A 34-year-old-man presented with a four-year history of wrist pain, managed unsuccessfully with radial styloidectomy and steroid injections. Trauma or other potential health issues were excluded as pain triggers.
MR images reveal marked capitate oedema (Fig. 1). A small hypointense lesion in T1 and T2 weighed images is seen in the proximal pole of this bone, associated with the presence of a calcified component (Fig. 2, 3).
Subsequent CT revealed a lucent nidus with a thin surrounding sclerotic reactive bone. A central sclerotic dot is also visible (Fig. 4).
Bone scintigraphy shows focal intense uptake of radioisotope at the corresponding site of the lesion seen on MR and CT images (Fig. 5).
Osteoid osteomas are benign tumours that are more frequently found in young patients. The main symptom is local pain, which typically aggravates at night and is relieved by salicylates. [1]
Osteoid osteomas are twice as frequent in men. [2, 3]
They are more prevalent in long bones, but can also affect other bones such as the spine, the small bones of the hand and feet, and even the skull. [2, 3] The incidence of osteoid osteomas in the hands is estimated as 8%, being more frequent in phalanges, followed by carpal bones, and less frequently found in metacarpal bones. [9]
Osteoid osteomas can be depicted by plain radiograph, but CT has the best diagnostic accuracy, even when compared with MR. [4, 5] Typically it shows a lucent nidus with surrounding sclerotic bone and a central sclerotic dot.
Bone scintigraphy has a high sensitivity, but is not specific, whereas the nidus might not be seen on MR. [6]
The size of the lesion is very important to differentiate osteoid osteomas from osteoblastomas, since the last ones are much larger (>2cm). [10]
It has been suggested that the natural history of osteoid osteomas is spontaneous healing, with pain resolution after 6 to 15 years. [7]
CT-guided procedures, particularly radiofrequency have modified the treatment of osteoid osteoma, with superior outcomes. [8]
This is the treatment option for our patient, although it hasn't been done yet, because the patient was recently diagnosed with a brain tumour which will be treated first.
Osteoid osteoma of capitate
Based on the provided wrist MRI, CT, and bone scan images, a focal lesion is observed in the right wrist (centered at the carpal bones). The main imaging characteristics include:
Taking into account the patient’s age, symptoms, and imaging findings, the following diagnoses are considered:
In summary, based on the typical CT appearance of a sclerotic rim surrounding a translucent nidus, the relatively higher incidence in young males, and the nature of the pain, osteoid osteoma is the primary suspected diagnosis.
Combining the patient’s clinical history (nighttime pain, prolonged wrist discomfort), lack of relief through conventional surgery and local injections, as well as CT/MRI/bone scan findings, the most likely diagnosis is:
Osteoid Osteoma
Currently, the patient is also diagnosed with a brain tumor, so the brain tumor treatment should be prioritized before proceeding with subsequent management for osteoid osteoma.
Osteoid osteoma often has a self-limiting course and may resolve spontaneously over several years. However, for patients with significant symptoms affecting daily life, the minimally invasive treatment of choice is CT-guided radiofrequency ablation (RFA), which has shown remarkable efficacy. Since the patient in this case has had persistent pain unresponsive to conservative treatments and has a long history of discomfort, it is recommended to complete the relevant treatment for the brain tumor first, and when appropriate, proceed with the following plan:
During the entire rehabilitation process, if there is a significant increase in pain, swelling, or other discomfort, training should be stopped immediately and a consultation with a doctor or rehabilitation therapist should be conducted to determine if adjustments are required.
Disclaimer:
The above report is provided as a medical reference analysis based on the supplied information and does not replace an in-person consultation or the advice of a professional physician. Specific diagnosis and rehabilitation plans should be determined by a professional medical team after a comprehensive evaluation of the patient’s actual condition.
Osteoid osteoma of capitate
