Rev. bras. ortop. vol.49 número1

rev bras ortop.2014;49(1):82–85

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Case

Report

Osteoid

osteoma

of

the

acromion

simulating

acromioclavicular

pain

夽

,

夽夽

Alberto

Naoki

Miyazaki

_,

_Marcelo

_Fregoneze,

_Pedro

_Doneux

_Santos,

Luciana

Andrade

da

Silva,

Guilherme

do

Val

Sella,

Douglas

Lobato

Lopes

Neto,

Melvis

Muchiuti

Junior,

Sergio

Luiz

Checchia

DepartamentodeOrtopediaeTraumatologia,FaculdadedeCiênciasMédicasdaSantaCasadeSãoPaulo,SãoPaulo,SP,Brazil

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Articlehistory:

Received17March2013 Accepted9April2013

Keywords:

Osteoidosteoma Boneneoplasms Acromion

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Theosteoidosteomaisabenignbonetumourthatusuallypresentswithnocturnalpainin youngadults,relievedbyrestandanti-inflammatories.Itcanaffectanybone;however,their occurrenceisrareintheacromion.Theauthorsdescribeacaseofosteoidosteomalocatedin theacromion,withsymptomsthatsimulatedacromionclaviculararthrosis.Thediagnosis wasmadebyCTscanandtreatmentwasexcisionofthenidusthrougharthroscopy.The diagnosiswasconfirmedbyhistopathology.Intheoutpatientsegment,thepatientremained asymptomatic,withcompleterecoveryoffunctionoftheaffectedlimb.

©2014SociedadeBrasileiradeOrtopediaeTraumatologia.PublishedbyElsevierEditora Ltda.Allrightsreserved.

Osteoma

osteóide

de

acrômio

que

simula

dor

acrômio-clavicular

Palavras-chave:

Osteomaosteóide Neoplasiasósseas Acrômio

r

e

s

u

m

o

Oosteomaosteóideéumtumorósseobenignoqueseapresentageralmenteemadultos jovenscomdornoturna,aliviadaporrepousoeanti-inflamatórios.Podeacometer qual-querosso.Entretanto,suaocorrêncianoacrômioérara.Osautoresdescrevemumcasode osteomaosteóidelocalizadonoacrômio,comsintomasquesimulavamartrose acrômio--clavicular.Odiagnósticofoifeitopormeiodetomografiacomputadorizadaeotratamento propostofoiaexéresedoniduspormeiodeartroscopia.Odiagnósticodefinitivofoi con-firmadoporexamehistopatológico.Nosegmentoambulatorial,a pacientepermaneceu assintomáticaecomrecuperac¸ãocompletadafunc¸ãodomembroacometido.

©2014SociedadeBrasileiradeOrtopediaeTraumatologia.PublicadoporElsevierEditora Ltda.Todososdireitosreservados.

夽_{Pleasecitethisarticleas:MiyazakiAN,FregonezeM,SantosPD,daSilvaLA,doValSellaG,NetoDLL,MuchiutiJuniorM,ChecchiaSL.}

Osteomaosteóidedeacrômioquesimuladoracrômio-clavicular.RevBrasOrtop.2014;49:82–85. 夽夽

WorkconductedatShoulderandElbowGroup,DepartmentdeOrthopaedicsandTraumatology,MedicalSciencesSchool,SantaCasa deSãoPaulo,SãoPaulo,SP,Brazil.

∗ _{Correspondingauthor.}

E-mail:ombro@ombro.med.br(A.N.Miyazaki).

2255-4971/$–seefrontmatter©2014SociedadeBrasileiradeOrtopediaeTraumatologia.PublishedbyElsevierEditoraLtda.Allrightsreserved.

rev bras ortop.2014;49(1):82–85

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Introduction

Osteoid osteoma is a benign osteoblastic lesion, and con-stitutesapproximately11%ofallbenignbonetumoursthat usuallyoccurinyoungmen.Thisneoplasmisfoundinthe secondorthirddecadeoflife.However,itcanbeseeninother agegroups.1 _{Anybonecanbeinvolved.However,thereisa} predilectionforlower extremities:halfofthecasesinvolve thefemurortibia.2_{Thescapulaisabonerarelyaffectedand} fewcaseshavebeenreportedintheliterature.Mosheiffetal.,3 inareviewoftheliterature,reportedtheinvolvementof12 scapulaein1236casesofosteoidosteoma.

Case

report

Afemalepatient,aged46years,right-handed,complainedof rightshoulderpainforthreemonths,especiallyatnight,with worseningduringphysicalactivities,andimprovedwiththe useofNSAIDs. Shedeniedany historyoftrauma or previ-ousdiseaseinthejoint.Shehasbeendiagnosedpreviously ashavingimpingementsyndromeandtreatedwithtwo sub-acromialcorticosteroidinjectionsandphysicaltherapy,with partialimprovementofsymptoms.

