The authors reported a series of 18 cases of osteoid osteoma of the wrist and hand. The most common symptom in their patients was localized pain which typically improved with salicylate therapy. Physical examination findings included swelling and point tenderness. Heat and redness of the overlying skin were sometimes present, and joint motion was restricted when the lesion occurred near an articulating surface. Early radiographs were unremarkable in almost all cases, whereas bone scintigraphy and CT scans depicted the lesions. At a mean follow-up of 4 years after resection, no patient reported pain and all had made complete functional recoveries. A recurrence was noted in 1 case, necessitating en bloc resection of the affected metacarpophalangeal joint.
Osteoid osteoma is a benign tumor consisting of a nidus of calcified osteoid surrounded by loose connective tissue and a rim of sclerotic reactive bone. The tumor accounts for approximately 10% of all benign lesions of bone, but it is rarely detected in the hand and wrist. Successful treatment entails curettage or en bloc bone excision, with recurrences attributed to incomplete removal. Newer radioablation techniques performed under computerized tomographic guidance are also very effective. If there is a high index of clinical suspicion for the lesion and initial radiographs are negative, additional imaging with bone scintigraphy and CT should be considered for diagnosis.
J Hand Surg