Musculoskelet Surg (2009) 93:S79–S81DOI 10.1007/s12306-009-0011-9

Subchondral osteoid osteoma of the glenoid

Oguz Poyanli · Koray Unay · Kaya Akan · Korhan Ozkan · Duygu Temiz

Published online: 16 March 2009© Springer-Verlag 2009

O. Poyanli · K. Unay (�) · K. Akan · K. OzkanDepartment of Orthopedics and TraumatologyGoztepe Research and Training HospitalKadikoy, Istanbul, Turkeye-mail: kunay69@yahoo.com

D. TemizDepartment of PathologyGoztepe Research and Training HospitalIstanbul, Turkey

Background

Shoulder pain has many causes. The most common causesare impingement syndrome, adhesive capsulitis and ten-donitis. Rarely, shoulder pain is caused by tumours and oneof these painful tumours may be an osteoid osteoma.

Osteoid osteoma is a benign osteoblastic tumour,which is always small in size, painful and often diaphy-seal. The lesion consists of a small oval or round masscalled a nidus. The most frequent localisations are thelong bones. Scapular involvement is very rare [1–3]. Thefollowing is a report of a case with an osteoid osteomathat involves the anterior glenoid rim and its treatment.

Case presentation

A 21-year-old male was referred to our clinic with a his-tory of shoulder pain gradually progressing in the lasttwo years. The pain was occurring especially at night; hehas developed diffuse shoulder pain radiating occasional-ly to his arm. Aspirin was used, but no pain relief wasachieved. Treatment with other non-steroidal anti-inflammatory agents like naproxen sodium partiallyrelieved his pain. His pain worsened in two months priorto his referral exam.

Physical examination revealed anterior shoulder painand a limitation in external rotation and abduction. Therewas no swelling or muscle atrophy. The patient had nohistory of chills, fever or weight loss. The patient’s com-plete blood counts, erythrocyte sedimentation rate, C-reactive protein, serum electrolytes, serum enzymes andalkaline phosphate level were all normal.

A shoulder roentgenogram revealed a hardly recognis-able bony sclerosis in the glenoid. A computed tomogra-

Abstract Osteoid osteoma of the scapula is a rare benignlesion. This is a case report of a subchondral osteoidosteoma that involved the anterior rim of glenoid.Surgical approach in this atypical area may seem difficult.The excision of the lesion and grafting was performed bya deltopectoral approach. One year after the surgery, thepatient remains pain free and has full range of motionwith no recurrence of the tumour.

Keywords Osteoid osteoma · Glenoid · Scapula · Rarediseases · Shoulder

tage. The nidus was too close to the cartilage.Corticocancellous iliac crest autografting of the cavitywas performed. Shortly after the operation, the pain dis-appeared. CT scan shows the bony cavity, which wascuretted and grafted one year after the operation (Fig. 3).The patient remains pain free, has full range of motionand no donor-side morbidity.

Histology of the lesion

The surgical specimen was approximately 0.5 cc red to tanbony fragments and contained sclerotic bone and nidus.Histologically, the nidus consisted of small disorganisedbone trabeculae distributed within a loose fibrovascularstroma that exhibited prominent osteoblastic activity.

Discussion

Large series show that osteoid osteoma can occur any-where in the skeleton [2–4]. The percentage of scapularosteoid osteoma is 1.5% and the involvement of glenoid isvery rare [3]. No case specifically involving the glenoidand treated with open surgery has been reported before.

The bone scan and CT scan were typical for thelesion. MRI is considered less useful in distinguishingosteoid osteoma from other lesions.

Complete removal of the tumour has been advocatedby many authors [4–6]. Percutaneous osteoid osteomatreatment with combination of radiofrequency ablationwas described and CT-guided needle biopsy has beenadvocated as an alternative treatment for the osteoidosteoma (spontaneous healing after biopsy), but wethought that these two techniques could be problematic

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phy (CT) scan revealed a subchondral nidus in the anteri-or rim of the glenoid (Fig. 1). Magnetic resonance imag-ing (MRI) demonstrated marrow oedema and compactbone island on the subchondral region of the glenoid. Abone scan using technetium-99 showed increased uptakein the region of the glenoid (Fig. 2). With these findings,a presumptive diagnosis of osteoid osteoma was made.

Surgical excision of the nidus was performed.Exposure was obtained through a deltopectoral approach.The exposure of subscapularis was facilitated by externalrotation of the arm. The subscapular tendon was elevatedfrom tuberculum minus. The capsule of the shoulder wasthus exposed and divided longitudinally, exposing theglenoid. The rim of the glenoid covering the lesion wasopened to allow curettage of the cyst and insertion of abone graft. Excision of the nidus was performed by curet-

Fig. 1 CT shows the nidus close to the subchondral part of the glenoid

Fig. 3 CT one year after the operation shows complete healing of thelesion

Fig. 2 Technetium-99 bone scan demonstrating uptake on the glenoid

because of the proximity of the lesion to the cartilage ofthe glenoid [7–10]. Only one osteoid osteoma of the gle-noid has been reported in the literature and it was treat-ed with CT-guided biopsy [10]. We approached the gle-noid with a deltopectoral incision. There has been norecurrence of pain in this case and surgical excisionappears to have been successful. Surgical excision andgrafting of glenoid subchondral osteoid osteoma by ananterior deltopectoral approach is a reliable method oftreatment.

Conflict of Interest statement The Authors declare that they have noconflict of interest related to the publication of this manuscript.

References

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