Evaluation of the Forearm in Untreated Adult Subjects With Multiple Hereditary Osteochondromatosis

Author(s): Noonan K, Levenda A, Sneed J, Feinberg JR, Mih A

Source: J Bone and Joint Surg 84-A:  397 – 403, 2002.

Summary:

This study evaluated 39 adult patients with multiple heredity osteochondromatosis of the forearm who were not treated with surgical intervention.  The average age of the participants was 42 years with a range of 20 – 80 years.  All patients answered a questionnaire, underwent a physical examination and a radiographic analysis.  Sixty-seven percent were employed, 28 percent were either retired homemakers or students, and only 5 percent were unemployed.  Only 5 participants reported that their current job or career choice was affected by limitations associated with their forearms.  Two-thirds of these individuals participated in sporting activities.  Forty-four percent reported dissatisfaction with the cosmetic appearance of their arm, but only half of those patients indicated a willingness to undergo surgery to improve the appearance.  Eighty-eight percent reported no pain.  Despite the subjective reports, 21 percent exhibited grip strength two standard deviations below the mean and 26 percent exhibited key pinch strength 2 standard deviations below the mean.  Nineteen percent of arms had an impairment rating greater than 10 percent.  Radiographically, only 4 percent exhibited degenerative joint changes.

This article provides useful information related to the natural history of adult patients with untreated multiple hereditary osteochondromatosis of the forearm.  Despite objective findings of diminished strength, motion, and function, most patients were gainfully employed and few felt they were limited in any way in their performance at work.  Most patients were pain free and many participated in recreational activities.  Although 44 percent reported dissatisfaction with their cosmetic appearance, less than half would undergo operative intervention to improve upon this.  Despite the notable radiographic deformities, only 4 percent exhibited degenerative joint changes.  No association could be found between gender, age or radiographic measurements and ultimate functional outcome.  It is clear that individuals with more chronic conditions can learn to compensate for upper extremity deficiencies to a great degree.  Surgery is often neither required nor requested.

 


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Journal of Bone and Joint Surgery