | edit source]
Osteochondroma, also referred to as osteocartilaginous exostosis or plainly exostosis, is the most common benign bone tumor.[1][2][3][4][5][6] It can present as solitory osteochondroma or as multiple osteochondromatosis[2]. Osteochondromas usually arise from the metaphysis of long bones, but can occur at other cortical bone metaphyses.[7][8][9] The most common sites for these tumors are the distal femur, proximal humerus, and proximal tibia. They can also be in flat bones, such as the ilium and scapula[5], and rarely affect the spine[7]. It is believed that these non-malignant tumors arise from unusual cartilaginous epiphyseal growth-plate tissue that spreads and grows by endochondral ossification.[10] These tumors may present with a stalk-like structure and are known as pedunculated. Osteochondromas without a stalk are called sessile exostoses.[2][11]
Epidemiology/Etiology[edit | edit source]
Epidemiology[edit | edit source]
Average age of clinical presentation is between 10 and 30.[2][7][10][8] These tumors account for 10%-15% of all bone tumors[3], while representing 36% of all non-malignant bone tumors[11] Solitary osteochondroma occur equally in males and females,[2] while multiple osteochondroma affects males more than females,[2] approximately 1,6:1.[10]
Etiology[edit | edit source]
The etiology regarding the development of solitary osteochondroma is currently unknown[6]. Multiple osteochondromatosis, on the other hand, does apear to have a genetic link. It is inherited in 70% of cases and has been associated with EXT 1 and EXT 2 genes. The association is currently not well understood and research is continuing to look into the link[2].
Characteristics/Clinical Presentation[edit | edit source]
Osteochondromas are usually asymptomatic and present most commonly as a painless bump near a joint, usually the knee or the shoulder. Other symptoms may present and are usually associated with the location of the osteochondroma. If the osteochondroma is located under a tendon, it may cause a snapping effect with activity as the tendon moves over the tumor. Additional symptoms may present if the osteochondroma is located near nerves and blood vessels. For example, a tumor on the posterior aspect of the knee may result in numbness and tingling, periodic changes in blood flow, loss of pulse, or colour change in the limb secondary to nerve and blood vessel compression.[2]
Symptoms[edit | edit source]
- Painless, palpable mass near a joint - knee and shoulder most commonly
- Numbness and tingling
- Snapping of tendon over tumor
- Restricted range of motion
- Period changes in blood flow
- Loss of pulse in affected limb due to vascular compression
- Colour change in limb due to vascular compression
Complications[edit | edit source]
- Vascular compression
- Radiculopathy secondary to spinal tumors[7]
- Myelopathy secondary to spinal tumors[7]
- Bursa formation
- Pathological fracture - most of which occur at the knee (distal femur or proximal tibia)[13]
- Infarction
- Osteomyelitis
Differential diagnosis[edit | edit source]
Malignant transformation from osteochondroma to osteosarcoma is possible in both solitary and multiple osteochondroma. This happens in approximately 1% of solitay osteochondroma cases[12][9][1] and 5-25% in multiple osteochondromas.[14][1]
It is also important to track the thickness of the cartilage gap once the bone has fully matured. A cartilage gap greater than 1.5cm[3] or 2.0cm[1] may suggest malignant transformation.[3][1]
Radiculopathy - Solitary spinal osteochondroma is rare, making up 2.5% of solitary osteochondromas[7]. I has been shown to mimic symptoms associated with radiculopathy, usually cervical.[8]
Diagnostic procedures[edit | edit source]
- X-Ray: Most commonly used to diagnose osteochondroma, as the excess bone growth can usually be picked up on a plain X-rays.[2][5]
- MRI: Magnetic resonance imaging can be used as well. Most times, MRI is used to examine whether or not cartilage is present on the surface of the exostosis.[14] If excess cartilage is indeed present (>1.5cm), the tumor should be checked for possible malignancy.[3]
MRI Image: Osteochondroma Proximal Tibia
- CT Scan: Computed tomography may also be used to evaluate the presence and physical characteristics of an osteochondroma[2], but it is not commonly used.[5]
Medical Management[edit | edit source]
Options regarding medical management of osteochondroma is indicated only if symptoms are present and depends on a variety of factors including age, severity, disease extent, and overall health. Observation is the best way to manage a non-symptomatic osteochondroma.[5][2]
- If symptoms are present, the medical options include:
1. pain medication
2. surgery
Solitary osteochondroma stalk resection.
