Osteoid osteoma of the shoulder and elbow: from diagnosis to minimally invasive removal.

PURPOSE: Musculoskeletal tumours are rare in the daily practice of an orthopaedic surgeon or even a shoulder and elbow specialist. Patient complaints are often related to secondary changes to the underlying disease making the correct diagnosis challenging. The goal of this study is to identify key symptoms and findings which should give rise to suspicion of an osteoid osteoma. METHODS: This retrospective study analyses the diagnostic pathway, surgical treatment and clinical outcome of six patients who underwent resection of an osteoid osteoma of the shoulder or elbow joint. RESULTS: Average follow-up was 24 months (range 16-36 months). The neoplasm was often associated with synovitis mimicking a frozen joint causing marked delay in tumour identification. Misdiagnosis led to surgery without addressing the tumour in two cases, making further surgical intervention necessary. Once the tumour was identified and removed the pain resolved rapidly. CONCLUSIONS: In cases of chronic shoulder or elbow pain without an adequate clinical history an underlying cause including rarities such as an osteoid osteoma or other musculoskeletal tumours should be taken into consideration. Particularly in young patients, a magnetic resonance imaging (MRI)-proven hot spot of unknown origin should prompt a computed tomography examination to further clarify the source of pain and stiffness. LEVEL OF EVIDENCE: IV, case series.

Arthroscopic subtalar arthrodesis for symptomatic osteoarthritis of the hindfoot: a prospective study of 41 cases.

BACKGROUND: This prospective study evaluated the results of arthroscopic subtalar arthrodesis for painful hindfoot osteoarthritis. METHODS: The hypotheses were that (1) the arthroscopic technique results in a reliable fusion rate, (2) the clinical outcome is better than the open procedure and (3) complication rates are lower. Forty-one arthroscopic subtalar fusions were done in 37 consecutive symptomatic patients without hindfoot deformity between December, 1997, and May, 2003. Indications for fusion were persistent pain with reduced range of motion and impaired daily activities. RESULTS: The average modified AOFAS ankle-hindfoot score improved from 53 (range 22 to 69) points preoperatively to 84 (range 41 to 94) points at final follow-up (average 55 months, range 24 to 89 months). Union was achieved in all cases. Radiographic progression of degeneration in the adjacent joints was observed in three patients. CONCLUSIONS: In painful hindfoot osteoarthritis the arthroscopic technique provides reliable fusion and high patient satisfaction with the advantages of a minimally invasive procedure.