On physical examination, her shoulders had no defor-mities, tumours or skin lesions, and muscle tropism was preserved. The range of active movement of the affected limbwasslightlylimitedbypainandthepassivemovement wasnormal. Provocative manoeuvresfor acromioclavicular joint(O’Brien,forcedadductionandpainonpalpation)were stronglypositiveandtheotherteststoevaluatetherotator cuffandinstabilityoftheshoulderjointresultednegative.

The Zanca view radiographs revealed changes in the acromioclavicularjoint(Fig.1).Amagneticresonance imag-ingstudyshowedanacromioclaviculararthrosiswithintense inflammatory process in the joint region with a cyst on theacromion,initiallyinterpretedasageode.However,our attentionwas drawnbythefact thattherewas anintense inflammatory process around the lesion, which was very regular and larger than usual; in addition, the images

Fig.1–Radiographoftherightshoulder,Zancaview, showingarthrosisofacromioclavicularjoint.

suggestedtheexistenceofsomesolidcontentinsideit(Fig.2A andB).

Thediagnosishypothesisofosteoidosteomawasproposed andthenwerequestedaCTscanforconfirmation;thenidus insidethecystcouldbeeasilyevidenced(Fig.3).

Allthecomplementarylaboratorytestswerenormal. Wechosearthroscopicsurgeryandresectionofthenidus (Fig.4),complementedwithabroaderthan usual acromio-plasty,untiltheremovaloftheentiretumour,andresection ofthedistalendoftheclavicle(Mumfordprocedure)wastaken (Fig.5).Thediagnosiswasconfirmedbypathologicalstudy.

Thepatienthadrapidregressionofsymptoms,with com-pleterecoveryofthefunctionalrangeofmotionoftheaffected limb,and remained asymptomatic untilherlast return,by occasionofthepostoperativeexaminationofsevenyears.

Discussion

Thescapulaisarare siteofosteoidosteoma locationand, therefore, is often failed to be included in the differential

84

Fig.3–AxialCTimageoftherightshouldershowing osteoidosteomaintheacromion,nexttothe

acromioclavicularjoint.

Fig.4–Surgicalarthroscopicimage,subacromialview, showingtheresectionofthetumourwithacurette.

diagnosis of chronic shoulder pain.4 _{The patient with an} osteoidosteomaischaracterizedbypainthatoccurs predomi-nantlyatnightandisrelievedbyaspirinoranti-inflammatory drugs.5_{Oftenthenocturnalpainisattributedtorotatorcuff} disease. However, the age range of patients with osteoid osteoma wouldimply inlower probabilityofa rotator cuff disease.

Multipletreatmentoptionsforthistumourareavailable: drugtherapy, percutaneousablationbyradiofrequencyand

Fig.5–Magneticresonanceimaging,rightshoulder, sagittalview,showingcompleteresectionofthelesion (acromioplasty)andresectionofthelateralendofthe clavicle.

surgical procedures involving the complete removalof the nidus, which can be achievedby curettage, en bloc resec-tion and, more recently, by arthroscopic route, with good results.6,7 _{If the patient’s symptoms are adequately} con-trolled,anti-inflammatorymedicationcanbeusedasafinal treatment. Patients treated in this manner usually expe-rience spontaneous healing of the lesion in three to four years.8

Degreefetal.7_{firstdescribedtheoccurrenceofanosteoid} osteomaintheacromioninafemalepatientaged56,whose treatment was open resection of the lesion. Kelly et al.6 described a case of arthroscopic resection of an osteoid osteoma located atthe anterior border ofthe glenoid ofa male patient aged30years,who had undergone two surg-eriesfortreatmentofaSLAPlesion.Theauthorsalsoreported an arthroscopicresection ofan osteoidosteomalocatedat the baseofthe coracoidprocessofamale patientaged12 years.

Ourchoicewasthearthroscopictreatment,asinthecases describedabove,becausethepatient’swasabenignlesionand wehadapossibilitytoresecttheentirelesionwithminimal tissuedamage.Thisoptionprovedtobeeffective,andcanbe appliedinsimilarcases.

Conflicts

of

interest

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2.MitsuiY,GotohM,YoshidaT,HiraiY,ShinozakiT,NakamaK, etal.Osteoidosteomaoftheproximalhumerus:amisleading case.JShoulderElbowSurg.2008;17(1):e13–5.

3.MosheiffR,LiebergallM,ZivI,AmirG,SegalD.Osteoid osteomaofthescapula.Acasereportandreviewofthe literature.ClinOrthopRelatRes.1991;262:129–31.

4.GlanzmannMC,HinterwimmerS,WoertlerK,ImhoffAB. Osteoidosteomaofthecoracoidmaskedaslocalizedcapsulitis oftheshoulder.JShoulderElbowSurg.2011;20(8):e4–7.

5.GraciaIA,ItarteJI,MajoJB,SaloGB,ProubastaIR.Osteoid osteomaofthecoracoidprocess.JSouthernOrthopAssoc. 2001;10(1):49–52.

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643–4.

8.HeckJrRK.Bone-formingtumors.In:CanaleT,BeatyJH, editors.Campbell’soperativeorthopaedics.11thed. Philadelphia:SaundersElsevier;2007.p.