- Solitary Osteochondromas - generally do not require surgery and are usually monitored with regular X-rays. Surgery for solitary osteochondromas are only suggested when the exostosis has grown completely and a mature skeleton is observed on an X-ray. The reason for this is to decrease the chance of reoccurrence.
- Surgery may be considered when:
1. pain is experienced with activity
2. pressure on a nerve or blood vessel
3. presence of a larger cartilage cap
4. bone growth has fully matured
- Multiple Osteochondromas - surgical removal is not indicated unless symptoms exist. It is very important to monitor osteochondromas though, epecially if multiple osteochondromas are present. If surgery is indicated, the tumor may be completely removed and a prosthesis may have to be used to replace any structural loss[2].
Medications
Medical treatment is usually not indicated for osteochondroma, since most times the condition is asymptomatic. Pain medication is only used if symptoms of pain present. Observation and regular monitoring is very important though.[2]
Physiotherapy management[edit | edit source]
Physical therapy is indicated most commonly for post-operative osteochondroma cases. Functional mobility will be the primary focus with the treatment addressing range of motion, strength, restoring proper biomechanics.[10]
Resources[edit | edit source]
http://orthoinfo.aaos.org/topic.cfm?topic=A00079
http://emedicine.medscape.com/article/1256477-overview
http://www.bonetumor.org/tumors-cartilage/osteochondroma
http://www.childrenshospital.org/az/Site1079/mainpageS1079P0.html
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Merck Manuals. Bone and joint tumors. Merck Manual Home Edition. Available from: http://www.merckmanuals.com/professional/sec04/ch044/ch044b.html (accessed 23/02/2011).
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 American Academy of Orthopaedic Surgeons. Osteochondroma (bone tumor). Available from:http://orthoinfo.aaos.org/topic.cfm?topic=A00079. 2007 (accessed 16/03/2011).
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Murphey MD, Choi JJ, Kransdorf MJ, Flemming DJ, Gannon FH. Imaging of osteochondroma: variants and complications with radiologic-pathologic correlation. Radiographics 2000;20(5):1407-34.
- ↑ Samartzis D, Marco R. Osteochondroma of the sacrum: a case report and review of the literature. Spine 2006;31(13):425-429.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 5.6 Goodman CC, Snyder TK. Differential Diagnosis for Physical Therapists: Screening for Referral. 4th edition. St. Louis, Missouri: Saunders Elsevier, 2007.
- ↑ 6.0 6.1 Hubbard T, Frey KM, Hosey RG, Milbrandt T. Tibial Osteochondroma in a High School Football Player. Athletic Therapy Today 2008;13(6):36-7.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Moon K, Lee J, Kim Y, Kwak H, Joo S, Kim I, Kim J, Kim S. Osteochondroma of the cervical spine extending multiple segments with cord compression. Pediatric Neurosurgery 2006;42:304-307.
- ↑ 8.0 8.1 8.2 Ratliff J, Voorhies R. Osteochondroma of the C5 lamina with cord compression: case report and review of the literature. Spine 2000; 25(10):1293-1295.
- ↑ 9.0 9.1 Roa A, Abraham G, Rajshekhar V. Osteochondroma of rib with neural foraminal extension and cord compression. Neurology India 2007;55(4):428-429.
- ↑ 10.0 10.1 10.2 10.3 10.4 10.5 Chin K, Kharrazi F, Miller B, Mankin H, Gebhardt M. Osteochondromas of the distal aspect of the tibia or fibula. Journal of Bone and Joint Surgery 2000;82:1269.
- ↑ 11.0 11.1 Yoshida T, Matsuda H, Horiuchi C, Taguchi T, Nagao J, Aota Y, Honda A, Tsukuda M. A case of osteochondroma of the atlas causing obstructive sleep apnea syndrome. Acta Oto-Laryngologica 2006;126:445-448.
- ↑ 12.0 12.1 12.2 Errani C, Jutte P, De Paolis M, Bacchini P, Mercuri M. Secondary synovial condromatosis in a bursa overlying an osteochondroma mimicking a peripheral chondrosarcoma-a case report. Acta Orthopaedica 2007;78(5):701-704.
- ↑ 13.0 13.1 13.2 Robbins M, Kuo S, Epstein R. Non-traumatic fracture of an osteochondroma mimicking malignant degeneration in an adult with hereditary multiple exostoses. Radiology Case Reports 2008;3:99.
- ↑ 14.0 14.1 Woertler K, Lindner N, Gosheger G, Brinkschmidt C, Heindel W. Osteochondroma: MR imaging of tumor-related complications. Eur Radiol. 2000;10(5):832-840.
